Practice Patterns and Return-to-Sports Timing of National Football League Head Team Physicians for ACL Reconstruction.

Background: Previous surveys of the practice patterns for anterior cruciate ligament (ACL) reconstruction in collegiate and professional team physicians have shown bone-patellar tendon-bone (BPTB) autograft being the most common graft, with variable return-to-sports timing. Purpose: To evaluate the current practice patterns and return-to-sports timing of National Football League (NFL) head team physicians for ACL reconstruction. Study Design: Cross-sectional study. Method: All 32 NFL head team orthopaedic surgeons were surveyed and asked their primary ACL graft preference, revision ACL graft preference, use of lateral extra-articular tenodesis (LET) or anterolateral ligament reconstruction (ALL), use of suture brace augmentation, return-to-sport timing, and whether functional testing was utilized in determining readiness of return to play. The years of experience of the physician were also evaluated. Results: All 32 head team physicians responded, with 31 (97%) using ipsilateral BPTB autograft in the primary setting and 1 using ipsilateral quadriceps autograft. In the revision setting, 24 (75%) physicians preferred a contralateral BPTB autograft, while 5 (16%) used an ipsilateral quadriceps autograft, 1 (3%) used a contralateral quadriceps autograft, and 2 (6%) used a BPTB allograft. One respondent (3%) used suture brace augmentation "most of the time" in the primary setting and always in the revision setting. No respondents utilized an ALL or LET in the primary setting and 2 (6%) respondents always performed an LET in revisions. Five others (16%) have performed at least 1 ALL or LET in an NFL athlete. Mean return to sports was at 9 months postoperatively, with no physicians allowing players to return before 7 months. All but 1 respondent used functional testing in return-to-sports decision-making. Conclusion: All but 1 of the 32 NFL head team physicians used BPTB autograft in primary ACL reconstruction. The majority preferred contralateral BPTB autograft in revisions, with a few considering extra-articular procedures or suture bracing in addition. On average, head team physicians allowed players to return at 9 months postoperatively, with none allowing return before 7 months. Nearly all utilized functional testing to aid in return-to-play decision-making. These homogenous findings in this high-risk and public athletic cohort aid in patient education and clinical decision-making for best treatment of ACL injuries, particularly in contact athletes.