NFL players: Play now, pay later. Is this the best we can do?

In orthopedics training, we used to joke that the only purpose of the heart was to provide blood supply to the knees.

The brain? Not so much.

NFL players, it seems, also rank knees ahead of the brain. A survey this week by USA Today asked 293 players on 20 NFL teams what body part they were most concerned about injuring in a game: 46 percent said knee and leg injuries, 24 percent said head and neck injuries, and 26 percent said none.

Now, even as an orthopedic surgeon, I’m not going to argue that knees are more valuable than the brain. The long-term consequences of on-field concussions have proved to be devastating to football players. Autopsies of more than 50 ex-NFL players have revealed signs of the degenerative brain disease chronic traumatic encephalopathy, an incurable disease linked to depression and dementia. Nine living former players have also received the same diagnosis. A lawsuit between 4,500 retired players and the NFL contends that the league knew about the dangers of head injuries and didn’t do enough about them. A $760 million settlement was recently rejected.

Given the increased awareness about the long-term dangers of concussions, the fact that current NFL players still say they fear knee injuries more than brain injuries is astonishing. A survey by ESPN polled 320 players and 85 percent of them said they would play in the Super Bowl even with a concussion.

Yet it makes sense. Players are caught up in the moment, there’s a narrow window of professional opportunity. The way football players see it, a concussion can sideline them for a few weeks (the future be damned), while a hit to the legs can result in an immediate end to his season or even career.

What this attitude reveals is the players’ short-term view of their life. This urgency to get back into the game with no regard for the future also risks the long-term health of their joints. Just as with a stop-gap approach to a concussion, players may not be factoring in the future consequences of their knee injury.

Thousands of former players are currently living in agony because of joint injuries they got when they were younger. An injured knee can be repaired in a number of ways, but quick-fix repair techniques, which aim to get players back on the field as soon as possible, can cause additional injury, such as when a piece of their hamstring is used to repair an ACL. Players can be reinjured or left severely crippled with arthritis later in life.

In the type of high-impact knee injuries sustained by football players, many parts of the knee are damaged, including the soft articular cartilage that protects the ends of the bones. This cartilage and all the other parts of the knee need to be carefully repaired and rehabilitated or the injury will result in arthritis, where the bones are no longer protected and rub painfully together. You can’t feel your articular cartilage wearing away until it’s too late.

Over the years, I have treated many former NFL players and a great many other ex-professional athletes suffering from the painful consequences of injuries they sustained in their youth. The shattering and life-destroying effects of arthritis cannot be overstated. Their quality of life has drastically decreased. Once superfit and muscular, with arthritis their activity goals are reduced to just being able to walk up the stairs without pain. They’re not even that old.

Fortunately, the techniques for preventing the arthritis after a knee injury are improving rapidly. We can now replace the damaged meniscus cartilage and repair the damaged articular cartilage with paste grafts and other techniques. Unfortunately, the time for healing is still too long for most athletes and it still takes months to recover (an eternity in a professional athlete’s life). On the horizon are additional techniques that we believe will speed the healing of these injured tissues, using growth factors and targeted progenitor cells, using substitute tissues from donors and pigs to replace the ruptured ligaments and recovery aids that may permit joints to recover in dramatically improved fashions.

My advice for anybody, pro athlete or not, would be to take the best care of your body that you can. Fix problems early, allow and induce your body to heal. It can last you a long time.

Medically authored by
Kevin R. Stone, MD
Orthopaedic surgeon, clinician, scientist, inventor, and founder of multiple companies. Dr. Stone was trained at Harvard University in internal medicine and orthopaedic surgery and at Stanford University in general surgery.