Prevalence of Surgical Repair for Athletic Pubalgia and Impact on Performance in Football Athletes Participating in the National Football League Combine

Purpose To examine the prevalence and impact of athletic pubalgia (AP) surgery in elite American football athletes participating in the National Football League (NFL) Combine. Methods Results from 1,311 athletes participating in the Combine from 2012 to 2015 were evaluated. Athletes with a history of AP repair were identified using the NFL Combine Database. Athlete history and available imaging was reviewed. NFL performance based on draft status, games played, games started, and current status in the NFL was gathered using publicly available databases. Statistical analysis was performed to detect for significant associations between athlete history and NFL performance in the presence of AP repair and pelvic pathology on postsurgical magnetic resonance imaging (MRI). Results AP repair was identified in 4.2% (n = 55) of athletes. MRI was performed in 35% (n = 19 of 55) with AP repair, of which 53% (n = 10 of 19) had positive pathology. Athletes with repair were not at risk of playing ( P  = .87) or starting ( P  = .45) fewer regular season games, going undrafted ( P  = .27), or not being on an active NFL roster ( P  = .51). Compared with athletes with negative imaging findings, positive pathology on MRI did not have a significant impact on games played ( P  = .74), games started ( P  = .48), draft status ( P  = .26), or being on an active roster ( P  = .74). Offensive linemen ( P  = .005) and athletes with a history of repair within 1 year of the Combine ( P  = .03) had a significantly higher risk of possessing positive pathology on MRI. Conclusions Athletes with a history of successful AP surgery invited to the NFL Combine and those with persistent pathology on MRI are not at increased risk for diminished performance in the NFL. Offensive linemen and athletes less than 1 year out from surgery have a higher risk for positive MRI findings at the pubic symphysis. Level of Evidence Level IV, prognostic study-case series.