Abstract
Background:
Meniscal surgery is common and debilitating in National Football League (NFL)-bound athletes. Although statistical performance has been demonstrated after surgery, functional performance as measured at the NFL Combine is not well-defined.
Purpose/Hypothesis:
The purpose of this study was to determine the functional performance, production scores, athleticism scores, overall scores, and draft position of NFL Combine participants after meniscal surgery compared with a matched control group. It was hypothesized that there would be no difference in functional performance or graded scores between athletes with meniscal surgery compared with controls.
Study Design:
Cohort Study; Level of evidence, 3.
Methods:
NFL-caliber athletes who had previous arthroscopic meniscal repair or meniscectomy and participated in the NFL Scouting Combine between 2014 and 2024 were compared with a control group. Data included the 40-yard dash, 10-second split, vertical, broad jump, shuttle, 3-cone drill, production, athleticism, and overall scores, prospect grades, and draft position.
Results:
A total of 48 athletes were included in the repair group; 43 athletes were included in the meniscectomy group, with the same number of controls after matching. Compared with controls, players in the meniscal repair group had significantly slower 3-cone drill (7.40 ± 0.43 vs 7.20 ± 0.38 seconds; P = .018), shuttle drill (4.51 ± 0.26 vs 4.38 ± 0.26 seconds; P = .016), lower athleticism (69.74 ± 12.95 vs 76.13 ± 11.28; P = .012), and overall scores (70.95 ± 14.22 vs 77.47 ± 8.30; P = .007). There was no significant difference in the 40-yard dash (P = .439) or vertical tests (P = .559). Players in the meniscectomy group had a significantly slower shuttle compared with controls (4.45 ± 0.31 vs 4.34 ± 0.18 seconds; P = .047), lower athleticism (69.62 ± 12.53 vs 76.67 ± 10.84; P = .007), and overall scores (70.59 ± 10.56 vs 75.24 ± 9.52; P = .035). There was no significant difference in the 40-yard dash (P = .164) or vertical tests (P = .108). There was no significant correlation between the NFL Combine performance and time from surgery.
Conclusion:
While overall athletic performance remained largely unaffected by arthroscopic meniscal repair or meniscectomy, specific drills, such as the 3-cone and shuttle drills, demonstrated significant declines, suggesting a negative effect on agility and quickness. Metrics used to score NFL prospects were also inferior in the meniscal repair and meniscectomy groups. These findings highlight the potential effects of meniscal surgery on athletic performance, underscoring the need for surgeon guidance on expectant postsurgical functional deficits for NFL-caliber athletes.
Meniscal tears can be debilitating injuries in high-level contact athletes, particularly football players. 11 Symptomatic meniscal tears may be managed with arthroscopic meniscectomy, which still leads to accelerated joint degeneration through the development of articular cartilage lesions and altered knee biomechanics.6,21,26,28,30 In comparison, meniscal repair for a tear of the meniscus preserves the native meniscus, requires a longer rehabilitation, and restores joint integrity.19,22
Meniscal tears are common injuries among National Football League (NFL) Combine participants5,23; however, their effect on predraft functional performance and draft position is largely unknown. Previous literature has identified an overall return to play rate of 80% to 86% and a mean return to play time of 4 to 8 months, depending on whether a meniscectomy or repair was performed.3,11 The literature on performance in NFL or NFL-caliber level players after meniscal tears only includes those who underwent partial meniscectomy and emphasizes statistical measures such as return to sports, games played, and/or games started.2,8 However, limited research exists on measurable functional performance outcomes after meniscal injuries. Previous research on anterior cruciate ligament (ACL) injuries has demonstrated that surgical intervention and rehabilitation often fail to fully restore functional performance in athletes.13,25 A previous study on ACL reconstruction (ACLR) among NFL athletes showed lasting deficits in agility and performance in drills requiring quick directional changes, even after returning to sport. 17 Consequently, understanding the rehabilitation needs and performance deficits associated with various injuries, particularly meniscal injuries, is becoming increasingly important.1,6 To date, no studies have looked at the effect of meniscal repair or partial meniscectomy on NFL Combine performance metrics.
Therefore, this study aimed to determine the functional performance and draft position of NFL Combine participants after arthroscopic meniscectomy or meniscal repair compared with an age-, size-, and position-matched control group. We hypothesized there would be no difference in functional athletic performance or draft position between players who underwent arthroscopic meniscectomy or repair as compared with controls.
Methods
This retrospective cohort study included NFL-caliber athletes who participated in the NFL Scouting Combine.
Meniscal Repair and Partial Meniscectomy Players
A cohort of 91 football players with a history of meniscal injury and subsequent meniscal surgery who participated in the NFL Scouting Combine between 2014 and 2024 was identified. Athletes were eligible if they (1) participated in the NFL Scouting Combine, (2) underwent primary arthroscopic partial meniscectomy or meniscal repair before they participated in the NFL Scouting Combine, and (3) had complete performance data. Players with a history of other lower extremity surgery were excluded. A total of 48 of these players underwent primary meniscal repair, while the other 43 players underwent meniscectomy. Players who underwent meniscal repair or partial meniscectomy were identified through publicly available internet sources such as team websites, press articles, personal websites, college football team websites, and professional team websites, similar to previous studies.7,12,15,17,29
The age, height, weight, body mass index, and position of each player at the time of their respective NFL Scouting Combine performance were recorded. Specific athletic performance data—including 40-yard dash, 10-yard split, vertical, broad jump, 3-cone drill, and shuttle—were also recorded (see Appendix). 24
Further performance measures utilized at the NFL Combine—including production score, athleticism score, overall score, prospect grade, and draft pick—were also recorded. Production score, athleticism score, and overall score are all based on the Next Gen Stats Draft Model, which can be found on each player’s draft profile on NFL.com. 31 Historical NFL Combine, pro day, and college production data are used to predict a player’s chance of success in the NFL. The model compiles scores between 50 and 99 to compile a production score based on college statistics, such as the number of touchdowns and yards for offensive players or the number of tackles/interceptions for defensive players. Similarly, a score between 50 and 99 is determined for an athleticism score based on combine performance in drills while also considering metrics such as top speed and acceleration. Last, an overall profile score based on production and athleticism is also curated. Of note, if a player did not participate in drills at the Combine or pro day, athleticism scores are estimated based on size and projected 40-yard dash time. The prospect grades range from 5.5 to 8 and are awarded by draft evaluators based on physical performance at the combine, taking into account 40-yard dash, vertical jump, psychological tests, and interviews.
Control Players
Players who underwent meniscal repair as well as players who underwent partial meniscectomy were matched to a control group based on age, height, weight, position, and combine year. Publicly available internet sources—including press articles and college football websites—were reviewed to identify controls. The control cohort was compiled by using a deidentified list of Combine participants during the same years as the player cohort. The deidentified list only included the age, height, weight, listed position at the Combine, and year of Combine performance. Combine performance statistics, such as 40-yard dash time, were not included in the deidentified list to eliminate bias in matching based on performance measures. An age-, size-, position-, and draft year-matched control group was then created by selecting players from the aforementioned list. Players with a history of any lower extremity surgery before their NFL Scouting Combine participation were excluded from the control group. Similar athletic performance data were collected for the control cohort—including 40-yard dash, 10-yard split, vertical, broad jump, 3-cone drill, and shuttle tests, as well as production score, athleticism score, overall score, prospect grade, and draft pick.
Statistical Analysis
Statistical analysis involved calculating means, standard deviations, and ranges for each performance measure and comparing them with those of matched controls. The meniscal surgery players were compared with the control players for differences in demographic information, year, and position played using 2-sample t tests for the continuous measures and chi-square tests for the categorical measures. Also, 2-sample t tests were used to compare performance metrics between each surgical group and its matched control. Pearson correlation coefficients were used to assess the relationship between age and performance measures for all players. In addition, correlation coefficients were calculated for years since surgery with performance measures for players who underwent meniscal repair as well as players who underwent meniscectomy. Statistical significance was set at P < .05.
Results
Patient Characteristics
A total of 91 NFL-caliber players who had a meniscal tear before the yearly NFL Scouting Combine were identified. A total of 48 players with meniscal repair and 43 players with partial meniscectomy met the inclusion criteria and were compared with matched controls. There was no significant difference between players with a meniscal tear and controls with regard to age, height, weight, year participated in the Combine, or position (Table 1).
Descriptive Statistics for Repair, Meniscectomy, and Control Groups a
Data are presented as mean + SD (range) or n (%).
Performance Drills
There were significant differences in Combine performances between players who had undergone previous meniscal surgery and the matched control cohort (Table 2). Both meniscal repair and partial meniscectomy groups recorded significantly slower shuttle drill times compared with their respective controls. The meniscal repair cohort had a mean shuttle drill time of 4.51 ± 0.26 seconds compared with 4.38 ± 0.26 seconds for the control group (P = .02), while the meniscectomy cohort had a mean time of 4.45 ± 0.31 seconds versus 4.34 ± 0.18 seconds for controls (P = .05). The meniscal repair group also had slower 3-cone drill times compared with the respective control group (7.40 ± 0.43 vs 7.20 ± 0.38 seconds; P = .02). Conversely, no significant differences were found between the meniscal surgery cohort and the control cohort for the 40-yard dash or 10-yard split tests. The repair group had a mean 40-yard dash time of 4.78 ± 0.31 seconds compared with 4.73 ± 0.32 seconds for controls (P = .439), and the meniscectomy group had a mean time of 4.77 ± 0.33 versus 4.68 ± 0.26 seconds for controls (P = .164). The mean 10-yard split times also showed no significant difference between groups, with a mean time of 1.64 ± 0.11 seconds for the repair cohort compared with 1.62 ± 0.11 seconds for the control cohort (P = .375), and a mean time of 1.63 ± 0.11 for the meniscectomy cohort versus 1.63 ± 0.23 seconds for the control cohort (P = .990). Similarly, vertical leap and broad jump performances did not differ significantly between groups. The repair group had a mean vertical jump of 32.88 ± 4.20 inches compared with 33.36 ± 3.82 inches for the control group (P = .559) and a mean broad jump of 116.76 ± 8.63 inches compared with 117.40 ± 9.38 inches for the control group (P = .729). The meniscectomy group had a mean vertical jump of 32.80 ± 4.34 inches compared with 34.28 ± 4.11 inches for the control group (P = .108) and a mean broad jump of 116.82 ± 9.02 inches compared with 119.30 ± 9.22 inches for the control group (P = .211).
Comparison of Performance Measures (Independent T Test) a
Data are presented as mean ± SD (range), unless otherwise indicated. Bold P values indicate statistical significance.
Outcome Scores and Draft Pick
The meniscal repair group also showed a significantly lower production (70.44 ± 11.56 vs 76.21 ± 9.67; P = .01), athleticism (69.74 ± 12.95 vs 76.13 ± 11.28; P = .01), and overall scores (70.95 ± 14.22 vs 77.47 ± 8.30; P = .01) compared with the control group (Table 2). The meniscectomy group demonstrated significantly lower athleticism scores (69.62 ± 12.53 vs 76.67 ± 10.84; P = .01), overall scores (70.59 ± 10.56 vs 75.24 ± 9.52; P = .04), and prospect grade (5.95 ± 0.42 vs 6.18 ± 0.37; P = .01). There were no significant differences in overall draft pick position between the meniscal surgery groups when compared with the control groups (P > .05).
Time Since Surgery and Performance Measures
There were no significant findings when determining a correlation between the number of years since meniscal repair and meniscectomy and the NFL Combine date, compared with Combine performance results (P > .05) (Table 3).
Correlation of Time Since Surgery with Performance Measures Across Repair and Meniscectomy Groups (Pearson Correlation Coefficient)
Athlete Age and Performance Measures
There was a significant negative correlation of −0.40 (P = .020) between performance in the 3-cone drill test and age in players who underwent a previous meniscal repair (Table 4). No other tests showed significant correlations (P > .05). In addition, there were no other significant correlations between Combine performance and age of the athletes in the meniscectomy group (P > .05).
Correlation of Age With Performance Measures Across All Players and the 3 Groups (Pearson Correlation Coefficient) a
The bold P value indicates significance.
Discussion
The main findings in the present study are that high-level, NFL-bound college football players who undergo operative management for a meniscal tear have functional deficits as evidenced by significantly slower 3-cone and shuttle drill times. The meniscal repair group also had significantly lower production, athleticism, and overall scores when compared with controls. Similarly, the meniscectomy group had significantly lower athleticism and overall scores as well as prospect grade compared with controls.
Although no previous studies have examined the effect of meniscal repair or meniscectomy on NFL Combine performance, Khalil et al 18 previously looked at the effect of previous partial meniscectomy on performance at the NBA combine. No significant differences were found between the surgical cohort and controls in the lane agility drill, shuttle run, three-quarter court sprint, standing vertical, or max vertical test. Comparatively, our study showed a significant decrease in agility performance measures in players who underwent meniscal surgery compared with controls. Further literature on postoperative speed, agility, jumping ability, and acceleration remains limited, and more research is needed to support our findings.
In 2018, Chahla et al 8 reported that NFL Combine participants (2009-2015) with previous meniscectomy demonstrated significantly lower objective performance metrics during their initial NFL careers compared with matched controls. Players with a history of meniscectomy experienced fewer games played and/or started in the first 2 postsurgery seasons (P < .05). In addition, these players showed reduced snap percentages during this period, with significant findings (P < .05) observed for defensive backs in both seasons and for running backs and wide receivers in the first season. While previous research highlights performance declines in athletes after meniscal surgery, our study introduces novel evidence of diminished measurable athletic performance in NFL-bound players during the draft.
Moreover, previous studies have shown that athletes undergoing meniscal repair or partial meniscectomy may not only have decreased performance measures but also a decrease in their level of play. Aune et al 2 performed a study on 77 NFL players who underwent a partial lateral meniscectomy and found that only 61% of players returned to play at their previous level of competition, with a mean length of time to return to play of 8.5 months. D’Ambrosi et al 10 also found that <80% of elite athletes in wrestling, baseball, soccer, rugby, or handball return to their preinjury playing levels. Although the patient population was not representative of high-level collegiate or NFL players, the effect on return to function is clear. Conversely, Ekhtiari et al 11 performed a systematic review on 355 elite athletes, including 153 American football athletes, and found a slightly higher return to preoperative function rate. The authors found an 86.5% return to play at their preoperative level for the meniscal repair group, with an 80.4% return to preoperative level for the meniscectomy group. However, the effect of a meniscal tear with subsequent surgery before the NFL will likely have a significant effect on an athlete's career, particularly in the highly competitive environment of the NFL, where performance metrics are crucial for success in addition to on-field performance.
The lack of significant differences in some speed and explosive power measures, such as the 40-yard dash and vertical leap tests, indicates that meniscal injuries may have a predominant effect on lateral and multidirectional movements. This has implications for NFL scouts and coaches, as agility metrics are often critical in evaluating an athlete's potential performance in the NFL. Despite rehabilitation, meniscal repair and partial meniscectomy may have lingering effects on knee stability and functional performance in drills requiring rapid directional changes. The observed declines in agility align with findings in similar studies on ACL injuries, which also documented deficits in lateral and multidirectional agility after reconstructive surgery. In 2015, Keller et al 17 published a similar study for NFL combine participants who had previously undergone ACLR. However, the authors found no significant differences between ACL reconstructed players and controls when comparing physical performance measures. Specifically, there was no significant difference in 40-yard dash time or shuttle time between the surgical cohort and the control cohort, similar to our study.
There remains no clear consensus on postoperative management after meniscal repair or partial meniscectomy.9,27 Postoperative rehabilitation may play a role in functional deficits for meniscal surgery patients; however, our study did not look at specific rehabilitation protocols. Rehabilitation protocols for sports performance training are typically different than more traditional rehabilitation protocols after meniscal surgery. 27 Postoperative treatment for postoperative athletes incorporates a variety of modalities—including hydrotherapy, electrotherapy, cryotherapy, resistance exercises, and sport-specific exercises at around 6 weeks. However, the functional performance deficits in NFL draft prospects who underwent meniscal surgery may be secondary to permanent changes in the knee that even adequate rehabilitation strategies cannot overcome. Previous research has shown that quadriceps weakness occurs after meniscal injury and subsequent surgery due to neural impairments or activation failure.14,20 In addition, proprioception and gait are altered after a meniscal tear, even after meniscal surgery, secondary to altered mechanoreceptors and biomechanical/biochemical changes, as well as postoperative pain and swelling.1,16,20 Biomechanically, an injury to the meniscus compromises the ability of the meniscus to transfer load to the joint, leading to increased strain on the cartilage in the knee. A postinjury and postsurgical environment also releases cytokines, catabolic enzymes, and immune cells, which prevent tissue repair.4,20 Furthermore, there are outside variables such as age and other patient factors independent from the surgery itself that contribute to a patient’s functional decline. We did find a negative correlation between meniscal repair athlete performance in the 3-cone drill and age in our study. Thus, there is a large interplay of insults to the knee of an athlete after tearing the meniscus and undergoing surgery. Future research could study sports-specific training aimed at restoring agility or, more importantly, further examine the relationship between surgical interventions, knee biomechanics, neuromuscular feedback loops, proprioceptive changes, and functional outcomes over time. Regardless, orthopaedic surgeons and ancillary staff will be more equipped to inform athletes of potential functional deficits after meniscus-related surgery with the outcomes that we show.
This study is not without limitations. It is possible that there are athletes who were not included in the study because of inaccuracies in reporting injuries or difficulty in finding online sources reporting the injury. It is also possible that the online sources used to find information on players’ injuries, time of surgery, and concomitant injuries were inaccurate. Athletes with other lower extremity surgeries were excluded, but those with nonsurgical lower extremity surgeries were still included (as finding information regarding these injuries online is not always possible), which could lead to bias. This method of finding player information also causes inherent selection bias, as the authors are doing their searching rather than using unavailable NFL Scouting Combine medical records. Similarly, when searching for controls, they may have had an injury that was not reported. Although controls were matched from a deidentified list, the selection of controls could also introduce bias, as the authors are not completely blinded when selecting control athletes. Furthermore, we did not compare athletes who had meniscectomy with athletes who had meniscal repair, which may provide beneficial information regarding the treatment of choice for meniscal tears in this population. It is also impossible to determine how the players and controls would have performed against each other before the players’ surgeries, as no preinjury performance data were recorded. Furthermore, some athletes chose not to participate in certain drills at the Combine, leaving some athletes with incomplete data. Last, the surgical techniques for meniscectomy and meniscal repair differ from athlete to athlete and are surgeon-dependent, which leads to a lack of standardization between players. However, this is the first study, to our knowledge, to examine the effect of meniscal repair and meniscectomy on high-level football players regarding measurable athletic performance tests compared with a control group. This study suggests a need to target certain rehabilitation protocols tailored specifically to agility and short lateral movements.
Conclusion
While overall athletic performance remained largely unaffected by arthroscopic meniscal repair or meniscectomy, specific drills such as the 3-cone and shuttle drills demonstrated significant declines, suggesting a negative effect on agility and quickness. Metrics used to score NFL prospects were also inferior in the meniscal repair and meniscectomy groups. These findings highlight the potential effects of arthroscopic meniscal surgery on critical aspects of athletic performance, underscoring the need for surgeon guidance on expectant postsurgical functional deficits for NFL-caliber athletes.
Footnotes
Appendix
The 40-yard dash and 10-yard split tests are intended to measure running speed, first-step quickness, and acceleration. 23 The vertical leap and broad jump tests measure a player’s lower body strength as well as power and explosiveness, while the 3-cone drill and the shuttle drill measure quickness and agility. The 3-cone drill is performed by a player maneuvering around 3 cones, with 4.6 meters (m) between each cone, placed in the shape of an L. The shuttle drill is performed by a player running 4.6 m in 1 direction, changing direction, running 9.1 m back in the opposite direction, and then returning 4.6 m to the starting point.
Final revision submitted March 18, 2025; accepted April 25, 2025.
One or more of the authors has declared the following potential conflict of interest or source of funding: T.F. is a paid presenter or speaker for BodyCad and is a paid consultant for Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Ethical approval was not sought for the present study.
