Poster 159. Long-Term Musculoskeletal and Neurologic Health Coupled with Educational and Leadership Success Among Former NCAA Division I Athletes

This is the authors' abstract. We don't add key points for this paper.

Objectives: Collegiate athletics involves nearly 500,000 student-athletes annually, but it is associated with a high injury burden among athletes. Previous studies suggest that former athletes can suffer from chronic injuries and long-term physical limitations. However, there is limited research examining the long-term quality of life (QoL) outcomes across multiple sports and age groups. This study aims to evaluate the physical and mental health outcomes of former varsity athletes from a single Division I NCAA institution. Methods: A retrospective, cross-sectional survey was conducted among alumni from the internal registry of varsity athletics at a single university. The survey assessed musculoskeletal injury history and current health using validated instruments such as the SF-12 Health Survey and the Marx Knee Activity Rating Scale. Statistical analyses included comparisons with U.S. normative data, arthroplasty prevalence, and regression modeling to assess the impact of injury, surgery, and concussion history on Quality of life (QoL). Results: A total of 323 alumni responded, representing 15 varsity sports. The most represented were football (12.5%), baseball (6.4%), cross-country (4.7%), swimming/diving (4.4%), men's basketball (4.4%), and men's soccer (3.9%). Overall, 94% reported >=1 time-loss musculoskeletal injury, and nearly one-third underwent surgery within 1 year of injury. Compared with U.S. normative values, several sports demonstrated significantly higher Physical Component Scores (PCS), indicating better physical health. Elevated PCS was observed in Swimming & Diving (ages 50-64), Men's Basketball (30-49, 50-64), Cross-country (30-49), Wrestling (50-64), Lacrosse (30-49), and Volleyball (65+). In contrast, Mental Component Scores (MCS) were consistently lower than population norms, with the most pronounced deficits in Swimming & Diving (all groups), Men's Basketball (all groups), Football (50-64, 65+), and Men's Soccer (30-49, 50-64). Arthroplasty rates were significantly higher than U.S. estimates. Among alumni aged 50-70, hip arthroplasty prevalence was >4-fold higher (ASPR 4.56; 95% CI, 2.45-8.48; p < .001) and knee arthroplasty nearly 3-fold higher (ASPR 2.92; 95% CI, 1.69-5.02; p < .001). In the 70+ cohort, hip (ASPR 4.59; 95% CI, 2.47-8.52; p < .001) and shoulder arthroplasty (ASPR 3.56; 95% CI, 1.15-11.03; p = .019) remained elevated. Across all ages, hip (ASPR 4.44; 95% CI, 2.86-6.88; p < .001), knee (ASPR 2.63; 95% CI, 1.75-3.96; p < .001), and shoulder (ASPR 3.58; 95% CI, 1.49-8.59; p = .002) arthroplasty prevalence was increased. To holistically assess outcomes, a composite Quality of Life (QoL) score (0-100) was derived. Alumni with any injury reported similar QoL to uninjured peers (81.0; 95% CI, 75.7-86.3; Δ 1.1; p = .68). In contrast, surgery was associated with a 10-point reduction (74.0; 95% CI, 68.0-80.1; Δ -9.7; p = .0002) and concussion history with a 7.5-point reduction (74.6; 95% CI, 68.0-81.3; Δ -7.5; p = .007). By body region, decrements were greatest for shoulder (72.4; Δ -8.7; p = .015), knee (74.1; Δ -7.1; p = .034), and spine/back injuries (53.4; Δ -25.5; p = .0039). Athletes with a history of surgery demonstrated worse long-term function. Knee surgery was linked to lower Lysholm scores (70.0 ± 14.7 vs 81.3 ± 12.6; p = .001) and PCS scores (45.3 ± 12.0 vs 50.3 ± 9.4; p = .012). ACL reconstruction was associated with reduced Lysholm scores (68.8 ± 18.1 vs 80.4 ± 12.7; p = .041). Hip and shoulder surgery trended toward lower PCS and higher QuickDASH disability, though differences were not significant. Marx activity scores were similar across surgical and non-surgical groups. Among alumni, 76% reported earning a professional or graduate degree, and 82% were employed in professional or executive careers. A substantial proportion (24%) reported an annual income >$200,000, and 41% identified themselves as leaders in their field. Athletic participation extended beyond college, with 62% continuing to play their sport recreationally, and 7% having played professionally. The vast majority (89%) reported they did not regret playing and would choose to participate again. Conclusions: Former collegiate athletes face substantial long-term health consequences, particularly in collision and pivoting sports, with higher arthroplasty rates and diminished mental health scores compared to national norms. Surgery and concussion history were the strongest predictors of reduced QoL, especially for athletes with shoulder, knee, and spine injuries. Despite these health challenges, alumni demonstrated high educational attainment, leadership, and professional success, with the overwhelming majority indicating they would choose to participate in college athletics again. These findings highlight the dual legacy of collegiate sports-significant long-term physical consequences, yet enduring psychosocial and professional benefits.