CHAPEL HILL, N.C. — The NFL's steroids era appears to have left a legacy of joint and ligament injuries as well as mental issues among those using the performance-enhancing drugs, according to a new survey.

The findings, released Friday and published in the March issue of the American Journal of Physical Medicine & Rehabilitation, come from a comprehensive health survey of 2,552 retired NFL players from the 1940s to the 1990s, conducted by the University of North Carolina's Center for the Study of Retired Athletes.

The study found that those who used steroids had significantly higher rates of herniated disks and knee ligament and meniscus injuries, plus more elbow, foot, ankle and toe problems than those who said they played steroids-free.

It also found a link between steroids and depression, attention deficit disorder and increased alcohol consumption.

"Our findings speak to the 'snowball effect' or compounded medical problems that appear to accompany steroid use," said Kevin Guskiewicz, a director at UNC's department of exercise and sport science and a senior author of the study.

Steroids were considered to be most prevalent — especially among linemen — in the NFL in the years immediately before the league began testing in the late 1980s, a belief supported by the study.

In the anonymous survey, 20.3 percent of the players from the 1980s answered yes when asked "During the time in which it was acceptable to use performance-enhancing steroids, did you use steroids?"

Of all of the retired players, 9.1 percent answered yes to the question. Offensive linemen (16.3 percent) and defensive linemen (14.8 percent) reported the highest proportion of steroids use.