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Cassinat J, Crowley M, Simpson J, Service BC. Changes in injury type among NBA athletes in response to the COVID-19 pandemic. PHYSICIAN SPORTSMED 2024; 52:486-491. [PMID: 38275138 DOI: 10.1080/00913847.2024.2311051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/24/2024] [Indexed: 01/27/2024]
Abstract
CONTEXT The 2019-2020 NBA season was altered significantly by the COVID-19 pandemic with a midseason suspension of games, the NBA 'bubble' tournament, and a shortened offseason. Concerns were raised regarding player conditioning and the potential increased risk of injury due to the schedule changes. The purpose of this study was to determine the impact of the COVID-19 pandemic and associated schedule changes on NBA injuries. It was hypothesized that injury rates would be higher in the year following the pandemic and teams who participated in the bubble would have higher injury rates in the following season than non-bubble teams. Furthermore, the types of injuries would shift toward more severe injuries in the condensed 2019-20 season and the following 2020-21 season. DESIGN Retrospective Cohort Study. METHODS The NBA's public injury reports were queried to identify players listed on an injury report. Standardized injury events were calculated for four pre-COVID-19 seasons (2015-2019), the COVID-19 season (2019-2020), and the post-COVID-19 season (2020-2021). Injury characteristics including type and location were extracted for each year and differences within each period were calculated. RESULTS When excluding injury events related to COVID-19 health and safety protocols, the overall injury events per 1000 exposures were not significantly different between time periods of pre-COVID-19, COVID-19, and post-COVID-19 seasons; (p = 0.199), and no difference was found in the rates of teams who participated in the bubble. Injuries, including soreness and strains, significantly decreased while fracture injuries significantly increased in the COVID-19 year. CONCLUSIONS The COVID-19 pandemic led to an increased number of games missed, but no increase in injury rates when accounting for health and safety protocols. Additionally, bubble participation had no impact on injury rates. However, despite no changes in injury rates, the types of injuries changed with an increased proportion of severe injuries and decreased proportion of minor injuries.
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Affiliation(s)
- Joshua Cassinat
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Matthew Crowley
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Jeffrey Simpson
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Benjamin C Service
- University of Central Florida College of Medicine, Orlando, FL, USA
- Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
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Anloague PA, Strack DS, Short S, Eaton C, Corbeil J, Windle S. Establishing a Reference Database for Select Clinical Measures in National Basketball Association Players. Sports Health 2024:19417381241275648. [PMID: 39206466 DOI: 10.1177/19417381241275648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Musculoskeletal injuries are prevalent in the NBA and are associated with a significant number of games missed. There is a lack of reference data for clinical measures in NBA players, making it difficult for sports medicine professionals to set goals and develop programs. HYPOTHESIS Values for clinical measures in NBA players will differ from those of the general population but will not differ between dominant (D) and nondominant (ND) limbs. STUDY DESIGN Descriptive laboratory study. LEVEL OF EVIDENCE Level 3. METHODS Clinical measures were taken on 325 players invited to NBA training camp (2008-2022). Measures included range of motion for great toe extension, hip rotation, weightbearing ankle dorsiflexion, flexibility, arch height (AH) indices, and tibial varum. RESULTS Clinical values for NBA players differ from reference norms of the general population. Results for NBA players include great toe extension (D, 40.4°; ND, 39.3°), 90/90 hamstring (D, 41.5°; ND, 40.9°), hip internal rotation (D, 29.0°; ND, 28.8°), hip external rotation (D, 29.7°; ND, 30.9°), total hip rotation (D, 60.2°; ND, 60.4°), Ely (D, 109.9°; ND, 108.8°), AH difference (D, 0.5 mm; ND, 0.5 mm), AH index (D, 0.310; ND, 0.307), arch stiffness (D, 0.024; ND, 0.024), arch rigidity (D, 0.924; ND, 0.925), tibial varum (D, 4.6°; ND, 4.5°), and weightbearing ankle dorsiflexion (D, 35.4°; ND, 35.6°). Descriptive statistics are presented; 2-tailed paired t tests show that, whereas most measures demonstrated differences between sides, the results were not statistically significant. CONCLUSION Clinical measures of NBA players differ from those reported for the general population and athletes of other sports although there were no statistically significant differences between D and ND limbs. CLINICAL RELEVANCE Establishing a reference database may help clinicians develop more sensitive and more effective preseason and return-to-play screening processes, aiding the management of player orthopaedic care and reducing injury risk.
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Affiliation(s)
- Philip A Anloague
- Physical Therapy Department, University of Dayton, Dayton, Ohio
- Indiana Pacers, Indianapolis, Indiana
| | | | | | | | | | - Shawn Windle
- Consultant, Independent Researcher, Indianapolis, Indiana
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Aksović N, Bubanj S, Bjelica B, Kocić M, Lilić L, Zelenović M, Stanković D, Milanović F, Pajović L, Čaprić I, Milić V, Dobrescu T, Sufaru C. Sports Injuries in Basketball Players: A Systematic Review. Life (Basel) 2024; 14:898. [PMID: 39063651 PMCID: PMC11278090 DOI: 10.3390/life14070898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: The objective of this systematic review was to collect relevant data in the available contemporary studies about sports injuries of basketball players and explain differences in sports injuries relative to gender, location, sport, and position on the court; (2) Methods: The papers were searched digitally using PubMed, MEDLINE, ERIC, Google Scholar, and ScienceDirect databases, from 1990 to 2024; (3) Results: The most frequent severe injuries for both genders are knee and ankle injuries and the most frequent forms of injury are ankle sprain and ligament strain. The most frequent injuries occur during running and after contact with the ball. Shooting guards sustain the highest injury rate followed by centers and point guards, while guards have the highest rate of adductor muscle injury; and (4) Conclusions: Studies indicate that ankle and knee injuries are prevalent among basketball players, with ankle sprains being particularly prevalent. Knee injuries are more common in female basketball players, including ACL injuries. Various factors contribute to injuries, including the biomechanics of jumping, landing, sudden changes in direction, and the physical demands placed on the body during the game.
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Affiliation(s)
- Nikola Aksović
- Faculty of Sport and Physical Education, University of Priština–Kosovska Mitrovica, 38218 Leposavić, Serbia; (N.A.); (L.L.)
| | - Saša Bubanj
- Faculty of Sport and Physical Education, University of Niš, 18000 Niš, Serbia; (M.K.); (D.S.)
| | - Bojan Bjelica
- Faculty of Physical Education and Sport, University of East Sarajevo, 71420 Pale, Bosnia and Herzegovina; (B.B.); (M.Z.); (L.P.)
| | - Miodrag Kocić
- Faculty of Sport and Physical Education, University of Niš, 18000 Niš, Serbia; (M.K.); (D.S.)
| | - Ljubiša Lilić
- Faculty of Sport and Physical Education, University of Priština–Kosovska Mitrovica, 38218 Leposavić, Serbia; (N.A.); (L.L.)
| | - Milan Zelenović
- Faculty of Physical Education and Sport, University of East Sarajevo, 71420 Pale, Bosnia and Herzegovina; (B.B.); (M.Z.); (L.P.)
| | - Dušan Stanković
- Faculty of Sport and Physical Education, University of Niš, 18000 Niš, Serbia; (M.K.); (D.S.)
| | | | - Lazar Pajović
- Faculty of Physical Education and Sport, University of East Sarajevo, 71420 Pale, Bosnia and Herzegovina; (B.B.); (M.Z.); (L.P.)
| | - Ilma Čaprić
- Department of Biomedical Science, State University of Novi Pazar, 36300 Novi Pazar, Serbia; (I.Č.); (V.M.)
| | - Vladan Milić
- Department of Biomedical Science, State University of Novi Pazar, 36300 Novi Pazar, Serbia; (I.Č.); (V.M.)
| | - Tatiana Dobrescu
- Department of Physical Education and Sport Performance, Vasile Alecsandri University, 600115 Bacau, Romania;
| | - Constantin Sufaru
- Department of Physical Education and Sport Performance, Vasile Alecsandri University, 600115 Bacau, Romania;
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Karlidag T, Bingol O, Kulakoglu B, Keskin OH, Durgal A, Ozdemir G. Effects of tendon elongation on plantar pressure and clinical outcomes: A comparative analysis between open repair and minimally invasive surgery. Knee Surg Sports Traumatol Arthrosc 2024; 32:1880-1890. [PMID: 38630070 DOI: 10.1002/ksa.12163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE The aim of this study was to assess whether variances in Achilles tendon elongation are linked to dissimilarities in the plantar pressure distribution following two different surgical approaches for an Achilles tendon rupture (ATR). METHODS All patients who were treated with open or minimally invasive surgical repair (MIS) and were over 2 years post their ATR were eligible for inclusion. A total of 65 patients with an average age of 43 ± 11 years were included in the study. Thirty-five patients were treated with open repair, and 30 patients were treated with MIS. Clinical outcomes were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) and ATR Score (ATRS). Achilles tendon elongation was measured using axial and sagittal magnetic resonance imaging scans. Plantar pressure measurements for the forefoot, midfoot and hindfoot during gait were divided into percentages based on total pressure, measured in g/cm2 for each area. RESULTS The average AOFAS score was found 'excellent' (93 ± 2.8) in the MIS group, while it was found 'good' (87.4 ± 5.6) in the open repair group. In addition, the MIS group showed significantly superior ATRS scores (78.8 ± 7.4) compared to the open repair group (56.4 ± 15.4) (p < 0.001). The average tendon elongation in the MIS group was 11.3 ± 2 mm, while it was 17.3 ± 4.3 mm (p < 0.001) in the open repair group. While the open repair group showed significantly higher plantar pressure distribution in the initial contact and preswing phases compared to uninjured extremities, there was no significant difference between the uninjured extremities and the MIS group. CONCLUSION In conclusion, the findings of this study demonstrated that minimally invasive surgery was associated with less tendon elongation, more proximity to the plantar pressure distributions of the uninjured extremity and superior clinical outcomes compared to open surgical repair. Therefore, minimally invasive surgery may be considered a more suitable option for acute Achilles tendon repair to achieve overall better outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Taner Karlidag
- Department of Orthopedics and Traumatology Surgery, Helios ENDO-Klinik, Hamburg, Germany
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Olgun Bingol
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Burak Kulakoglu
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Omer Halit Keskin
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Atahan Durgal
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Guzelali Ozdemir
- Department of Orthopedics and Traumatology, Ankara Bilkent City Hospital, Ankara, Turkey
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Heifner JJ, Kilgore JE, Nichols JA, Reb CW. Syndesmosis Injury Contributes a Large Negative Effect on Clinical Outcomes: A Systematic Review. Foot Ankle Spec 2024; 17:284-294. [PMID: 35048741 DOI: 10.1177/19386400211067865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION The literature largely addresses questions of diagnostic accuracy and therapeutic accuracy. However, the magnitude of the clinical impact of syndesmosis injury is commonly described in intuitive yet qualitative terms. This systematic review aimed to quantify the impact of syndesmosis injury. METHODS Published clinical outcomes data were used to compute an effect size reflecting the impact of syndesmosis injury. This was done within the clinical contexts of isolated syndesmosis injury and syndesmosis injury with concomitant ankle fracture. Clinical outcomes data included Olerud-Molander (OM) and American Orthopaedic Foot and Ankle Society (AOFAS) scores, visual analog scale for pain, and days missed from sport competition. Parametric data were compared with Student t tests. Effect size was computed using Cohen's d. RESULTS In ankle fracture patients, syndesmosis injury demonstrated a large effect size for OM (d = 0.96) and AOFAS (d = 0.83) scores. In athletic populations without concomitant ankle fracture, syndesmosis injury demonstrated a large effect size on days missed from competition (d = 2.32). DISCUSSION These findings confirm the magnitude of the negative impact of syndesmosis injury in athletic populations with isolated injury and in ankle fracture patients. In ankle fracture patients, this large negative effect remains despite surgery. Thus, syndesmosis repair may not fully mitigate the impact of the injury. LEVELS OF EVIDENCE Level III: Systematic review.
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Affiliation(s)
- John J Heifner
- School of Medicine, St. George's University, Great River, New York
| | - Jack E Kilgore
- College of Medicine, University of Florida, Gainesville, Florida
| | - Jennifer A Nichols
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Christopher W Reb
- Division of Foot and Ankle, Department of Orthopaedics & Rehabilitation, University of Florida, Gainesville, Florida
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Hull PA, Collins AP, Maag B, Schwartzman J, Gapinski ZA, Service BC. Mechanism of Knee Injuries in the National Basketball Association: A Video-Based Analysis. Adv Orthop 2024; 2024:5594149. [PMID: 38682118 PMCID: PMC11055643 DOI: 10.1155/2024/5594149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 05/01/2024] Open
Abstract
Background To characterize the mechanism of knee injuries among NBA players during the 2010-2020 seasons using video-based analysis. Methods An injury database of NBA players was queried for knee injuries from the 2006-07 to 2020-21 seasons and cross-referenced with NBA injury reports. Youtube.com was searched to identify available injury footage. The mechanism of knee injury during play was analyzed by three independent reviewers. Non-mechanistic data related to the injury was gathered from news reports and official NBA websites. Results A total of 2,868 knee injuries occurred in NBA players from 2010 to 2020 seasons; 121 had high quality videos for analysis. The most common mechanism of injury was knee flexion in valgus with internal rotation (27.3%, p < 0.001), which was associated with injury to the ACL (55.2%, p=0.0001). Injuries occurred most often with control of the ball (62.8%, p=0.0064), while on offense (73.6%, p=0.0001), and without contact (71.1%, p=0.0001). A 28.1% incidence of re-injury was observed in the first 3-year period, and 43.8% of knee injuries required surgery. The average number of games missed due to injury requiring surgery was 55.1 games compared to 8.5 games in those treated nonoperatively (p < 0.0001). Conclusion Understanding mechanisms of knee injury may guide preventative strategies and injury management programs in NBA players. Video-based analysis reveals the situational characteristics and mechanisms of knee injuries, but further studies are needed to develop injury prevention programs, efficacy of prevention strategies, and rehabilitation to minimize games missed from these injuries.
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Affiliation(s)
- Peyton A. Hull
- Baylor University Medical Center, Department of Orthopaedic Surgery, Dallas, TX, USA
| | - Andrew P. Collins
- University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, WA, USA
| | - Brenden Maag
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Orlando, FL, USA
| | - Jonathan Schwartzman
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Orlando, FL, USA
| | - Zachary A. Gapinski
- Orlando Health Jewett Orthopedic Institute, 1222 South Orange Ave. 5th Floor, Orlando, FL, USA
| | - Benjamin C. Service
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd., Orlando, FL, USA
- Orlando Health Jewett Orthopedic Institute, 1222 South Orange Ave. 5th Floor, Orlando, FL, USA
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Tosarelli F, Buckthorpe M, Di Paolo S, Grassi A, Rodas G, Zaffagnini S, Nanni G, Della Villa F. Video Analysis of Anterior Cruciate Ligament Injuries in Male Professional Basketball Players: Injury Mechanisms, Situational Patterns, and Biomechanics. Orthop J Sports Med 2024; 12:23259671241234880. [PMID: 38524890 PMCID: PMC10960353 DOI: 10.1177/23259671241234880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 03/26/2024] Open
Abstract
Background Improving our understanding of the situations and biomechanics that result in an anterior cruciate ligament (ACL) injury in basketball players may support the design of more effective programs to mitigate the risk of injury. Purpose To (1) describe the mechanisms, situational patterns, and gross biomechanics (kinematics) of ACL injuries in professional basketball matches using video analysis and (2) document the distribution of ACL injuries according to player position, phase of the match, and location on the court. Study Design Case series; Level of evidence, 4. Methods A total of 38 ACL injuries in professional male European basketball leagues from the 2013-2014 to 2019-2020 seasons were identified. There were 36 (95%) injury videos analyzed for injury mechanisms and situational patterns, while biomechanical analysis was possible in 32 cases. Overall, 3 independent reviewers evaluated each video. Data according to player position (n = 38), phase of the match (n = 38), and location on the court (n = 36) were evaluated. Results More injuries occurred while attacking (n = 25 [69%]) than defending (n = 11 [31%]). There was 1 (3%) direct contact injury, 21 (58%) indirect contact injuries, and 14 (39%) noncontact injuries. Most injuries (83%) occurred during 3 main situations: offensive cut (n = 17 [47%]), landing from a jump (n = 8 [22%]), and defensive cut (n = 5 [14%]). Injuries generally involved knee flexion (with minimal hip/trunk flexion and reduced plantarflexion) in the sagittal plane and knee valgus loading in most cases (75%). A similar number of injuries occurred during the first (53%) and second (47%) halves of the match, with a higher prevalence in the second (37%) and fourth (34%) quarters. Half of the injuries occurred during the first 10 minutes of effective playing time. More injuries occurred in guards (58%), and 73% of all injuries occurred in the scoring zone. Conclusion Indirect contact was the main injury mechanism found in male professional basketball players. The offensive cut was the most common situational pattern. Biomechanical analysis confirmed a multiplanar mechanism, with knee loading in the sagittal plane accompanied by dynamic valgus. More injuries occurred in the first 10 minutes of a player's effective playing time, within the scoring zone, and among guards.
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Affiliation(s)
- Filippo Tosarelli
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
| | - Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
- Faculty of Sport, Technology and Health Sciences, St Mary's University, Twickenham, London, UK
| | - Stefano Di Paolo
- Clinica Ortopedica e Traumatologica II, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gil Rodas
- Medical Services, Football Club Barcelona, Barcelona, Spain
- Barça Innovation Hub, Football Club Barcelona, Barcelona, Spain
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gianni Nanni
- Education and Research Department, Isokinetic Medical Group, Bologna, Italy
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Cassinat JJ, Aceto M, Schwartzman J, Ghattas Y, Gapinski Z, Service BC. Multivariate Analysis of Risk Factors for Injury and Surgical Interventions in Ankle and Knee Injuries in NBA Athletes. Open Access J Sports Med 2024; 15:1-8. [PMID: 38348303 PMCID: PMC10859044 DOI: 10.2147/oajsm.s442750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024] Open
Abstract
Objective Lower extremity ankle and knee injuries occur at a high rate in the National Basketball Association (NBA) often requiring surgical intervention. This study aimed to identify surgical rates and risk factors for surgical intervention using multivariate analysis in ankle and knee injuries in NBA player. Methods Player demographics, performance metrics, advanced statistics, and injury characteristics were recorded using publicly available data. To standardize injury events over multiple years, injury events per 1000 athlete exposure events (AE, one player participating in one game) were calculated. Descriptive analysis and multivariate logistic regression were completed to find associations with surgical intervention in ankle and knee injuries. Results A total of 1153 ankle and knee injuries were included in the analysis with 73 (6.33%) lower extremity injuries treated with surgery. Knee injuries had a higher incidence of surgical intervention (0.23 AE) than ankle injuries (0.04 AE). The most frequent surgical knee injury was meniscus tear treated with meniscus repair (0.05 AE) and the most frequent ankle surgery was surgical debridement (0.01 AE) Multivariate logistic regression indicated lower extremity injuries that required surgery were associated with more minutes per game played (odds ratio [OR] 1.13; p = 0.02), a greater usage rate (OR 1.02 p < 0.001), the center position (OR 1.64; 95% [CI] 1.2-2.24; p = 0.002) and lower player efficiency rating (OR 0.96; 95% p < 0.001). Conclusion Knee surgery was significantly more frequent than ankle surgery despite similar injury rates per 1000 exposures. The center position had the greatest risk for lower extremity injury followed by minutes played while a higher player efficiency rating was protective against surgical intervention. Developing strategies to address these factors will help in the management and prevention of lower extremity injuries requiring surgical intervention.
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Affiliation(s)
- Joshua J Cassinat
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Matthew Aceto
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Jonathan Schwartzman
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Yasmine Ghattas
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Zachary Gapinski
- Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
| | - Benjamin C Service
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
- Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute, Orlando, FL, USA
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Allahabadi S, Galivanche AR, Coss N, Tenzing N, Gatto AP, Murray JC, Allahabadi S, Pandya NK. Severe Acute Respiratory Syndrome Coronavirus 2 Did Not Substantially Impact Injury Patterns or Performance of Players in the National Basketball Association From 2016 to 2021. Arthrosc Sports Med Rehabil 2024; 6:100841. [PMID: 38205401 PMCID: PMC10776416 DOI: 10.1016/j.asmr.2023.100841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose To perform a descriptive epidemiologic analysis of National Basketball Association (NBA) injuries from 2016 to 2021, to evaluate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019, or COVID-19) on injury patterns and performance statistics, and to determine the effect of infection with SARS-CoV-2 on individual performance statistics. Methods Injury epidemiology in the NBA from the 2016 to 2021 seasons was collected using a comprehensive online search. Injuries and time missed were categorized by injury location and type. Player positions and timing of injury were recorded. Performance statistics were collected including traditional game statistics and Second Spectrum (speed, distance) statistics. Comparisons were made over seasons and comparing the pre-COVID-19 pandemic seasons to the pandemic era seasons. Players diagnosed with COVID-19 were analyzed for changes in performance in the short or long term. Results Of the 3,040 injuries captured, 1,880 (61.84%) were in the lower extremity. Guards (77.44%) and forwards (75.88%) had a greater proportion of soft-tissue injuries (P < .001) than centers. Guards had the highest proportion of groin (3.27%, P = .001) and hamstring (6.21%, P < .001) injuries. Despite minor differences on a per-season basis, there were no differences in injury patterns identified between pre-COVID-19 and COVID-19 eras. Of players diagnosed with COVID-19 during the NBA Bubble, there were no detriments in short- or long-term performance identified, including traditional game statistics and speed and distance traveled. Conclusions In the NBA seasons from 2016 to 2021, most injuries were to the lower extremity. The SARS-CoV-2 pandemic did not substantially impact injury patterns in the NBA, including locations of injury and type of injury (bony or soft tissue). Furthermore, infection with SARS-CoV-2 does not appear to have a significant impact on performance in basketball-specific or speed and distance measures. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Anoop R. Galivanche
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Nathan Coss
- School of Medicine, University of California San Francisco, San Francisco, California, U.S.A
| | - Norbu Tenzing
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Andrew P. Gatto
- College of Osteopathic Medicine, Touro University California, Vallejo, California, U.S.A
| | - Jerome C. Murray
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Sameer Allahabadi
- Baylor Scott & White Institute for Rehabilitation, Baylor University Medical Center, Dallas, Texas, U.S.A
| | - Nirav K. Pandya
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
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10
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Allahabadi S, Quigley R, Frazier L, Joyce K, Cole BJ. Outcomes and Return to Sport After Knee Osteochondral Allograft Transplant in Professional Athletes. Orthop J Sports Med 2024; 12:23259671241226738. [PMID: 38410170 PMCID: PMC10896054 DOI: 10.1177/23259671241226738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/21/2023] [Indexed: 02/28/2024] Open
Abstract
Background Limited data are available on the outcomes and return-to-sport rates after osteochondral allograft transplant in professional athletes. Purpose To evaluate the experience of a single senior surgeon in treating professional athletes with osteochondral allograft transplant, including analyzing clinical outcomes and return to sport. Study Design Case series; Level of evidence, 4. Methods The authors performed a retrospective review of professional athletes treated with primary osteochondral allograft to the knee between January 1, 2001, and January 1, 2021, by a single surgeon. Athletes were required to play at the professional level in their sport and have a minimum of 2 years of follow-up. Return-to-sport rates and timing were evaluated. Patient-reported outcomes were assessed preoperatively and at final follow-up. Reoperations and failures were also tabulated. Results The study included 15 professional athletes who represented a variety of sports, with follow-up at a mean of 4.91 ± 2.2 years (range, 2.0-9.4 years). The majority (8 athletes; 53%) had undergone prior surgeries to the operative knee. Eleven (73%) returned to sport at a mean of 1.22 ± 0.4 years (range, 0.75-2 years), and of the 8 undergoing isolated osteochondral allograft, 7 (87.5%) returned at 1.28 ± 0.3 years. Ten athletes (66.7% of total; 90.9% of those who returned) returned to sport at the same level or higher compared with before surgery. Significant improvements were seen in each assessed patient-reported outcome score at final follow-up. Two of the 3 (66.7%) patients who underwent concomitant meniscal allograft transplant were able to return to sport at the same level or higher than presurgery. Three (20%) underwent second-look arthroscopy, 1 (6.7%) of whom underwent cartilage debridement of the osteochondral allograft. Conclusion Osteochondral allograft transplant in professional athletes can result in a high rate of return to play at a similar or higher level as presurgery, even when performed with concomitant procedures such as meniscal allograft transplant. High-level athletes should expect significant postoperative improvement in clinical outcomes.
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Affiliation(s)
- Sachin Allahabadi
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Quigley
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Landon Frazier
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Kaitlyn Joyce
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
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11
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Lin E, Tummala SV, Morikawa L, Vij N, Petty SB, McQuivey KS, Chhabra A. Strains/Sprains and Fractures Are the Most Common Hand and Wrist Injuries in National Basketball Association Athletes Who Return to Preinjury Player Efficiency and Equal or Greater True Shooting Percentage Within Two Years of Injury. Arthrosc Sports Med Rehabil 2023; 5:100829. [PMID: 38107373 PMCID: PMC10724484 DOI: 10.1016/j.asmr.2023.100829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/24/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose To characterize the prevalence and incidence of in-game hand and wrist injuries in the National Basketball Association (NBA), to determine the factors associated with an equal or greater player efficiency rating (PER), and to determine the factors associated with an equal or greater true shooting percentage (TS%) 2 years after a hand and wrist injury using a large-scale national database of NBA players. Methods Injury data from seasons 2015-2016 to 2020-2021, with exclusion of the 2019-2020 because of abbreviated play due to the coronavirus disease 2019, were extracted from a public online database, Pro Sports Transactions. Injury characteristics and NBA player demographic information were assessed using descriptive statistics. Poisson logistic regression analyses were performed to identify risk factors associated with equal or increased PER and TS% 2years after injury. Results There were 214 reported hand and wrist injuries, and of these injuries, 173 (81%) were classified as structural. The most common injury types were a strain or sprain (0.63 per 1,000 game exposures), followed by fractures (0.37 per 1,000 game exposures). Older age (relative risk [RR] 0.89; 95% confidence interval [CI] 0.84-0.95) and more years played in the NBA were modestly associated with relative risk of having a decreased PER at 2 years after injury. Increased weight (RR 1.02; 95% CI 1-1.05) and increased body mass index (RR 1.14; 95% CI 1.01-1.29) were also modestly associated with having a decreased PER and TS%, respectively at 2 years after injury. Conclusions Strains/sprains and fractures are the most common hand and wrist injuries sustained by NBA players. Regardless of dominant or nondominant hand and wrist injuries, NBA players are likely to return to baseline overall player efficiency based on PER and TS% within 2 years of injury. Clinical Relevance Our study characterizes hand and wrist injuries of NBA players and provides an understanding for these injuries on player performance at 2 years.
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Affiliation(s)
- Eugenia Lin
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | | | | | - Neeraj Vij
- Department of Orthopedic Surgery, University of Kansas – Wichita, Wichita, Kansas, U.S.A
| | | | - Kade S. McQuivey
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Anikar Chhabra
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
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12
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Hong CC, Schaarup SO, Calder J. Differential elongation of the gastrocnemius after Achilles tendon rupture: a novel technique of selective shortening to treat push-off weakness with case series and literature review. Knee Surg Sports Traumatol Arthrosc 2023; 31:6046-6051. [PMID: 37837575 DOI: 10.1007/s00167-023-07619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Differential elongation of the gastrocnemius after Achilles tendon rupture (ATR) may compromise the ability of athletes to return to competition. Recognition of this differential elongation of the gastrocnemius relative to the soleus is vital to treat patients with weakness in push-off. This paper describes a novel technique performed for selective shortening of the gastrocnemius to treat push-off weakness. METHODS Three patients with differential proximal retraction of the gastrocnemius greater than 20 mm after treatment for ATR with inability to run and jump underwent surgical correction with this novel technique and were followed-up for 2 years. A novel selective shortening of the gastrocnemius with autologous hamstring graft was performed in these patients. The Achilles Tendon Total Rupture Score (ATRS) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score were recorded preoperatively and at the final follow-up. RESULTS All three patients were able to return to running and jumping at final follow-up. The ATRS improved significantly in the strength, fatigue, running and jumping domains but there appeared to be a less notable improvement in activities of daily living domain. The AOFAS score showed improvement with the greatest margin in the domain of activity limitation. CONCLUSION This procedure is the first described selective shortening method of the gastrocnemius tendons after differential elongation following ATR. It is a safe and reliable technique providing improved ATRS and AOFAS scores in three patients who were all able to return to running and jumping sports at 2-year follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Choon Chiet Hong
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK.
- Department of Orthopaedic Surgery, National University Hospital of Singapore, 1E, Kent Ridge Road, Singapore, 119228, Singapore.
- Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | | | - James Calder
- Fortius Clinic (FIFA Medical Centre of Excellence), 17 Fitzhardinge Street, London, W1H 6EQ, UK
- Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
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13
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Saito T, Matsumura N, Kawamoto S, Doi N, Aoyama T, Nagai-Tanima M. Analyses of actions which cause anterior cruciate ligament injuries in the national basketball association players: YouTube-based video analyses. BMC Sports Sci Med Rehabil 2023; 15:130. [PMID: 37828552 PMCID: PMC10571282 DOI: 10.1186/s13102-023-00747-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/08/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are among the most common injuries in the National Basketball Association (NBA), and it is important to investigate the actual nature of the injury because it can impair a player's performance after returning to the game. Although the moment of injury has been investigated, the details of the movements and circumstances leading to injury in basketball games are unknown. This study aimed to clarify the actions leading to ACL injuries and to investigate their characteristics, based on YouTube video analyses of the NBA players. METHODS Players with ACL injuries in the NBA were identified through web-based research over 10 seasons (2011/2012-2021/2022, through October 2021), with 29 recorded videos of ACL injuries in the NBA. Actions were categorized based on basketball-specific gestures, and determined whether the player was in contact with an opponent or not and, if so, the location of the contact was analyzed focusing on two time points: at the injury frame (IF) and one step before the injury frame (IF-1). The "injury leg" timing was counted for each of the first and second steps after ball possession. RESULTS The majority (68.2%) of ACL injury occurred during the 2 steps phase (only two steps can proceed after ball retention in basketball, so we defined them as two steps) in the offense action, and most notably during the first step (80.0%). 73.3% of players who were injured during the 2 steps phase got contact to an area other than the knee (Indirect contact) at the IF-1, with 81.8% of contact being located in the upper body contralateral to the respective knee injury. The probability of players with ACL injuries during the 2 steps at the IF-1 who got Indirect contact was statistically significantly greater than those who got no contact with other players (p = 0.042). CONCLUSIONS We argue that including pre-injury play and contact falls into the novelty category. Through YouTube-based video analyses, this study revealed that ACL injuries tend to be characterized by specific types of actions, the timing of contact, and the location of contact in NBA players.
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Affiliation(s)
- Takanobu Saito
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Natsuki Matsumura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Shinichi Kawamoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Naoki Doi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Tomoki Aoyama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan
| | - Momoko Nagai-Tanima
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 kawahara-cho, shogoin, Sakyo-ku, 606-8507, Kyoto, Japan.
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14
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Morikawa LH, Tummala SV, Brinkman JC, Crijns TJ, Lai CH, Chhabra A. Shoulder and Elbow Injuries in National Basketball Association Athletes and Their Effects on Player Performance. Orthop J Sports Med 2023; 11:23259671231202973. [PMID: 37810744 PMCID: PMC10559716 DOI: 10.1177/23259671231202973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 10/10/2023] Open
Abstract
Background Shoulder and elbow function is essential to basic basketball actions. Outside of anterior shoulder instability, injuries in these joints are not well characterized in National Basketball Association (NBA) players. Purpose To describe the epidemiology and associated risk factors of shoulder and elbow injuries in NBA players and identify factors that influence player performance upon return to play. Study Design Descriptive epidemiology study. Methods Historical injury data from the 2015-2020 NBA seasons were retrieved from Pro Sports Transactions, a public online database. An injury was defined as a health-related concern resulting in an absence of ≥1 NBA games. Primary measures included pre- and postinjury player efficiency rating (PER) and true shooting percentage (TS%) with interquartile ranges (IQRs), stratified by extremity dominance. Multivariate logistic regression analyses with stepwise regression were performed to identify risk factors associated with return-to-play performance. Results A total of 192 shoulder and elbow injuries were sustained among 126 NBA athletes, with incidence rates of 1.11 per 1000 game exposures (GEs) and 0.30 per 1000 GEs, respectively. Sprain/strain and general soreness were the most common injury types in both the shoulder and the elbow. In the 2 years after injury, baseline PER was achieved in all groups, except for players with dominant shoulder injuries (baseline PER, 16 [IQR, 14-18] vs 2-year PER, 13 [IQR 11-16]; P = .012). Younger age was associated with quicker return to baseline PER (odds ratio, 0.77 [95% CI, 0.67-0.88]). Shoulder and elbow injuries did not negatively influence TS% upon return to play (baseline TS%, 0.55% [IQR, 0.51%-0.58%] vs 1-year TS%, 0.55% [IQR, 0.52%-0.58%]; P = .13). Conclusion Dominant shoulder injuries negatively influenced PER during the first 2 seasons upon return to play in NBA players. Therefore, expectations that players with this type of injury immediately achieve baseline statistical production should be tempered. Shooting accuracy appears to remain unaffected after shoulder or elbow injury.
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Affiliation(s)
- Landon H. Morikawa
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | | | | | - Tom J. Crijns
- Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Cara H. Lai
- Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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15
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Bodendorfer BM, DeFroda SF, Newhouse AC, Yang DS, Shu HT, Wichman D, Murphy JP, Milner JD, Hartnett DA, Gould H, Chahla J, Nho SJ. Recurrence of Hamstring Injuries and Risk Factors for Partial and Complete Tears in the National Football League: An Analysis From 2009-2020. PHYSICIAN SPORTSMED 2023; 51:139-143. [PMID: 34878369 DOI: 10.1080/00913847.2021.2013106] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To (1) characterize hamstring injury (HSI) recurrence rates across the 2009-2010 to 2019-2020 NFL seasons and (2) to identify HSI recurrence risk factors among positions and determine the weekly return to play (RTP) recurrence risk. We hypothesized that older players, skill position players, and players returning to play faster were most at risk. METHODS Public data from the 2009-2010 to 2019-2020 seasons were reviewed to identify HSIs. Player characteristics were collected before and two seasons following injury. A week-by-week analysis of recurrence risk was evaluated with linear and logarithmic trendlines of the best fit. RESULTS A total of 2075 HSI were identified with a mean age of 26.2 years (20.0-43.0), BMI of 29.6 (22.7-43.5), and 3.4 seasons of experience (0-17), with 1826 strains (88.0%), 236 partial tears (11.3%), and 13 complete tears (0.63%). Of the 2075 injuries, 796 (38.4%) were recurrent, with 247 (11.9%) being a same-season reinjury. Logistic regression found that fewer weeks before RTP, in-game injury, and lower BMI were risk factors for same-season recurrence. For any recurrence, logistic regression identified more recent year of injury, lower BMI, and longer playing experience as significant risk factors. Wide receivers were found to be at risk for same-season recurrence. For any-season recurrence, defensive backs, linebackers, running backs, tight ends, and wide receivers were at risk. Week-by-week recurrence analysis determined the greatest risk to be when players returned within 2 weeks (13.4%). CONCLUSIONS There is a high rate of HSI recurrence in the NFL. Risk factors for same-season injury include shorter time to RTP, in-game injury, lower BMI, and playing wide receiver. Risk factors for any-season recurrence were more recent year of injury, lower BMI, longer playing experience, and playing defensive back, linebacker, running back, tight end, or wide receiver. The greatest risk factor for HSI recurrence was RTP within 2 weeks.
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Affiliation(s)
- Blake M Bodendorfer
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Chicago, IL, USA
| | - Steven F DeFroda
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Chicago, IL, USA
| | - Alexander C Newhouse
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Chicago, IL, USA
| | - Daniel S Yang
- Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Henry T Shu
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Daniel Wichman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Chicago, IL, USA
| | - Jordan P Murphy
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - John D Milner
- Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Davis A Hartnett
- Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Heath Gould
- Department of Orthopedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Jorge Chahla
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Chicago, IL, USA
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Hip Preservation Center, Chicago, IL, USA
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Allahabadi S, Kwong JW, Pandya NK, Shin SS, Immerman I, Lee NH. Return to Play After Thumb Ulnar Collateral Ligament Injuries Managed Surgically in Athletes—A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023. [DOI: 10.1016/j.jhsg.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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17
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Collins AP, Ali S, Zaruta D, Perry N, Riemenschneider J, Service BC. Validity of Video-Based Analysis for Analyzing Shoulder Injuries in the National Basketball Association. Orthop J Sports Med 2023; 11:23259671231157768. [PMID: 36896095 PMCID: PMC9989390 DOI: 10.1177/23259671231157768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 11/09/2022] [Indexed: 03/11/2023] Open
Abstract
Background Shoulder injuries are very common in athletes playing in the National Basketball Association (NBA). With increasing injury video uploads available online, we may be able to identify and systematically describe the mechanism of these injuries in these athletes. Purpose To (1) determine the validity of video-based analysis to evaluate mechanisms of shoulder injuries in NBA players during the 2010-2020 seasons and (2) report on commonly sustained injuries, circumstances associated with injury, and number of games missed owing to injury. Study Design Cross-sectional study; Level of evidence, 3. Methods An injury report data set was queried for shoulder injuries among NBA players between the 2010-2011 season and the 2019-2020 season, and results were cross-referenced using YouTube.com to identify high-quality videos of the injuries. Out of 532 shoulder injuries in this time frame, video evidence from 39 (7.3%) were evaluated for mechanism of injury and other corresponding situational data. From the remaining shoulder injuries, a randomly selected control cohort of 50 injuries occurring in the same interval was assessed for descriptive injury data, incidence of recurrence, necessity for surgery, and number of games missed, to compare with corresponding data from injuries in the videographic evidence cohort. Results In the videographic evidence cohort, the most common mechanism of injury was lateral contact to the shoulder (41%; P < .001), which was associated with an injury to the acromioclavicular joint (30.8%; P < .001). Injuries occurred more often when the team was on offense (58.9%; P < .001) versus defense. Players who required surgery missed 33 more games on average than players who did not require surgery (P < .001). For the injured players, a 33% incidence of reinjury was identified in the 12 months after their initial injury. As compared with the control cohort, no significant differences were noted in injury laterality, recurrence rates, necessity for surgical management, time in the season, or number of games missed. Conclusion Despite its low yield of 7.3%, video-based analysis may be a useful tool to determine the mechanism of shoulder injuries in the NBA, given the similarities of injury characteristics as compared with the control group.
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Affiliation(s)
- Andrew P Collins
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Sabah Ali
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Douglas Zaruta
- Orlando Health Jewett Orthopedic Institute, Orlando, Florida, USA
| | - Nichole Perry
- Orlando Health Jewett Orthopedic Institute, Orlando, Florida, USA
| | | | - Benjamin C Service
- College of Medicine, University of Central Florida, Orlando, Florida, USA.,Orlando Health Jewett Orthopedic Institute, Orlando, Florida, USA.,College of Medicine, Florida State University, Tallahassee, Florida, USA
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18
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Cross AG, Khalil LS, Tomlinson M, Tramer JS, Makhni EC, Cox BA. Percutaneous Achilles Tendon Repair Using Ultrasound Guidance: An Intraoperative Ultrasound Technique. Arthrosc Tech 2023; 12:e173-e180. [PMID: 36879876 PMCID: PMC9984726 DOI: 10.1016/j.eats.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/12/2022] [Indexed: 01/21/2023] Open
Abstract
Rupture of the Achilles tendon is a common injury seen in patients of varying ages and activity levels. There are many considerations for treatment of these injuries, with both operative and nonoperative management providing satisfactory outcomes in the literature. The decision to proceed with surgical intervention should be individualized for each patient, including the patient's age, future athletic goals, and comorbidities. Recently, a minimally invasive percutaneous approach to repair the Achilles tendon has been proposed as an equivalent alternative to the traditional open repair, while avoiding wound complications associated with larger incisions. However, many surgeons have been hesitant to adopt these approaches due to poor visualization, concern that suture capture in the tendon is not as robust, and the potential for iatrogenic sural nerve injury. The purpose of this Technical Note is to describe a technique using high-resolution ultrasound guidance intraoperatively during minimally invasive repair of the Achilles tendon. This technique minimizes the drawbacks of poor visualization associated with percutaneous repair, while providing the benefit of a minimally invasive approach.
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Affiliation(s)
- Austin G Cross
- Cox Sports Medicine and Orthopedic Surgery, Mt. Pleasant, Michigan, U.S.A
| | - Lafi S Khalil
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan, U.S.A
| | - Maggie Tomlinson
- Cox Sports Medicine and Orthopedic Surgery, Mt. Pleasant, Michigan, U.S.A
| | - Joseph S Tramer
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan, U.S.A
| | - Eric C Makhni
- Henry Ford Hospital, Department of Orthopaedic Surgery, Detroit, Michigan, U.S.A
| | - Benjamin A Cox
- Cox Sports Medicine and Orthopedic Surgery, Mt. Pleasant, Michigan, U.S.A
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Abstract
PURPOSE OF REVIEW Treatment of overhead athletes requires a systematic approach that will make an accurate diagnosis, deliver effective treatment, and make timely and safe return to sport. RECENT FINDINGS New data has shown success rates and return to play effectiveness after different types of cervical and lumbar surgery. Cervical foraminotomy has been shown to have the highest rate and fastest return to play, but with the highest incidence of need for revision surgery. Cervical artificial disc replacement has shown promising results in the general population and is being done more commonly in elite athletes, but has an unknown risk for failure. Cervical fusion is a well-established and effective treatment, but has the longest healing time and risk for adjacent level pathology. In the lumbar spine, discectomy has a long and proven track record, fusion is rarely performed but can be effective, and artificial disc replacement is extremely rare in an elite athlete. An effective and comprehensive approach can diagnose, treat, and return overhead athletes to competitive play.
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Affiliation(s)
- Robert G. Watkins
- Marina Spine Center, 4640 Admiralty Way, Suite 600, Marina del Rey, CA 90292 USA
| | - David Chang
- Marina Spine Center, 4640 Admiralty Way, Suite 600, Marina del Rey, CA 90292 USA
| | - Robert G. Watkins
- Marina Spine Center, 4640 Admiralty Way, Suite 600, Marina del Rey, CA 90292 USA
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Choudhry H, Singleton A, Candella K, Stegelmann S, Falbo R, Carmody C, Levine J. Return to play and performance in the National Basketball Association after undergoing operative or nonoperative treatment for foot fracture. J Orthop 2022; 34:160-165. [PMID: 36090784 PMCID: PMC9450068 DOI: 10.1016/j.jor.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 01/10/2023] Open
Abstract
Background The incidence of distal lower extremity fractures in National Basketball Association (NBA) athletes continues to increase. There is a paucity of data regarding return-to-play (RTP) rates and performance after sustaining foot fractures in these athletes. The purpose of this study is to quantify RTP rates and performance in NBA players after sustaining a foot fracture. Methods Sixty-two NBA athletes suffered foot fractures between 2005 and 2021 according to publicly accessible online data. Each athlete was matched to a control player based on age at start of career, age at index injury year, body mass index (BMI), and position played. Performance statistics from 3 seasons prior and 3 seasons following the index injury season were recorded. Results We found that players who suffered foot fracture injuries are expected to make a full recovery and reach their previous level of performance within three years. 100% of players treated nonoperatively returned to play; meanwhile only 90% of players who were treated operatively returned to play. This difference is statistically significant. Conclusion NBA athletes have a high RTP rate after sustaining a foot fracture. Players may experience an initial decrease in playing time and performance when returning to play, however, these variables were found to return to baseline over time. After three seasons, player statistics returned to baseline in mostly every category, including player efficiency rating (PER). We found that players are expected to make a full recovery and return to their previous level of performance, regardless of whether they were treated operatively or not. Players treated nonoperatively returned to play at a rate of 100% meanwhile those treated operatively returned at a rate of 90%. Therefore, it is our recommendation that players opt for nonoperative treatment when possible.
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Affiliation(s)
- Hassan Choudhry
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Amy Singleton
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Kristofer Candella
- Touro College of Osteopathic Medicine, 230 W 125 St 3rd Floor, New York, NY, 10027, USA
| | - Samuel Stegelmann
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Ryan Falbo
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Clayton Carmody
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
| | - Jason Levine
- Mercy Health St., Vincent Medical Center, Department of Orthopedics, 2409 Cherry Street, Suite #10, Toledo, OH, 43608, USA
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Barahona M, Mosquera M, De Padua V, Galan H, Del Castillo J, Mejias S, Bacarreza F, Araya O, Kuhn A, Vaisman A, Graieb A, Almazan A, Helito C, Fuentes C, Collazo C, Esquivel D, Gigante F, Motta F, Ochoa G, Arteaga G, Ferrer G, Zvietcovich G, Cardona J, Hurtado J, Erlund L, Costa-Paz M, Roby M, Ponzo N, Sarmiento P, Yáñez R, Urbieta S, Marques de Olivera V, Álvaro Zamorano, Radice F, Nardin L, Gelink A, Hernandez R, Rosa ADL, Irarrazaval S, Cordivani F, Canuto S, Gravini G. Latin American formal consensus on the appropriate indications of extra-articular lateral procedures in primary anterior cruciate ligament reconstruction. J ISAKOS 2022:S2059-7754(22)00082-7. [PMID: 36087904 DOI: 10.1016/j.jisako.2022.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/09/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To create a practice guideline for the appropriate indications of an extra-articular procedure in primary anterior cruciate ligament reconstruction (ACLR). METHODS The formal consensus method described by the Haute Autorité de Santé was used. The Latin American Society of Arthroscopy, Articular Replacement, and Sports Injuries (SLARD) recruited three groups of experts on ACLR. Initially, the steering group, consisting of eight surgeons, performed a systematic review of the literature and elaborated on 192 scenarios for primary ACLR. The rating group, composed of 23 surgeons, rated each scenario in two rounds, with an in-between in-person meeting for discussion. Median scores and agreement levels were estimated to classify each scenario as inappropriate, uncertain or appropriate for adding anterolateral reconstruction. Finally, the lecture group, consisting of 10 surgeons, revised each stage of the method, results and interpretation. RESULTS Of the scenarios, 11.97% were rated as appropriate for adding an extra-articular lateral procedure, 7.81% as inappropriate and 80.21% as uncertain. The key recommendations for the addition of extra-articular lateral techniques were as follows: it is appropriate when the patient is under 25 years of age, has high-grade physical examination findings, practises a pivoting sport and has hyperlaxity; meanwhile, it is inappropriate when the patient has low-grade physical examination findings, has normal laxity and does not practise a pivoting sport. CONCLUSIONS The appropriate indications of extra-articular lateral procedures in primary ACLR were determined on the basis of the best available evidence and expert opinion following a formal consensus method. LEVEL OF EVIDENCE V.
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22
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DeFroda SF, Bodendorfer BM, Hartnett DA, Milner JD, Yang DS, Silber ZS, Forsythe B. Defining the contemporary epidemiology and return to play for high ankle sprains in the National Football League. PHYSICIAN SPORTSMED 2022; 50:301-305. [PMID: 33906554 DOI: 10.1080/00913847.2021.1924046] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND High ankle sprains and syndesmotic injuries are commonly sustained by National Football League players, yet there is apaucity of literature reporting the incidence, risk factors and return to play (RTP) rates for these injuries. The purpose of this study is to examine the epidemiology and trends in incidence of high ankle sprains across 11 NFL seasons. METHODS Publicly available data from the 2009-2010 through 2019-20 seasons were reviewed to identify injuries and collect player characteristics and return to play. Incidence of high ankle injuries was calculated per 10,000 athlete-exposures. Linear regression was performed for incidence of injuries. Risk factors for failure to RTP were identified through multivariate logistic regression, controlling foryear of injury, player position, body mass index (BMI), age at injury, and years of experience before injury. RESULTS A total of 533 high ankle sprains were identified in 498 players at an average age of 25.8 ± 3.1 and average BMI of 31.8 ± 4.6. The annual incidence of high ankle sprains in the NFL increased at alinear rate of 0.067per 10,000 player exposures (R2 = 0.3357) in 2009, to 1.75per 10,000 player exposures to 2.49 in 2019-20. Most injuries were in offensive players (304/533 injuries, 57.0%). Overall, 89.7% (478/533) of players returned to play; average RTP time was 80.5 ± 132.9 days. Defensive players had afaster RTP (68.1 ± 114.6 days) compared to offensive players (90.1 ± 144.8 days) (p = 0.084). Higher age at injury was found to increase the risk of failure to RTP (p = 0.0088). CONCLUSION RTP rate was high following high ankle sprain aamongNFL players at 90%, with an average recovery period of 11 weeks. Defensive players experience RTP faster than offensive players. Future studies are needed to determine performance outcomes following RTP, along with which patients might benefit from surgery.
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Affiliation(s)
- Steven F DeFroda
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Blake M Bodendorfer
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
| | - Davis A Hartnett
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | - John D Milner
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | - Daniel S Yang
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | - Zachary S Silber
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, RI
| | - Brian Forsythe
- Division of Sports Medicine, Department of Orthopedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, USA
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23
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Mansfield K, Dopke K, Koroneos Z, Bonaddio V, Adeyemo A, Aynardi M. Achilles Tendon Ruptures and Repair in Athletes-a Review of Sports-Related Achilles Injuries and Return to Play. Curr Rev Musculoskelet Med 2022; 15:353-361. [PMID: 35804260 DOI: 10.1007/s12178-022-09774-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Achilles tendon ruptures (ATR) are detrimental to sports performance, and optimal treatment strategy and guidelines on return to play (RTP) remain controversial. This current review investigates the recent literature surrounding nonoperative versus operative management of ATR, clinical outcomes, and operative techniques to allow the athlete a successful return to their respective sport. RECENT FINDINGS The Achilles tendon (AT) is crucial to the athlete, as it is essential for explosive activities such as running and jumping. Athletes that sustain an ATR play in fewer games and perform at a lower level of play compared to age-matched controls. Recent studies also theorize that ATRs occur due to elongation of the tendon with fatigue failure. Biomechanical studies have focused on comparing modes of fixation under dynamic loading to recreate this mechanism. ATRs can be career-ending injuries. Fortunately, the recent incorporation of early weight-bearing and functional rehabilitation programming for non-operative and operative patients alike proves to be beneficial. Especially for those treated nonoperatively, with the incorporation of functional rehabilitation, the risk of re-rupture among non-operative patients is beginning to approach the historical lower risk of re-rupture observed among patients treated operatively. Despite this progress in decreasing risk of re-rupture particularly among non-operative patients, operative managements are associated with unique benefits that may be of particular interest for athletes and active individuals. Recent studies demonstrate that operative intervention improves strength and functional outcomes with more efficacy compared to nonoperative management with rehabilitation. The current literature supports operative intervention in elite athletes to improve performance and shorten the duration to RTP. However, we acknowledge that surgical intervention does have inherent risks. Ultimately, most if not all young and/or high-level athletes with an ATR benefit from surgical repair, but it is crucial to take a stepwise algorithmic approach and consider other factors, which may lead towards nonoperative intervention. These factors include age, chronicity of injury, gap of ATR, social factors, and medical history amongst others in this review.
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Affiliation(s)
- Kirsten Mansfield
- Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Drive, H089, Hershey, PA, 17033, USA
| | - Kelly Dopke
- Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Drive, H089, Hershey, PA, 17033, USA
| | - Zachary Koroneos
- Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Drive, H089, Hershey, PA, 17033, USA
| | - Vincenzo Bonaddio
- Penn State Milton Hershey Medical Center Department of Bone and Joint, 30 Hope Drive, Building A; PO Box 859, Hershey, PA, 17033, USA
| | - Adeshina Adeyemo
- Penn State Milton Hershey Medical Center Department of Bone and Joint, 30 Hope Drive, Building A; PO Box 859, Hershey, PA, 17033, USA
| | - Michael Aynardi
- Penn State Milton Hershey Medical Center Department of Bone and Joint, 30 Hope Drive, Building A; PO Box 859, Hershey, PA, 17033, USA.
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24
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Lian J, Sewani F, Dayan I, Voleti PB, Gonzalez D, Levy IM, Musahl V, Allen A. Systematic Review of Injuries in the Men's and Women's National Basketball Association. Am J Sports Med 2022; 50:1416-1429. [PMID: 34213367 DOI: 10.1177/03635465211014506] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Numerous studies have reported the incidence and outcomes of injuries in the men's and women's National Basketball Association (NBA and WNBA, respectively). PURPOSE To synthesize published data regarding the incidence and outcomes of all injuries in the NBA and WNBA in a comprehensive review. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched 3 electronic databases (PubMed, MEDLINE, Embase) for studies of all levels of evidence since 1990 pertaining to injuries sustained by active players in the NBA and WNBA. Studies were excluded if the cohort of interest included ≤3 active players. RESULTS The initial search of the 3 databases yielded 1253 unique studies, of which 49 met final inclusion criteria for this review. Only 4 studies included athletes in the WNBA. Based on the mean annual incidence, the 5 most common orthopaedic sports injuries sustained in the NBA were concussions (9.5-14.9 per year), fractures of the hand (3.5-5.5 per year), lower extremity stress fractures (4.8 per year), meniscal tears (2.3-3.3 per year), and anterior cruciate ligament tears (1.5-2.6 per year). Cartilage defects treated using microfracture, Achilles tendon ruptures, and anterior cruciate ligament injuries were 3 injuries that led to significant reductions in performance measurements after injury. CONCLUSION With advances in sports technology and statistical analysis, there is rapidly growing interest in injuries among professional basketball athletes. High-quality prospective studies are needed to understand the prevalence and effect of injuries on player performance and career length. This information can inform preventative and treatment measures taken by health care providers to protect players and guide safe return to play at a high level.
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Affiliation(s)
- Jayson Lian
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Faraz Sewani
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Isaac Dayan
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Pramod B Voleti
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - David Gonzalez
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - I Martin Levy
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Answorth Allen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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25
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DeFroda SF, Patel DD, Milner JD, Yang DS, Owens BD. Performance After Concussion in National Basketball Association Players. Orthop J Sports Med 2022; 10:23259671221083661. [PMID: 35309236 PMCID: PMC8928399 DOI: 10.1177/23259671221083661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Concussions have received national attention in collision sports such as football, soccer, and hockey, but less focus has been placed on basketball. Purpose: To determine return-to-play (RTP) and player performance in the first and second season after concussion in National Basketball Association (NBA) players. Study Design: Descriptive epidemiology study. Methods: An online database of publicly available NBA athlete injuries was queried for instances of “concussion” between 2010 and 2018. The age at injury, team, position, height, weight, body mass index, NBA experience, date of concussion, date of return, and seasons played postconcussion was recorded for each player. Regular-season statistics (games started, games played, minutes played, and player efficiency rating [PER]) were compiled for the season before, and 2 seasons immediately after, injury. Kaplan-Meier survivorship plots were computed for athlete RTP and retirement endpoints. Results: A total of 81 injuries were identified from 2010 to 2018, with a rate of 2.0 concussions per 100 player-years. Overall RTP was 100% after concussion, with nearly all (88%) returning in the season of injury; 12% of players experienced a season-ending concussion. RTP averaged 37.3 days after injury, varying widely (range, 2-291 days). Compared with preinjury season (78.0%), athletes played in significantly fewer overall games in the season of injury (36.6%; P < .0001), as well as 1 (69.5%; P = .0229) and 2 seasons postinjury (73.2%; P = .3192). PER scores were not significantly different across the study period. Each point increase in a player’s preinjury PER score was associated with a 2.4% decrease in PER from the preinjury season to season of injury (P = .0016) and a 3.1% decrease from preinjury to season after injury (P = .0053). Each increasing year of age or year of experience was associated with 5% decline in PER score at 1 season after injury. Conclusion: NBA players had a high RTP after concussion, with most returning in the same season as the injury. Players sustaining concussions played significantly fewer games for at least 2 seasons after injury. Performance via PER did not change across the entire cohort; however, players with higher preinjury PER, and older players were more likely to sustain a greater decline in performance after injury.
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Affiliation(s)
- Steven F. DeFroda
- Department of Orthopaedics, Missouri Orthopaedic Institute, Columbia, Missouri, USA
| | - Devan D. Patel
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - John D. Milner
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Daniel S. Yang
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
| | - Brett D. Owens
- Department of Orthopaedic Surgery, Brown University, Warren Alpert School of Medicine, Providence, Rhode Island, USA
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26
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LaPrade CM, Chona DV, Cinque ME, Freehill MT, McAdams TR, Abrams GD, Sherman SL, Safran MR. Return-to-play and performance after operative treatment of Achilles tendon rupture in elite male athletes: a scoping review. Br J Sports Med 2022; 56:515-520. [PMID: 35144918 DOI: 10.1136/bjsports-2021-104835] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the current evidence regarding return-to-play (RTP) and performance after Achilles tendon rupture in elite athletes treated with operative intervention. DESIGN Scoping review. DATA SOURCES Published sources identified through a PubMed search of elite athletes, defined as professional or division one collegiate athletes in baseball, basketball, American football or soccer. METHODS Our search yielded a total of 2402 studies, with 13 studies fulfilling the study criteria of reporting elite athletes with objective measures of their athletic performance. A total of 709 elite athletes were included from the NBA, NFL, Major League Baseball (MLB), National Collegiate Athletic Association (NCAA) football and professional soccer. RESULTS AND DISCUSSION Overall, 61%-100% of elite male athletes RTP after Achilles tendon rupture and operative repair. NBA players had inferior performance compared with their preoperative status as well as controls of non-injured players. Studies did not show significantly different performance after Achilles injury for MLB players. Professional soccer, NFL and NCAA football studies reported varying performance after injury. CONCLUSIONS Evidence suggests that sports with explosive plantarflexion demands, such as basketball, may be associated with a greater decrease in performance despite operative intervention after Achilles rupture.
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Affiliation(s)
- Christopher M LaPrade
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Deepak V Chona
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Mark E Cinque
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Timothy R McAdams
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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27
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Abdelatif NMN, Batista JP. Endoscopic Flexor Hallucis Longus Transfer for the Management of Acute Achilles Tendon Ruptures in Professional Soccer Players. Foot Ankle Int 2022; 43:164-175. [PMID: 34558318 DOI: 10.1177/10711007211036439] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Acute Achilles tendon ruptures (AATRs) that occur in athletes can be a career-ending injury. The aim of this study was to describe return to play and clinical outcomes of isolated endoscopic flexor hallucis longus (FHL) transfer in active soccer players with AATR. METHODS Twenty-seven active male soccer players who underwent endoscopically assisted FHL tendon transfer for acute Achilles tendon ruptures were included in this study. Follow up was 46.2 (±10.9) months after surgery. Return to play criteria and clinical outcome measures were evaluated. RESULTS All players returned to playing professional competitive soccer games. Return to active team training was at a mean of 5.8 (±1.1) months postoperatively. However, return to active competitive match play occurred at a mean of 8.3 (±1.4) months. Twenty-two players (82%) were able to return to their preinjury levels and performances and resumed their professional careers at the same soccer club as their preinjury state. One player (3.7%) shifted his career to professional indoor soccer. At 26 months postoperatively, the mean Tegner activity scale score was 9.7 (±0.4), the mean Achilles tendon total rupture score was 99 (±2), and the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot score was 99 (±3). No patients reported any great toe complaints or symptomatic deficits of flexion strength. CONCLUSION The current study demonstrated satisfactory and comparable return to play criteria and clinical results with minimal complications when using an advanced endoscopically assisted technique involving FHL tendon transfer to treat acute Achilles tendon ruptures in this specific subset of patient cohort. LEVEL OF EVIDENCE Level II, prospective cohort case series study.
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Affiliation(s)
| | - Jorge Pablo Batista
- Head Ankle and Knee Section, Orthopaedics Department, Centro Artroscópico Jorge Batista SA, Ciudad Autónoma de Buenos Aires (CABA), CP, Argentina.,Department of Sport Medicine, Club Atlético Boca Juniors, Buenos Aires, Argentina
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28
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Grassi A, Caravelli S, Fuiano M, D'Hooghe P, Filippini M, Della Villa F, Mosca M, Zaffagnini S. Epidemiology of Achilles Tendon Rupture in Italian First Division Football (Soccer) Players and Their Performance After Return to Play. Clin J Sport Med 2022; 32:e90-e95. [PMID: 33538516 DOI: 10.1097/jsm.0000000000000879] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the epidemiology, incidence rate, incidence proportion, and prevalence of Achilles tendon ruptures (ATRs) in professional footballers and their performance after the injury. DATA SOURCES Professional male footballers participating in Serie A in 11 consecutive seasons (2008/2009-2018/2019) were screened to identify ATRs through the online football archive transfermarkt.com. Exposure in matches and training was calculated. The number of matches played in the 5 seasons before and after ATRs was obtained, when possible, together with transfers to a different team or participation in lower Divisions. MAIN RESULTS Eleven ATRs were found in 11 footballers with a mean age of 29.8 ± 4.4 years; 72% of ATR involved the nondominant leg; 58% occurred during matches and 42% during training, with no peculiar distribution along the playing season. The overall incidence proportion was 0.17% (0.11% during matches and 0.06% during training). The overall incidence rate was 0.007 injuries per 1000 hours of play (0.051 during matches and 0.003during training; P < 0.0001). All players returned to play soccer after a mean of 170 ± 35 days after ATRs and participated in an official match after a mean of 274 ± 98 days. However, 2 seasons after ATRs, 3 footballers were playing in a lower Division; 1 played less than 10 matches (compared with >25 matches in the 5 seasons before an ATR) and 1 had retired. CONCLUSIONS An overall ATR rate of 0.007 per 1000 hours of soccer play and an incidence proportion of 0.17% were reported. All footballers return to play; however, up to 40% players decreased the level of play by reducing the number of games or participating in a lower Division 2 seasons after an ATR.
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Affiliation(s)
- Alberto Grassi
- 2nd Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Silvio Caravelli
- 2nd Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Mario Fuiano
- 2nd Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pieter D'Hooghe
- Department of Orthopaedic Surgery and Sports Medicine, Aspetar Hospital, Doha, Qatar ; and
| | - Matteo Filippini
- 2nd Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Massimiliano Mosca
- 2nd Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Clinic of Orthopaedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Ji Y, Xu R, Zuo H, Wang Z, Jin H. Biomechanics Analysis of the Lower Limbs in 20 Male Sprinters Using the International Society of Biomechanics Six-Degrees-of-Freedom Model and the Conventional Gait Model. Med Sci Monit 2021; 27:e933204. [PMID: 34824191 PMCID: PMC8631367 DOI: 10.12659/msm.933204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 08/17/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This biomechanics study of the lower limbs aimed to compare the use of the International Society of Biomechanics Six-Degrees-of-Freedom (ISB-6DOF) model and the conventional gait model (CGM), formerly known as the Helen Hayes model, in 20 male sprinters who habitually used the forefoot (FF) or rearfoot (RF) strike modes. MATERIAL AND METHODS We used a motion capture system to compare the difference in lower-extremity joint mechanics between sprinters' forefoot or rearfoot strike mode during unplanned sidestepping (UPSS). Twenty elite sprinters participated in a motion capture test under 2 models. Each of the 10 participants were classified as having a habitual forefoot strike mode or rearfoot strike mode during unplanned sidestepping. Joint mechanics and gait parameters were calculated according to the designed movement. RESULTS Comparison of the 2 models showed that the knee joint angles were inconsistent (P<0.05), highlighting the difficulty of the Helen Hayes model in anatomical recognition. The results of the 2 models show that during the unplanned sidestepping, the sprinter using the habitual rearfoot strike mode had a greater load through the knee joint (P<0.05). Sprinters who used the habitual forefoot strike mode experienced greater load through their ankle joints (P<0.05). CONCLUSIONS The findings from this biomechanics study showed that when compared with the ISB-6DoF model, the findings from the CGM were more reproducible for the evaluation of FF and RF strike during unplanned sidestepping.
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Affiliation(s)
- Youbo Ji
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Rui Xu
- Department of Endocrinology, Shanghai National Research Center for Endocrine and Metabolic Disease, State Key Laboratory of Medical Genomics, Shanghai Institute for Endocrine and Metabolic Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
- Norman Bethune Health Science Center of Jilin University, Changchun, Jilin, PR China
| | - Hao Zuo
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin, PR China
| | - Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, Jilin, PR China
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30
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Schultz BJ, Thomas KA, Cinque M, Harris JD, Maloney WJ, Abrams GD. Tendency of Driving to the Basket Is Associated With Increased Risk of Anterior Cruciate Ligament Tears in National Basketball Association Players: A Cohort Study. Orthop J Sports Med 2021; 9:23259671211052953. [PMID: 34778484 PMCID: PMC8573492 DOI: 10.1177/23259671211052953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Driving to the basket in basketball involves acceleration, deceleration, and lateral movements, which may expose players to increased anterior cruciate ligament (ACL) injury risk. It is unknown whether players who heavily rely on driving have decreased performance on returning to play after ACL reconstruction (ACLR). Hypothesis: Players with a greater tendency to drive to the basket would be more likely to tear their ACL versus noninjured controls and would experience decreased performance when returning to play after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: Season-level performance statistics and ACL injuries were aggregated for National Basketball Association (NBA) seasons between 1980 and 2017 from publicly available sources. Players’ tendency to drive was calculated using 49 common season-level performance metrics. Each ACL-injured player was matched with 2 noninjured control players by age, league experience, and style of play metrics. Points, playing minutes, driving, and 3-point shooting tendencies were compared between players with ACL injuries and matched controls. Independent-samples t test was utilized for comparisons. Results: Of 86 players with a total of 96 ACL tears identified in the NBA, 50 players were included in the final analysis. Players who experienced an ACL tear had a higher career-average drive tendency than controls (P = .047). Players with career-average drive tendency ≥1 standard deviation above the mean were more likely to tear their ACL than players with drive tendency <1 standard deviation (5.2% vs 2.7%; P = .026). There was no significant difference in total postinjury career points (P = .164) or career minutes (P = .237) between cases and controls. There was also no significant change in drive tendency (P = .152) or 3-point shooting tendency (P = .508) after return to sport compared with controls. Conclusion: NBA players with increased drive tendency were more likely to tear their ACL. However, players who were able to return after ACLR did not underperform compared with controls and did not alter their style of play compared with the normal changes seen with age. This information can be used to target players with certain playing styles for ACL injury prevention programs.
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Affiliation(s)
- Blake J Schultz
- Department of Orthopaedics, Stanford University, Redwood City, California, USA
| | - Kevin A Thomas
- Department of Orthopaedics, Stanford University, Redwood City, California, USA
| | - Mark Cinque
- Department of Orthopaedics, Stanford University, Redwood City, California, USA
| | - Joshua D Harris
- Houston Methodist Orthopedics & Sports Medicine, Houston, Texas, USA
| | - William J Maloney
- Department of Orthopaedics, Stanford University, Redwood City, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedics, Stanford University, Redwood City, California, USA.,Investigation performed at Stanford University, Redwood City, California, USA
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Anterior Cruciate Ligament Reconstruction Does Not Impact Career Earnings After Return to Play in National Basketball Association Athletes. Arthrosc Sports Med Rehabil 2021; 3:e1491-e1497. [PMID: 34712986 PMCID: PMC8527322 DOI: 10.1016/j.asmr.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/05/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To quantify the financial impact of an anterior cruciate ligament (ACL) injury on the remaining career earnings of National Basketball Association (NBA) players. Methods We performed a retrospective review of all NBA players who had an ACL rupture between 2000 and 2019. Players were matched to healthy controls by age, position, body mass index, and player efficiency rating at the time of injury (index year). Player information collected included demographic information, position, team role, draft pick, date of injury, contract length, and earnings during the 3 years before and 7 years after the index year, as well as new contract length and earnings after injury. Results A total of 12 players (22%) did not return to play (RTP). No statistically significant difference in annual earnings was present at any time point between cohorts. When we examined the mean difference in earnings between the first 3 post-index seasons and the 3 pre-index seasons, both the ACL and control cohorts showed increased salaries as players’ careers progressed, without a significant difference in earnings. When comparing cohorts, we found no significant difference in the length and earnings of contracts during the index year. Furthermore, there was no significant difference in the length or earnings of the first new contract signed after the index year between cohorts. Additionally, NBA players who were able to RTP after ACL reconstruction were more likely to experience increased earnings if they had greater experience and performance prior to their injury (P < .01). Conclusions Our study found that NBA players did not experience diminished earnings after RTP from an ACL reconstruction when compared with matched controls. Furthermore, no differences were seen in lengths of new contracts or in contract earnings between cohorts. Players with greater experience and performance prior to injury were more likely to have increased earnings after ACL reconstruction. Level of Evidence Level III, retrospective case-control study.
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Hodgens BH, Geller JS, Rizzo MG, Munoz J, Kaplan J, Aiyer A. Performance Outcomes After Surgical Repair of Achilles Tendon Rupture in the Women's National Basketball Association. Orthop J Sports Med 2021; 9:23259671211030473. [PMID: 34527757 PMCID: PMC8436311 DOI: 10.1177/23259671211030473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Achilles tendon ruptures are devastating in elite athletes. There are currently no studies examining the effects of Achilles tendon rupture on performance outcomes in the Women’s National Basketball Association (WNBA). Hypothesis: Athletes in the WNBA who sustained an Achilles tendon rupture and underwent subsequent surgical repair will sustain declines in performance metrics when compared with their preinjury statistics and matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Seventeen WNBA players who sustained an Achilles tendon rupture from 2000 to 2019 were identified through publicly available injury reports and player profiles. Athlete information collected included age, body mass index, position, and service in the WNBA when the tear occurred. Statistics were collected for 1 season before and 2 seasons after the injury, and the player efficiency rating (PER) was calculated. Players were matched to uninjured controls by service in the WNBA, position, and performance statistics. Results: On average, players were 28 years of age at the time of Achilles tendon rupture, with a service time in the WNBA of 6.5 years. Four players never returned to play in the WNBA, while 7 players failed to play more than 1 season. Players who did return played significantly fewer minutes per game compared with preinjury in both postinjury seasons 1 and 2 (mean difference, –6.11 and –6.54 min/game, respectively; P < .01 for both) and had a significantly decreased PER in postinjury season 2 (mean difference, –2.53; P = .024). After returning to play, the injured players experienced significant decreases when compared with controls in field goals (–0.85 vs +0.20; P = .047), free throws (–1.04 vs +0.12; P < .01), steals (–0.48 vs +0.24; P = .018), and points scored (–2.89 vs +0.58; P = .014). Conclusion: WNBA players experienced significant decreases in performance metrics after Achilles tendon rupture compared with their preinjury levels and compared with uninjured controls. Overall, 23.5% of players failed to return to the WNBA, while 41.2% failed to play for more than 1 season.
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Affiliation(s)
- Blake H Hodgens
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph S Geller
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Michael G Rizzo
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Julianne Munoz
- University of Miami Sports Medicine Institute, Miami, Florida, USA
| | | | - Amiethab Aiyer
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
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Saxena A, Maffulli N, Jin A, Isa E, Arthur WP, Asthana S. Acute Achilles Tendon Rupture Repair in Athletically Active Patients: Results on 188 Tendons. J Foot Ankle Surg 2021; 60:935-940. [PMID: 33947591 DOI: 10.1053/j.jfas.2021.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 02/03/2023]
Abstract
We report on the outcome of acute Achilles tendon ruptures by a single surgeon using open and percutaneous techniques was performed. This prospective study included 186 patients with 188 ruptured Achilles tendons. A traditional open technique was primarily performed on patients from January 2001 to December 2011. From January 2012 to January 2018, a percutaneous repair was primarily performed. Outcome measures included the Roles and Maudsley (RM) score, ability to perform a single leg heel raise, calf atrophy and return to activity. There were 149 males (average age 42.5 ± 12.7 years) and 39 females (average age 41.7 ± 11.4 years). Of the 188 ruptured tendons (92 repairs on the right Achilles and 96 on the left), 103 were repaired percutaneously and 85 had open repairs. There were 18 (9.6%) complications. Three re-ruptures occurred, one following open and two following percutaneous repairs, all within 12 weeks of the original repair. Two patients developed a Venousthromboembolism (1.0%). Thirteen patients had suture reactions; three infections (1.6%), 11 wound complications (5.8%), and 3 required surgical excision of the suture material (1.6%). Non-absorbable sutures were associated with more wound complications and were more frequently used in open repairs (p = .003). Patients who underwent open repair experienced more wound complications (p = .0001). Patients who underwent percutaneous repair using absorbable suture experienced a lower rate of overall complications (p = .0007). Basketball (n = 29) was the most common sport during which ruptures occurred. Return to activity (RTA) was 8.2 ± 2.9 months. There was no difference for RTA between males and females (p = .54) and RM scores (p= .69), nor surgical technique, and no difference for RTA based on the desired activity (p = .47). 123 of the 188 patients returned to their desired activity (65.5%). There was a statistically significant evidence of a positive association between inability to perform heel-raises and decreased activity (p = .01).
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Affiliation(s)
- Amol Saxena
- Department of Sports Medicine, Sutter-PAMF, Palo Alto, CA.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine, Surgery and Dentistry, Salerno, Italy; Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK; School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
| | - Anqi Jin
- PAMF Research Institute, Researcher, Palo Alto, CA
| | | | | | - Saumya Asthana
- Rosalind Franklin University, Scholl College, Chicago IL
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Forlenza EM, Lavoie-Gagne OZ, Lu Y, Diaz CC, Chahla J, Forsythe B. Return to Play and Player Performance After Achilles Tendon Rupture in UEFA Professional Soccer Players: A Matched-Cohort Analysis of Players From 1999 to 2018. Orthop J Sports Med 2021; 9:23259671211024199. [PMID: 35146029 PMCID: PMC8822021 DOI: 10.1177/23259671211024199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 02/03/2023] Open
Abstract
Background: Achilles tendon rupture (ATR) is a potentially career-ending injury in professional athletes. Limited information exists regarding return to play (RTP) in professional soccer players after this injury. Purpose: To determine the RTP rate and time in professional soccer players after ATR and to evaluate player performance relative to matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 132 professional soccer players who suffered an ATR between 1999 and 2018. These athletes were matched 2:1 to uninjured controls by position, age, season of injury, seasons played, and height. We collected information on the date of injury, the date of RTP, and player performance metrics (minutes played, games played, goals scored, assists made, and points per game) from official team websites, public injury reports, and press releases. Changes in performance metrics for the 4 years after the season of injury were compared with metrics 1 season before injury. Univariate comparisons were performed using independent-sample, 2-group t tests and Wilcoxon rank-sum tests when normality of distributions was violated. Results: The mean age at ATR was 27.49 ± 4.06 years, and the mean time to RTP was 5.07 ± 2.61 months (18.19 ± 10.96 games). The RTP rate was 71% for the season after injury and 78% for return at any timepoint. Overall, 9% of the injured players experienced a rerupture during the study period. Compared with controls, the injured players played significantly less (-6.77 vs -1.81 games [P < .001] and -560.17 vs -171.17 minutes [P < .05]) and recorded fewer goals (-1.06 vs -0.29 [P < .05]) and assists (-0.76 vs -0.02 [P < .05]) during the season of their Achilles rupture. With the exception of midfielders, there were no significant differences in play time or performance metrics between injured and uninjured players at any postinjury timepoint. Conclusion: Soccer players who suffered an ATR had a 78% RTP rate, with a mean RTP time of 5 months. Injured players played less and demonstrated inferior performance during the season of injury. With the exception of midfielders, players displayed no significant differences in play time or performance during any of the 4 postinjury seasons.
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Affiliation(s)
- Enrico M Forlenza
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ophelie Z Lavoie-Gagne
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Connor C Diaz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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Chauhan A, Stotts J, Ayeni OR, Khan M. Return to play, performance, and value of National Basketball Association players following Achilles tendon rupture. PHYSICIAN SPORTSMED 2021; 49:271-277. [PMID: 34010095 DOI: 10.1080/00913847.2021.1932634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Achilles tendon ruptures are devastating injuries for National Basketball Association (NBA) players: prior studies have demonstrated decreased performance following return-to-play, but none have evaluated the effect of injury on rate-adjusted contextual statistics to assess the true change in performance. Additionally, there exists a paucity of data on the independent impact on defensive performance following return.Hypothesis: Compared to both control-matched peers and preoperative careers, we hypothesize that player production based on rate-adjusted contextual statistics will significantly decline following Achilles tendon rupture.Study design: Retrospective Cohort StudyMethods: Publicly available NBA injury data on Achilles tendon rupture were reviewed from the 1996 -1997 to the 2016-2017 seasons. Controls were matched based on height, position, age, and rate-adjusted statistics. Extracted data included Value over Replacement Player Rating, Box Plus-Minus, Win Shares, offensive rating, defensive rating, and time to return-to-play, and was collected for the season before and two seasons following injury.Results: Twenty-five NBA players with surgically treated complete Achilles ruptures met inclusion and exclusion criteria. The return-to-play rate from Achilles tendon ruptures from 1996-1997 to 2016-2017 was 80%, with a mean recovery period of 311.0 ± 100.9 days. After 2 years, performance significantly declined for Value over Replacement Player Rating, Box Plus-Minus, and offensive rating compared to controls and cases. However, there was no significant effect on defensive rating (P = 0.38). After two seasons, returning players had a Value over Replacement Player Rating that was 24.1% below pre-injury levels, contributed 1.4 fewer points per 100 possessions by Box Plus-Minus, and yielded 2.4 fewer wins by Win Shares.Conclusions: Achilles tendon rupture results in significant decreases in offensive production and career longevity. The injury does not have a significant impact on defensive production.Clinical relevance: Achilles tendon ruptures significantly affect basketball players ability to return-to-play, and their in-game performance.Level of evidence: 3.
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Affiliation(s)
- Avinash Chauhan
- Division of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Jeff Stotts
- Department of Athletic Training, St Vincent Health System, Little Rock, Arkansas, United States
| | - Olufemi R Ayeni
- Division of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Moin Khan
- Division of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada
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Bodendorfer BM, DeFroda SF, Shu HT, Knapik DM, Yang DS, Verma NN. Incidence of Pectoralis Major Injuries Has Increased 40% Over the Last 22 National Football League Seasons. Arthrosc Sports Med Rehabil 2021; 3:e1113-e1118. [PMID: 34430891 PMCID: PMC8365205 DOI: 10.1016/j.asmr.2021.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To examine trends in the incidence of pectoralis major (PM) injuries over the last 22 National Football League (NFL) seasons and identify risk factors for injuries requiring operative management. Methods Publicly available data from the 1998-1999 through 2019-2020 NFL seasons were reviewed to identify PM injuries, demographics, injury mechanisms, and management. Injury incidence was calculated using linear regression per 10,000 athlete-exposures, while risk factors for operative management were identified through multivariate logistic regression. Results There were 258 PM injuries. Mean athlete age at the time of injury was 27.1 years (range: 21-37) with a mean body mass index of 32.6 (range: 24.8-43.1). Overall incidence was 0.603 per 10,000 athlete-exposures, which was found to significantly increase with time by 0.039 per athlete-exposures per year (R2 = .787, P < .001). Defensive athletes accounted for 64.7% of PM injuries. Repair was performed in 48.8% of athletes, with defensive linemen (odds ratio [OR] 3.78, CI 1.42-10.60, P = .009), defensive backs (OR 12.20, CI 2.13-76.60, P = .006), linebackers (OR 8.98, CI 2.58-33.60, P < .001), more recent time of injury (OR 1.11, CI 1.05-1.17, P < .001), and shorter NFL experience (OR .77 for older athletes, CI .59-.99), P = .047) at significant risk for operative treatment. Conclusion A total of 258 PM injuries were identified over 22 NFL seasons, with an overall incidence of 0.603 per 10,000 athlete-exposures, which was found to increase by 0.039 injuries per 10,000 athlete-exposures per year. Repair was performed in 48.8% of athletes, with more recent time of injury, shorter NFL experience, defensive linemen, defensive backs and linebackers at significantly higher risk for operative treatment. Study Design Cohort study; Level of evidence, 3
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Affiliation(s)
| | | | - Henry T Shu
- School of Medicine, The Johns Hopkins University, Baltimore, Maryland, U.S.A
| | | | - Daniel S Yang
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, U.S.A
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Bodendorfer BM, DeFroda SF, Shu HT, Knapik DM, Yang DS, Verma NN. Performance and Survivorship of National Football League Players with Pectoralis Major Injuries. Arthrosc Sports Med Rehabil 2021; 3:e1097-e1104. [PMID: 34430889 PMCID: PMC8365217 DOI: 10.1016/j.asmr.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/30/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this study was to determine return-to-play (RTP), performance and career survivorship for National Football League (NFL) athletes sustaining pectoralis major (PM) injuries with comparison among grades of injury and between nonoperative and operative management. METHODS Publicly available data from the 1998-2020 NFL seasons were reviewed to identify athletes with PM injuries. Athlete characteristics were collected 1 season before and 2 seasons after injury. Percent of total games played in a season, player efficiency rating (PER), and Pro Football Focus (PFF) grades were compared for the preinjury season and 2 postinjury seasons. Kaplan-Meier survivorship plots were computed for RTP and postinjury career length, whereas a log-rank test was used to compare survivorship differences. RESULTS In total, 258 PM injuries were reported at a mean age of 27.1 ± 3.3 years. A total of 126 surgical repairs occurred in 48.8% (n = 126) of injuries, with athletes undergoing repair possessing a lower RTP rate and longer time to RTP compared to athletes treated conservatively (P < .001). Survival analysis revealed shorter career length for athletes sustaining PM tears compared to strains (P < .001), although no difference in career length was appreciated on the basis of injury management (P = .980). Defensive linemen and wide receivers had lower PER during their second postinjury seasons (P = .019 and .030, respectively), whereas defensive linemen had lower PFF grades during their second post-injury seasons (P = .044). CONCLUSION NFL athletes requiring PM repair may experience a lower likelihood of RTP, and longer RTP timing, likely because of higher-grade injuries. Defensive linemen and wide receivers experiencing PM injuries are at risk for diminished performance post-injury. Career length does not appear to be affected based on injury management. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
| | | | - Henry T. Shu
- School of Medicine, The Johns Hopkins University, Baltimore, MD
| | | | - Daniel S. Yang
- Warren Alpert Medical School, Brown University, Providence, RI
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Abstract
Although the safety of contact sports has improved over the years, participation in any sport always carries a risk of injury. When cervical or lumbar spine injuries do occur, prompt diagnosis is essential, and athletes must be held out of the sport if indicated to prevent further harm and allow for recovery. This article highlights some of the most common cervical spine pathologies (stinger/burners, strain, stenosis/cord neuropraxia, disc herniation, and fracture/instability) and lumbar spine pathologies (strain, disc degeneration, disc herniation, fracture, spondylolysis/spondylolisthesis, and scoliosis) encountered in sports and reviews the associated return to play guidelines and expectations for each condition.
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Sanchez R, Hodgens BH, Geller JS, Huntley S, Kaplan J, Aiyer A. Effect of Achilles Tendon Repair on Performance Outcomes After Return to Play in National Collegiate Athletic Association Division I Basketball Athletes. Orthop J Sports Med 2021; 9:23259671211015239. [PMID: 34262980 PMCID: PMC8246508 DOI: 10.1177/23259671211015239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Achilles tendon (AT) ruptures are devastating injuries that are highly prevalent among athletes. Despite our understanding of the effect of AT rupture and in particular its relationship to basketball, no study has examined the effects of AT rupture and repair on performance metrics in collegiate basketball players. Purpose: To evaluate the effect of AT rupture and subsequent surgical repair on performance metrics in National Collegiate Athletic Association (NCAA) Division I basketball players who return to play after injury. Study Design: Descriptive epidemiology study. Methods: NCAA Division I basketball players who sustained an AT rupture and underwent subsequent surgical repair between 2000 and 2019 were identified by systematically evaluating individual injury reports from databases comprising NCAA career statistics and individual school statistics; 65 male and 41 female players were identified. Athletes were included if they participated in at least one-half of the games of 1 collegiate season before tearing the AT and at least 1 season after operative repair. A total of 50 male and 30 female athletes were included. Each injured athlete was matched to a healthy control by conference, position, starter status at time of injury, class year, and number of games played. Matched controls were healthy players and experienced no significant injuries during their NCAA careers. Results: After AT repair, male athletes had significantly more minutes per game, points per game, and compared with before injury. Total blocks significantly decreased after injury. Female athletes scored significantly more points per game but demonstrated a significantly lower 3-point shooting percentage after return to play. Despite undergoing AT rupture and repair, 14% of male players played in the National Basketball Association, and 20% of injured female athletes played in the Women’s National Basketball Association. Conclusion: After returning to play, men demonstrated a significant drop-off in performance only in regard to total blocks. Female athletes after AT repair demonstrated a significant improvement in points per game but had a significant drop-off in 3-point shooting percentage.
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Affiliation(s)
- Rafael Sanchez
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Blake H Hodgens
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Joseph S Geller
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Samuel Huntley
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | | | - Amiethab Aiyer
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
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Johns W, Walley KC, Seedat R, Thordarson DB, Jackson B, Gonzalez T. Career Outlook and Performance of Professional Athletes After Achilles Tendon Rupture: A Systematic Review. Foot Ankle Int 2021; 42:495-509. [PMID: 33218267 DOI: 10.1177/1071100720969633] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this systematic review is to examine the literature on Achilles tendon (AT) injuries in professional athletes to determine their rate of return to play (RTP), performance, and career outcome after AT rupture. METHODS A literature search of MEDLINE, Google Scholar, CINAHL, and Cochrane Library databases was performed. Included studies reported outcomes related to RTP (time and rate), durability and player participation, and player performance following AT rupture in professional athletes of the National Football League (NFL), National Basketball Association (NBA), Major League Baseball (MLB), and professional soccer leagues. RESULTS Fifteen studies met inclusion criteria for analysis. Athletes were able to return to professional sport participation 76% of the time, with mean time to RTP of 11 months following AT injury. Athletes experienced a decline in player efficiency ratings, power ratings, and sport- and position-specific statistics in the NFL, NBA, and professional soccer leagues compared to noninjured controls. RTP rate was significantly lower following AT rupture in comparison to athletes sustaining other common orthopedic injuries such as anterior cruciate ligament injuries, meniscal tears, and ankle fractures in both NFL and NBA athletes. CONCLUSION AT rupture prohibits nearly 25% of professional athletes from returning to their respective sport. Of those able to return to compete at a professional level, the mean time to RTP is 11 months-nearly double the estimated 6-month recovery for RTP in the general population. Furthermore, player performance and durability were curtailed following AT rupture. This review of the literature should be used to set evidence-based goals and establish realistic expectations for RTP for elite athletes following AT injuries. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- William Johns
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Raees Seedat
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Ben Jackson
- School of Medicine, University of South Carolina, Columbia, SC, USA
| | - Tyler Gonzalez
- School of Medicine, University of South Carolina, Columbia, SC, USA
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Leek CC, Soulas JM, Sullivan AL, Killian ML. Using tools in mechanobiology to repair tendons. ACTA ACUST UNITED AC 2021; 1:31-40. [PMID: 33585822 DOI: 10.1007/s43152-020-00005-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of review The purpose of this review is to describe the mechanobiological mechanisms of tendon repair as well as outline current and emerging tools in mechanobiology that might be useful for improving tendon healing and regeneration. Over 30 million musculoskeletal injuries are reported in the US per year and nearly 50% involve soft tissue injuries to tendons and ligaments. Yet current therapeutic strategies for treating tendon injuries are not always successful in regenerating and returning function of the healing tendon. Recent findings The use of rehabilitative strategies to control the motion and transmission of mechanical loads to repairing tendons following surgical reattachment is beneficial for some, but not all, tendon repairs. Scaffolds that are designed to recapitulate properties of developing tissues show potential to guide the mechanical and biological healing of tendon following rupture. The incorporation of biomaterials to control alignment and reintegration, as well as promote scar-less healing, are also promising. Improving our understanding of damage thresholds for resident cells and how these cells respond to bioelectrical cues may offer promising steps forward in the field of tendon regeneration. Summary The field of orthopaedics continues to advance and improve with the development of regenerative approaches for musculoskeletal injuries, especially for tendon, and deeper exploration in this area will lead to improved clinical outcomes.
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Affiliation(s)
- Connor C Leek
- College of Engineering, Department of Biomedical Engineering, 5 Innovation Way, Suite 200, University of Delaware, Newark, Delaware 19716
| | - Jaclyn M Soulas
- College of Engineering, Department of Biomedical Engineering, 5 Innovation Way, Suite 200, University of Delaware, Newark, Delaware 19716.,College of Agriculture and Natural Resources, Department of Animal Biosciences, 531 South College Avenue, University of Delaware, Newark, Delaware 19716
| | - Anna Lia Sullivan
- College of Engineering, Department of Biomedical Engineering, 5 Innovation Way, Suite 200, University of Delaware, Newark, Delaware 19716.,College of Agriculture and Natural Resources, Department of Animal Biosciences, 531 South College Avenue, University of Delaware, Newark, Delaware 19716
| | - Megan L Killian
- College of Engineering, Department of Biomedical Engineering, 5 Innovation Way, Suite 200, University of Delaware, Newark, Delaware 19716.,College of Medicine, Department of Orthopaedic Surgery, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, Michigan 48109
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Tramer JS, Khalil LS, Buckley P, Ziedas A, Kolowich PA, Okoroha KR. Effect of Achilles Tendon Rupture on Player Performance and Longevity in Women's National Basketball Association Players. Orthop J Sports Med 2021; 9:2325967121989982. [PMID: 34104656 PMCID: PMC8172334 DOI: 10.1177/2325967121989982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/04/2020] [Indexed: 11/16/2022] Open
Abstract
Background Women's National Basketball Association (WNBA) players have a greater incidence of lower extremity injury compared with male players, yet no data exist on functional outcomes after Achilles tendon rupture (ATR). Purpose To evaluate the effect of Achilles tendon repair on game utilization, player performance, and career longevity in WNBA athletes. Study Design Cohort study; Level of evidence, 3. Methods WNBA players from 1997 to 2019 with a history of ATR (n = 12) were matched 1:2 to a healthy control group. Player characteristics, game utilization, and in-game performance data were collected for each athlete, from which the player efficiency rating (PER) was calculated. Statistical analysis was performed comparing postinjury data to preinjury baseline as well as cumulative career data. Changes at each time point relative to the preinjury baseline were also compared between groups. Results Of the 12 players with ATR, 10 (83.3%) returned to play at the WNBA level at a mean (±SD) of 12.5 ± 3.3 months. Four players participated in only 1 WNBA season after injury. There were no differences in characteristics between the 10 players who returned to play after injury and the control group. After return to play, the WNBA players demonstrated a significant decrease in game utilization compared with preinjury, playing in 6.0 ± 6.9 fewer games, starting in 12.7 ± 15.4 fewer games, and playing 10.2 ± 9.1 fewer minutes per game (P < .05 for all). After the index date of injury, the players with Achilles repair played 2.1 ± 1.2 more years in the WNBA, while control players played 5.35 ± 3.2 years (P < .01) Additionally, the players with Achilles repair had a significant decrease in PER in the year after injury compared with preinjury (7.1 ± 5.3 vs 11.0 ± 4.4; P = .02). The reduction in game utilization and decrease in PER in these players was maintained when compared with the matched controls (P < .05 for both). Conclusion The majority of WNBA players who sustained ATR were able to return to sport after their injury; however, their career longevity was shorter than that of healthy controls. There was a significant decrease in game utilization and performance in the year after return to play compared with healthy controls.
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Affiliation(s)
- Joseph S Tramer
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Lafi S Khalil
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Patrick Buckley
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Alexander Ziedas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Patricia A Kolowich
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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DeFroda SF, Patel DD, Milner J, Yang DS, Owens BD. Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. Orthop J Sports Med 2021; 9:2325967120981649. [PMID: 33738307 PMCID: PMC7934048 DOI: 10.1177/2325967120981649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) injury in National Basketball Association (NBA) players can have a significant impact on player longevity and performance. Current literature reports a high rate of return to play, but there are limited data on performance after ACL reconstruction (ACLR). Purpose/Hypothesis: To determine return to play and player performance in the first and second seasons after ACLR in NBA players. We hypothesized that players would return at a high rate. However, we also hypothesized that performance in the first season after ACLR would be worse as compared with the preinjury performance, with a return to baseline by postoperative year 2. Study Design: Case series; Level of evidence, 4. Methods: An online database of NBA athlete injuries between 2010 and 2019 was queried using the term ACL reconstruction. For the included players, the following data were recorded: name; age at injury; position; height, weight, and body mass index; handedness; NBA experience; dates of injury, surgery, and return; knee affected; and postoperative seasons played. Regular season statistics for 1 preinjury season and 2 postoperative seasons were compiled and included games started and played, minutes played, and player efficiency rating. Kaplan-Meier survivorship plots were computed for athlete return-to-play and retirement endpoints. Results: A total of 26 athletes underwent ACLR; of these, 84% (95% CI, 63.9%-95.5%) returned to play at a mean 372.5 days (95% CI, 323.5-421.5 days) after surgery. Career length after injury was a mean of 3.36 seasons (95% CI, 2.27-4.45 seasons). Factors that contributed to an increased probability of return to play included younger age at injury (odds ratio, 0.71 [95% CI, 0.47-0.92]; P = .0337) and fewer years of experience in the NBA before injury (odds ratio, 0.70 [95% CI, 0.45-0.93]; P = .0335). Postoperatively, athletes played a significantly lower percentage of total games in the first season (48.4%; P = .0004) and second season (62.1%; P = .0067) as compared with the preinjury season (78.5%). Player efficiency rating in the first season was 19.3% less than that in the preinjury season (P = .0056). Performance in the second postoperative season was not significantly different versus preinjury. Conclusion: NBA players have a high rate of RTP after ACLR. However, it may take longer than a single season for elite NBA athletes to return to their full preinjury performance. Younger players and those with less NBA experience returned at higher rates.
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Affiliation(s)
- Steven F DeFroda
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Devan D Patel
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - John Milner
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Daniel S Yang
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Brett D Owens
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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Allahabadi S, Su F, Lansdown DA. Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players. Orthop J Sports Med 2021; 9:2325967120982076. [PMID: 33623799 PMCID: PMC7878958 DOI: 10.1177/2325967120982076] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 08/31/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Athletes in the Women’s National Basketball Association (WNBA) and National Basketball Association (NBA) are subject to high injury rates given the physical demands of the sport. Comprehensive data regarding injury patterns and rates in these athletes are limited. Purpose: To summarize available data on orthopaedic and sports medicine–related injuries through 2020 in professional female and male basketball players. Study Design: Systematic review; Level of evidence, 4. Methods: A search was conducted using PubMed and Embase through April 5, 2020, to identify injury studies regarding WNBA and NBA players. Studies were included if the injury or surgery was considered a direct consequence of game play including musculoskeletal/orthopaedic, concussion, ophthalmologic, and craniomaxillofacial injuries. Systematic reviews, screening studies, or studies without sufficient WNBA or NBA player subgroup analysis were excluded. Results: A total of 49 studies met inclusion criteria, 43 (87.8%) of which detailed musculoskeletal injuries. The lower extremity represented 63.3% of studies. A majority (59.2%) of studies were level 4 evidence. The source of data was primarily comprehensive online search (n = 33; 67.3%), followed by official databases (n = 11; 22.4%). Only 3 studies concerned WNBA athletes compared with 47 that concerned NBA athletes. The lowest return-to-play rates were cited for Achilles tendon repairs (61.0%-79.5%). Variability in return-to-play rates existed among studies even with similar seasons studied. Conclusion: The majority of literature available on orthopaedic and sports medicine–related injuries of NBA and WNBA athletes is on the lower extremity. The injuries that had the greatest effect on return to play and performance were Achilles tendon ruptures and knee cartilage injuries treated using microfracture. The reported outcomes are limited by heterogeneity and overlapping injury studies. There are limited available data on WNBA injuries specifically.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Favian Su
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Sheu C, Ferkel RD. Athletic Performance in the National Basketball Association After Arthroscopic Debridement of Osteochondral Lesions of the Talus. Orthop J Sports Med 2021; 9:2325967120970205. [PMID: 33457433 PMCID: PMC7802091 DOI: 10.1177/2325967120970205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/01/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Use of marrow-stimulating techniques to treat osteochondral lesions of the
talus (OLTs) in National Basketball Association (NBA) players is
controversial. Hypothesis: NBA players will be able to return to preinjury playing status after
treatment of OLTs by arthroscopic debridement alone without
marrow-stimulating techniques. Study Design: Cohort study; Level of evidence, 3. Methods: Between the 2000 and 2015 seasons, 10 NBA players were treated with
arthroscopic debridement of an OLT. The following performance outcomes were
compared pre- and postoperatively: seasons played, games played, games
started, minutes per game, points per game, field goals, 3-point shots,
rebounds, assists, double doubles, triple doubles, steals, blocks,
turnovers, personal fouls, assists per turnovers, steals per turnovers, NBA
rating, scoring efficiency, and shooting efficiency. In addition, the
players were compared with a matched control group using mixed effects
regression and Fisher least significant difference modeling. Results: All 10 players returned to play in the NBA after arthroscopic debridement
without microfracture or drilling of an OLT. When compared with preoperative
performance, postoperative mean points scored, assists made, and steals made
increased by 2.86 (P = .042), 0.61 (P =
.049), and 0.15 (P = .027), respectively. Only field goal
percentage decreased postoperatively when compared with matched controls;
however, this normalized by the end of the second season after surgery.
There was no statistically significant change in any of the other
performance factors when compared with matched controls. All patients
returned to basketball during the same season (n = 1) or the following
season (n = 9) if the operation was performed off-season. The mean length of
career after surgery was 4.1 years, with 5 players still playing in the
league at the time of this study. Conclusion: After arthroscopic debridement of an OLT without drilling or microfracture,
there was a high rate of return to the NBA, with improved points scored,
assists, and steals made after surgery when compared with preoperative
performance. There was no statistically significant change in any
performance factors when compared with uninjured matched controls. Lesion
size did not affect player career length. These data should be used to
manage patients’ and teams’ expectations regarding players’ ability to
return to elite levels of athletic performance after surgery of an OLT.
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Affiliation(s)
| | - Richard D Ferkel
- Southern California Orthopedic Institute, Van Nuys, California, USA
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Allahabadi S, Amendola A, Lau BC. Optimizing Return to Play for Common and Controversial Foot and Ankle Sports Injuries. JBJS Rev 2020; 8:e20.00067. [PMID: 33405494 DOI: 10.2106/jbjs.rvw.20.00067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
» Surgical decision-making should consider factors to help optimize return to play for athletes with foot and ankle injuries, including injuries to the syndesmosis, the Achilles tendon, the fifth metatarsal, and the Lisfranc complex. Understanding influential factors on return to play may help orthopaedic surgeons counsel athletes and coaches on expectations for a timeline to return to play and performance metrics. » Outcomes after rigid and flexible fixation for syndesmotic injuries are generally favorable. Some data support an earlier return to sport and higher functional scores with flexible fixation, in addition to lower rates of reoperation and a decreased incidence of malreduction, particularly with deltoid repair, if indicated. » Minimally invasive techniques for Achilles tendon repair have been shown to have a decreased risk of wound complications. Athletes undergoing Achilles repair should expect to miss a full season of play to recover. » Athletes with fifth metatarsal fractures have better return-to-play outcomes with surgical management and can expect a high return-to-play rate within approximately 3 months of surgery. » Percutaneous treatment of Lisfranc injuries may expedite return to play relative to open procedures.
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Affiliation(s)
- Sachin Allahabadi
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California
| | - Annunziato Amendola
- Duke Sport Science Institute, Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Brian C Lau
- Duke Sport Science Institute, Division of Sports Medicine, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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THE GAP BETWEEN RESEARCH AND CLINICAL PRACTICE FOR INJURY PREVENTION IN ELITE SPORT: A CLINICAL COMMENTARY. Int J Sports Phys Ther 2020; 15:1229-1234. [PMID: 33344038 DOI: 10.26603/ijspt20201229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
As clinicians strive to apply evidence-based principles, team-based practitioners have identified a large gap as it relates to published research, ideal applications of evidence-based practice, and actual clinical practice related to injury prevention in elite sport within the United States. For rehabilitation professionals, especially those intimately involved in the research of injury prevention, the solution often seems quite clear and defined. However, preventing injury by implementing the latest recommendation from the most recent prospective study on the using the FIFA 11 + warm-up, a Copenhagen Adduction exercise, or a plyometric drill with elite athletes may not be as effective as was seen among the cohort used in the study. In addition to extrapolating research, clinicians face additional challenges such as variance among professions, schedule density, and off-season contacts with athletes. There is an inherent difficulty in the application of research to practice in elite sport as it relies on the teamwork of not only the practitioner and athlete, but the entire sporting organizational structure and those involved in athlete participation. The purpose of this clinical commentary is to explore the difficulty with application of research in clinical practice and to discuss potential strategies for improving carry over from research to clinical practice.
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48
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Khalil LS, Jildeh TR, Tramer JS, Abbas MJ, Hessburg L, Mehran N, Okoroha KR. Effect of Achilles Tendon Rupture on Player Performance and Longevity in National Basketball Association Players. Orthop J Sports Med 2020; 8:2325967120966041. [PMID: 33294475 PMCID: PMC7708715 DOI: 10.1177/2325967120966041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: National Basketball Association (NBA) players who return to sport (RTS) after Achilles tendon rupture have been reported to have poor outcomes. Purpose: To evaluate the effect of Achilles tendon ruptures on player performance and career longevity in NBA athletes. Study Design: Cohort study; Level of evidence, 3. Methods: NBA players who sustained Achilles tendon ruptures between 1970 and 2019 were identified using publicly available resources and were matched 1:1 to a healthy control group by age, position, height, and body mass index. Demographic characteristics, player utilization (games and minutes), and performance efficiency rating (PER) were documented for all athletes. The season of Achilles tendon rupture was set as the index year, and statistical analysis compared postindex versus preindex data both acutely and in the long term. Percentages relative to preoperative values were calculated to compare the injured and control groups in a standardized fashion. Results: Of 47 players, 34 (72.3%) with Achilles tendon ruptures returned to play at the NBA level after surgical intervention. A total of 7 players were excluded from the study. No differences were found in demographic characteristics or PER (2 years before injury) between the remaining 27 players and matched controls. The injured players had significantly shorter careers compared with control players (3.1 ± 2.3 vs 5.8 ± 3.5 seasons, respectively; P < .05). Injured players demonstrated significant declines in games per season (GPS), minutes per game (MPG), and PER at 1 year and 3 years after RTS compared with preindex baseline (P < .05). Injured players, compared with control players, had reduced relative percentages of games started (GS) (50% vs 125%, respectively), MPG (83% vs 103%), and PER (80% vs 96%) at 1 year after return (P < .05), but reductions at extended 3-year follow-up were seen only in GPS (71% vs 91%) and GS (39% vs 99%) (P < .05). Conclusion: Our study found that 72.3% of NBA players returned to play after Achilles tendon repair, but they had shorter careers compared with uninjured controls. Players returning from Achilles tendon repairs had decreased game utilization and performance at all time points relative to their individual preindex baseline. However, for the injured players when compared with controls, game utilization but not performance was found to be decreased at 3-year follow-up.
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Affiliation(s)
- Lafi S Khalil
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joseph S Tramer
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muhammad J Abbas
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Luke Hessburg
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Nima Mehran
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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Khalil LS, Matar RN, Rahman T, Franovic S, Abbas MJ, Hessburg L, Mehran N, Okoroha KR. Effect of Workload After ACL Reconstruction on Rerupture Rates in NBA Players. Orthop J Sports Med 2020; 8:2325967120964467. [PMID: 33283004 PMCID: PMC7682245 DOI: 10.1177/2325967120964467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/11/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Rupture of the anterior cruciate ligament (ACL) is a common and potentially career-altering injury sustained by players in the National Basketball Association (NBA). Strategies have been employed by the league to prevent reinjury of players after ACL reconstruction (ACLR), including minute restrictions and rest games; however, it remains unknown whether workload metrics after ACLR influence the risk for reinjury and revision surgery. Purpose: To evaluate whether workload changes after return to play (RTP) from primary ACLR influences the risk of rerupture in NBA players. Study Design: Case-control study; Level of evidence, 3. Methods: We identified NBA players from 1975 to 2018 who underwent primary ACLR as well as those who required revision ACLR. Primary outcomes included workload measures such as games played, games started, and minutes per game. Secondary outcomes included in-game performance statistics. Statistical analysis was used to compare relative workload and performance 3 years before and 3 years after undergoing primary ACLR. Workload was also compared between the control group of NBA players who underwent primary ACLR and those who required revision ACLR. Results: A total of 68 players who underwent primary ACLR were included, 8 of whom subsequently required revision ACLR. In their first season upon RTP, control players (primary ACLR) demonstrated a significant reduction in all workload metrics relative to the season before injury (P < .001), while the revision group demonstrated an unchanged to increased workload. In a comparison between the primary and revision groups during the first season after RTP, the primary group demonstrated significantly fewer games started (mean ± SD, 22.2 ± 3.0 vs 35.8 ± 8.3; P = .039) and minutes per game (20.5 ± 1.1 vs 27.0 ± 3.1; P = .048) than revision players. The primary ACLR group demonstrated reduced cumulative workload trends for the first 3 years after RTP relative to 3 years before injury, which was not demonstrated in the revision ACLR group, albeit statistically insignificant. Conclusion: Our study found that after ACLR, a reduction in workload parameters relative to preinjury baseline was associated with players who did not sustain rerupture. Further study is required to determine if workload measures following RTP from primary ACLR should be individualized relative to preinjury baseline.
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Affiliation(s)
- Lafi S Khalil
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Robert N Matar
- University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Tahsin Rahman
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Sreten Franovic
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Muhammad J Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Luke Hessburg
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
| | - Nima Mehran
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
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50
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Patel BH, Okoroha KR, Jildeh TR, Lu Y, Baker JD, Nwachukwu BU, Foster MG, Allen AA, Forsythe B. Adductor injuries in the National Basketball Association: an analysis of return to play and player performance from 2010 to 2019. PHYSICIAN SPORTSMED 2020; 48:450-457. [PMID: 32202444 DOI: 10.1080/00913847.2020.1746978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives: 1) To evaluate return to play (RTP) timing in National Basketball Association (NBA) athletes following adductor injuries, and 2) to evaluate the effect of adductor injuries on player performance, game availability, and career longevity following RTP. Methods: Adductor injuries in NBA athletes from the 2009-2010 to 2018-2019 seasons were identified utilizing publicly available records via previously validated methodology. RTP time was calculated, and player performance and game availability were compared pre- vs. post-injury. Additionally, an injury-free control group matched for age, BMI, position, and experience was assembled to allow for comparisons in performance, availability, and career length. Results: In total, 79 adductor injuries across 65 NBA athletes were identified. The average injured player was 28.3 ± 4.0 years of age, and had 6.5 ± 4.2 seasons of NBA experience. Guards were injured more frequently than forwards or centers (49% vs 25% vs 25%, respectively). All players were able to RTP following first-time adductor injury after missing an average of 7.7 ± 9.8 games (median [IQR]: 4 [1-9]) and 16.9 ± 20.4 days (median [IQR]: 9 [3.5-20]). Twelve players (18.5%) suffered an adductor re-injury at a mean latency of 509.5 ± 503.9 days. Adductor injuries did not result in significant changes in any major statistical category (points, assists, rebounds, steals, blocks, turnovers, field goal percentage), player efficiency rating (PER), minutes/game, games/season, or a number of all-star selections (all P > 0.05) following RTP. Additionally, when compared to matched controls, no difference was found in pre- to post-injury change of PER, games/season, or minutes/game (all P > 0.05). Career longevity was not significantly different between groups (P = 0.44). Conclusion: Following adductor injury, NBA players returned to gameplay after missing an average of 16 to 17 days, or 7 to 8 games. Adductor injury did not affect player performance, nor game availability or career longevity.
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Affiliation(s)
- Bhavik H Patel
- Midwest Orthopaedics at RUSH, Rush University Medical Center , Chicago, IL, USA
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Health System , Detroit, MI, USA
| | - Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Health System , Detroit, MI, USA
| | - Yining Lu
- Midwest Orthopaedics at RUSH, Rush University Medical Center , Chicago, IL, USA
| | - James D Baker
- Midwest Orthopaedics at RUSH, Rush University Medical Center , Chicago, IL, USA
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery , New York, NY, USA
| | - Mitchell G Foster
- School of Medicine, University of California, San Diego , La Jolla, CA, USA
| | - Answorth A Allen
- Department of Orthopaedic Surgery, Hospital for Special Surgery , New York, NY, USA
| | - Brian Forsythe
- Midwest Orthopaedics at RUSH, Rush University Medical Center , Chicago, IL, USA
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