Performance After Operative Versus Nonoperative Management of Shoulder Instability in the National Basketball Association

Shoulder dislocations in professional male football (soccer): A retrospective epidemiological analysis of the German Bundesliga from season 2012/2013 until 2022/2023

PURPOSE

Injuries exert a detrimental impact on the team performance in professional football. Shoulder dislocations are known for their severity and often cause substantial lay-off times. However, there is a notable gap in the general understanding regarding the frequency and convalescence of these events in professional football. Thus, the aims of this study were (1) to determine the incidence, (2) to evaluate return to competition (RTC) and redislocation events (RDEs) and (3) to identify relevant player-, match- and injury-related parameters.

METHODS

All shoulder dislocations within the highest three German football leagues (1.-3. Bundesliga) during the seasons 2012/2013 until 2022/2023 were identified. Player-, injury- and match-related data were obtained by performing a media analysis. Data were analysed using descriptive statistics. p Value was set at 0.05.

RESULTS

A total of 90 first-time shoulder dislocations in 89 players with a median age of 25 years (interquartile range [IQR]: 23-28) were available for analysis. The incidence was 9.1 per 1000 Bundesliga matches played and increased over time. Forty-four (49%) shoulder dislocations were treated conservatively and 46 (51%) operatively. Median RTC was 24 days (IQR: 12-43) following conservative and 103 days (IQR: 85-135) following surgical treatment (p < 0.001). Twenty-two (24%) players suffered a redislocation, of whom 13 (59%) underwent initial conservative and nine (41%) initial surgical treatment (not significant [n.s.]). RDE following conservative treatment was after a median of 4 months (IQR: 2-22) and 7 months (IQR: 3-23) following surgical treatment (n.s.).

CONCLUSION

The incidence of shoulder dislocation within professional football is increasing and currently amounts to 9.1 per 1000 matches played. A conservative treatment leads to a quicker RTC, while frequency and time to RDE were similar regardless of treatment. The increasing incidence of shoulder dislocations in professional football necessitates an analysis of relevant injury mechanisms and the implementation of specific preventive measures.

LEVEL OF EVIDENCE

Level III.

Shoulder and Elbow Injuries in National Basketball Association Athletes and Their Effects on Player Performance

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.

Systematic Review of Injuries in the Men's and Women's National Basketball Association

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.

Editorial Commentary: Operative Versus Nonoperative Management of Shoulder Instability in the National Football League Athlete: Do What Needs to Be Done-Treatment Choice Does Not Affect Future Performance or Games Played

Shoulder instability is common in the National Football League athlete. Nonoperative versus operative treatment of shoulder labrum injury without bone loss depends on many factors, including type and direction of instability, presence or absence of pain and recurrent instability that limits function, and player and season situational issues. Prophylactic surgical treatment in an effort to enhance future player performance and increase the number of future games played should be discouraged. Management of shoulder instability should be based on clinical indication and surgical stabilization should not be done prophylactically in the hope of increasing the number of future games played or enhancing performance.

Career Longevity and Performance After Shoulder Instability in National Football League Athletes

PURPOSE

To investigate the career longevity, game utilization, and performance of National Football League (NFL) athletes after glenohumeral instability events treated operatively versus nonoperatively.

METHODS

Using public resources, we identified NFL players who sustained a shoulder instability event from September 2000 to February 2019. Players with prior shoulder instability, without NFL experience before injury, or who did not return to play (RTP) after injury were excluded. Demographic information, utilization (games and seasons), and season approximate value (SAV) statistics were recorded 1 year prior to injury and 3 years after RTP. Statistical analysis compared utilization and the SAV after RTP for athletes managed operatively versus nonoperatively.

RESULTS

We identified 97 NFL players who sustained their first instability event while playing in the NFL, 91 of whom returned to play (93.8%). Quarterbacks were significantly more likely to undergo immediate surgical management compared with players in other positions (P = .023). The final analysis included 58 players managed operatively and 33 managed nonoperatively by the end of the index season. Players treated operatively played in significantly more seasons after RTP during their remaining careers (4.1 ± 2.7 seasons vs 2.8 ± 2.5 seasons, P = .015). There were no differences in games played or started, offensive or defensive snap count percentage, or performance (SAV) before and after injury when compared between cohorts (P > .05). After surgical stabilization, time to RTP (36.62 ± 10.32 weeks vs 5.43 ± 12.33 weeks, P < .05) and time interval before recurrent instability (105.7 ± 100.1 weeks vs 24.7 ± 40.6 weeks, P < .001) were significantly longer than with nonoperative treatment. Additionally, the operative cohort experienced less recurrent instability (27% vs 50%, P = .035).

CONCLUSIONS

Athletes who RTP in the NFL after a shoulder instability injury do so with a similar workload and performance irrespective of surgical or nonsurgical management. Whereas nonoperative treatment is associated with faster RTP, operative management is associated with fewer recurrent instability events, greater time between recurrent instability events, and greater career longevity.

LEVEL OF EVIDENCE

Level III, retrospective case-control study.

Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players

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.