Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players

Abstract

Background: Anterior cruciate ligament (ACL) rupture is a significant injury in National Basketball Association (NBA) players.

Hypotheses: NBA players undergoing ACL reconstruction (ACLR) have high rates of return to sport (RTS), with RTS the season following surgery, no difference in performance between pre- and postsurgery, and no difference in RTS rate or performance between cases (ACLR) and controls (no ACL tear).

Study design: Case-control.

Methods: NBA players undergoing ACLR were evaluated. Matched controls for age, body mass index (BMI), position, and NBA experience were selected during the same years as those undergoing ACLR. RTS and performance were compared between cases and controls. Paired-sample Student t tests, chi-square, and linear regression analyses were performed for comparison of within- and between-group variables.

Results: Fifty-eight NBA players underwent ACLR while in the NBA. Mean player age was 25.7 ± 3.5 years. Forty percent of ACL tears occurred in the fourth quarter. Fifty players (86%) RTS in the NBA, and 7 players (12%) RTS in the International Basketball Federation (FIBA) or D-league. Ninety-eight percent of players RTS in the NBA the season following ACLR (11.6 ± 4.1 months from injury). Two players (3.1%) required revision ACLR. Career length following ACLR was 4.3 ± 3.4 years. Performance upon RTS following surgery declined significantly (P < 0.05) regarding games per season; minutes, points, and rebounds per game; and field goal percentage. However, following the index year, controls' performances declined significantly in games per season; points, rebounds, assists, blocks, and steals per game; and field goal and free throw percentage. Other than games per season, there was no significant difference between cases and controls.

Conclusion: There is a high RTS rate in the NBA following ACLR. Nearly all players RTS the season following surgery. Performance significantly declined from preinjury level; however, this was not significantly different from controls. ACL re-tear rate was low.

Clinical relevance: There is a high RTS rate in the NBA after ACLR, with no difference in performance upon RTS compared with controls.

Keywords: ACL; NBA; National Basketball Association; anterior cruciate ligament; knee injury.

Conflict of interest statement

The following authors declared potential conflicts of interest: Bernard R. Bach, Jr, MD, received royalties from SLACK Inc. and payment for work from Arthrex, Smith and Nephew, Ossur, and Linvatec; Brian Forsythe, MD, has received payment for work from Arthrex, Smith and Nephew, Ossur, and Linvatec; and Brian J. Cole, MD, MBA, is a board member for AAOS Board, American Journal of Orthopedics, American Journal of Sports Medicine, Cartilage, Educational Committee AANA, Elsevier, International Committee AANA, Journal of Bone and Joint Surgery - American, and Journal of Shoulder and Elbow Surgery; a consultant for Allosource, Arthrex, Inc, Biomimetic, Carticept, DePuy, A Johnson & Johnson Company, and Zimmer; received payment for lectures from Genzyme; received royalties from Arthrex, Inc, DJ Orthopaedics and Elsevier; and received payment for work from Arthrex, Ossur, Smith and Nephew, and Linvatec.

Figures

Figure 1.

Flow chart of selection process for inclusive NBA players within a priori selected years of subjects. The 1 player unable to return to sports (RTS) sustained 2 ACL tears (bilateral) over his NBA career. He was able to RTS in the NBA after the first ACL tear but unable to RTS in the NBA or any professional league after the second ACL tear.

Figure 2.

Number of ACL tears per year in the NBA.

Figure 3.

Number of players in the NBA before and after ACL reconstruction (solid line) or post–index year for controls (dashed line) (years 1-5).