The Primary Risk Factors for Season-Ending Injuries in Professional Basketball Are Minutes Played Per Game and Later Season Games.

PURPOSE: To determine the incidence rates and associated risk factors of season-ending injuries (SEIs) in the National Basketball Association (NBA) from the 2015-20 seasons. METHODS: Publicly available records of active NBA players between the 2015-16 and 2020-21 seasons were reviewed to identify players with an SEI. In this study, SEI was classified as any injury that resulted in failure to return at least 5 games before the end of the team's game schedule. Injury data from the 2019-20 NBA season, shortened because of the coronavirus disease 2019 pandemic, were omitted. The primary outcome was the incidence of SEIs reported per 1,000 game exposures (GEs). Player demographics, basketball statistics, injury characteristics, and timing of injury were recorded. Secondary analysis, including bivariate analysis and multivariate logistic regression, was performed to investigate factors associated with having an SEI. RESULTS: In total, 196 players (15.6% of all players) sustained a combined 238 SEIs between the 2015-16 and 2020-21 seasons, indicating a rate of 1.74 SEIs per 1,000 GEs. When characterized by body part, knee injuries were found to be the most frequent SEI, at a rate of 0.47 injuries per 1,000 GEs. Accounting for potential confounders, having an SEI was significantly associated with more minutes per game played (odds ratio, 1.06, 95% confidence interval, 0.99-1.01, P < .001). CONCLUSIONS: SEIs occurred in 15.6% of players in this study, with an overall rate of 1.74 SEIs per 1,000 GEs. The most significant risk factor associated with injury was minutes per game. SEI was more likely to occur in the third and fourth quartiles of the NBA season than in the first or second quartile. LEVEL OF EVIDENCE: Level III, retrospective comparative prognostic investigation.

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.

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.

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.

Characterization of Ankle Injuries and Associated Risk Factors in the National Basketball Association: Minutes Per Game and Usage Rate Associated With Time Loss.

Background: Ankle injuries are more common in the National Basketball Association (NBA) compared with other professional sports. Purpose/Hypothesis: The purpose of this study was to report the incidence and associated risk factors of ankle injuries in NBA athletes. It was hypothesized that factors associated with an increased physiologic burden, such as minutes per game (MPG), usage rate, and associated lower extremity injury, would be associated with increased ankle injury risk and time loss. Study Design: Descriptive epidemiology study. Methods: Ankle injury data from the 2015-2016 through 2020-2021 NBA seasons were evaluated. The truncated 2019-2020 season due to the COVID-19 pandemic was omitted. The primary outcome was the incidence of ankle injuries, reported per 1000 game-exposures (GEs). Secondary analysis was performed to identify risk factors for ankle injuries through bivariate analysis and multivariable logistic regression of player demographic characteristics, performance statistics, injury characteristics, and previous lower extremity injuries. Factors influencing the time loss after injury were assessed via a negative binomial regression analysis. Results: A total of 554 ankle injuries (4.06 injuries per 1000 GEs) were sustained by NBA players over 5 NBA seasons, with sprain/strain the most common injury type (3.71 injuries per 1000 GEs). The majority of ankle injury events (55%) resulted in 2 to 10 game absences. The likelihood of sustaining an ankle injury was significantly associated with a greater number of games played (P = .029) and previous injury to the hip, hamstring, or quadriceps (P = .004). Increased length of absence due to ankle injury was associated with greater height (P = .019), MPG (P < .001), usage rate (P = .025), points per game (P = .011), and a prior history of foot (P = .003), ankle (P < .001), and knee injuries (P < .001). Conclusion: The incidence of ankle injuries was 4.06 per 1000 GEs in professional basketball players. Games played and prior history of hip, hamstring, or quadriceps injuries were found to be risk factors for ankle injuries. Factors associated with physiologic burden such as MPG and usage rate were associated with an increased time loss after injury.

Can single-stage bilateral unicompartmental knee arthroplasty be safely performed in patients over 70?

Background: For patients with bilateral, symptomatic unicompartmental knee arthritis, single-stage bilateral unicompartmental knee arthroplasty (ssBUKA) presents an attractive option. However, most studies have examined younger patient cohorts and the safety of ssBUKA remains controversial for older individuals. Therefore, the purpose of this study was to compare complication rates following ssBUKA for patients ≤70 and > 70 years old. Methods: A retrospective chart review of 238 patients having undergone ssBUKA was performed, including 134 patients ≤70 and 104 patients >70. Post-operative complications were recorded at the six-week post-operative visit, along with emergency room visits and hospital readmissions within 90 days. Results: Compared to patients ≤70, patients >70 were more frequently female (43.3% and 55.8%, respectively) (p = 0.037) and had significantly lower body mass index (30.41 ± 4.64 and 27.30 ± 3.68, respectively) (p < 0.001). Patients >70 were discharged home (50%) less commonly than patients ≤70 (73.1%) (p < 0.001). Two patients ≤70 (1.5%) and two patients >70 (1.9%) sought emergency room treatment (p = 0.589), with respiratory complications most common. There were no differences regarding any postoperative complications between patients ≤70 and > 70 years old. Conclusion: These results suggest that patients >70 can safely undergo ssBUKA, as it does not appear to increase the incidence of early post-operative complications compared to patients ≤70. However, 50% of patients >70 were not able to discharge directly home following surgery.

Performance Is Regained Within 2 Seasons After Quadriceps Tendon Tears in National Basketball Association Players.

Purpose: To characterize quadriceps tendon injuries over 30 National Basketball Association (NBA) seasons and assess the effects on player performance upon return to play. Methods: Partial and complete quadriceps tendon tears in NBA players between the 1990-1991 and 2021-2022 seasons were queried from a publicly available database. The primary outcomes were changes in player performance statistics obtained from each player's preindex season and first 2 postindex seasons. These interseason changes were compared with the changes of a healthy control cohort. Each injured player was matched with 2 controls using position, career length and win shares by season. The secondary measure of this study was the rate of return to play. Results: Nine quadriceps tendon tears (6 partial, 3 complete) were identified in NBA players. Seven (78%) of the players returned to play in NBA games, missing 50 ± 30 games and 214 ± 112 calendar days on average. Comparisons between these player's preindex and first postindex seasons revealed significant declines in games played (73.2 ± 6.6 vs 41.8 ± 10.8, P = .009) and minutes per game (27.2 ± 2.9 vs 23.0 ± 3.7, P = .042). When compared with controls, only the decrease in games played was significant (-31.3 ± 7.6 vs 1.4 ± 8.2, P = .004). These findings were consistent when comparing preindex and second postindex seasons (games played: 79.6 ± 1.9 vs -28.4 ± 5.4, P = .006; minutes per game: 29.3 ± 2.6 vs 51.2 ± 4.6, P = .003). All other player performance metrics including player efficiency rating returned to near-baseline levels in the first 2 seasons after injury. Conclusion: NBA players with quadriceps tendon tears return to play in 78% of cases. These athletes achieved preinjury levels of performance within 1 to 2 seasons, but with reduced games played per season. Level of Evidence: IV, therapeutic case series.

Knee Injuries and Associated Risk Factors in National Basketball Association Athletes.

Purpose: To determine structural knee injury rates and to identify risk factors and the number of games missed associated with these injuries in National Basketball Association (NBA) players from the 2015 to 2020 seasons. Methods: Publicly available player records of active NBA players between the 2015 and 2020 seasons (excluding the shortened 2019 season) were reviewed to identify players with a knee injury associated with missing one or more games. Player demographics, anthropometric measurements, statistics, injury characteristics, and history of other lower-extremity injuries were recorded. We sought factors associated with having a structural knee injury in bivariate analysis and multivariable logistic regression. Negative binomial regression was conducted to evaluate factors associated with the total number of games missed. Results: Two hundred twelve players (of 1,011, 21%) sustained a structural knee injury. Accounting for potential confounders, having a structural knee injury was associated with more minutes per game played (odds ratio [OR] 1.1; 95% confidence interval [CI] 1.0-1.2; P = .002), a greater usage rate (OR 1.1; 95% CI 1.0-1.2; P = .004), and a lower player efficiency rating (OR 0.94; 95% CI 0.89-1.0; P = .041). A greater number of missed games was associated with more minutes per game (regression coefficient [RC] 0.065; 0.028-0.10; P = .001), fewer points per game (RC -0.078; -0.14 to -0.017; P = .013), and greater usage rate (RC 0.032; 0.0040-0.060; P = .025). Conclusions: Structural knee injuries occurred in 21% of players in this study with an overall rate of 5.42 injuries per 1,000 game exposures. Significant risk factors associated with injury were minutes per game, usage rate, and true shooting percentage. Player efficiency was significantly associated with a decreased risk of injury. Increased minutes per game and usage rate were significantly associated with a longer duration of game loss. Level of Evidence: Level IV, case series.

Effect of a Condensed NBA Season on Injury Risk: An Analysis of the 2020 Season and Player Safety.

Background: Health and safety concerns surrounding the coronavirus 2019 (COVID-19) pandemic led the National Basketball Association (NBA) to condense and accelerate the 2020 season. Although prior literature has suggested that inadequate rest may lead to an increased injury risk, the unique circumstances surrounding this season offer a unique opportunity to evaluate player safety in the setting of reduced interval rest. Hypothesis: We hypothesized that the condensed 2020 NBA season resulted in an increased overall injury risk as compared with the 2015 to 2018 seasons. Study Design: Descriptive epidemiology study. Methods: A publicly available database, Pro Sports Transactions, was queried for injuries that forced players to miss ≥1 game between the 2015 and 2020 seasons. Data from the 2019 season were omitted given the abrupt suspension of the league year. All injury incidences were calculated per 1000 game-exposures (GEs). The primary outcome was the overall injury proportion ratio (IPR) between the 2020 season and previous seasons. Secondary measures included injury incidences stratified by type, severity, age, position, and minutes per game. Results: A total of 4346 injuries occurred over a 5-season span among 2572 unique player-seasons. The overall incidence of injury during the 2020 season was 48.20 per 1000 GEs but decreased to 39.97 per 1000 GEs when excluding COVID-19. Despite this exclusion, the overall injury rate in 2020 remained significantly greater (IPR, 1.42 [95% CI, 1.32-1.52]) than that of the 2015 to 2018 seasons (28.20 per 1000 GEs). On closer evaluation, the most notable increases seen in the 2020 season occurred within minor injuries requiring only a 1-game absence (IPR, 1.53 [95% CI, 1.37-1.70]) and in players who were aged 25 to 29 years (IPR, 1.57 [95% CI, 1.40-2.63]), averaging ≥30.0 minutes per game (IPR, 1.67 [95% CI, 1.47-1.90]), and playing the point guard position (IPR, 1.67 [95% 1.44-1.95]). Conclusion: Players in the condensed 2020 NBA season had a significantly higher incidence of injuries when compared with the prior 4 seasons, even when excluding COVID-19-related absences. This rise is consistent with the other congested NBA seasons of 1998 and 2011. These findings suggest that condensing the NBA schedule is associated with an increased risk to player health and safety.

Outcomes After Hip Labral Reconstruction Using Peroneus Longus Graft: A Novel Graft Experience.

Currently, there is no consensus on the ideal graft for hip labral reconstruction. The purpose of this study was to describe the surgical technique and report the short-term outcomes after hip labral reconstruction using a peroneal longus allograft. Eleven patients diagnosed with femoracetabular impingement and irreparable damage to the acetabular labrum underwent labral reconstruction with a peroneus longus allograft. The average follow-up time was 227 days (range: 26-457 days). Pre-operative radiographic measurements included an average pre-operative center edge angle of 29.0° (range: 19° to 37°) and an average alpha angle of 62.9° (range: 55° to 71°). All patients underwent femoroplasty, with additional procedures including 7 acetabuloplasties and 6 microfractures. The average visual analogue score for pain improved from 4.91±2.17 preoperatively to 3.85±2.0 postoperatively but this was not significant (P=.26). No patients sustained post-operative complications or allograft failures during follow up. Compared to other acetabular labral reconstruction options, the strength and shape of thedcd peroneus tendon may best replicate the native hip labrum. The current findings of no immediate post-operative complications or early failures suggests the peroneus longus allograft may be a viable option for hip labrum reconstruction.

Similar infection rates in a new wound closure method following knee arthroplasty.

Surgical site infections, defined as acute wound infections requiring surgical intervention within 90 days post-surgery, were retrospectively compared between a novel, zipper-like closure method (ZM) and staples in 682 patients (904 knees) and 772 patients (971 knees), respectively. The incidence of deep infections was 0.6% for staples and 0.2% for ZM (p = 0.169) and superficial infections was 0.1% for staples and 0.0% for ZM (p = 0.518). With no difference in wound complications, the ZM may be preferred since the two-week post-operative clinic visit required for wound check and staple removal was eliminated, thereby, decreasing clinic volume.

Component positioning of the first 300 mobile bearing unicompartmental knee arthroplasties.

The Oxford® Partial Knee has excellent long-term survivorship but high surgical times indicate a learn curve. This retrospective review included a radiographic evaluation of component placement of the initial 300 procedures following conversion from fixed bearing implant use. The anteroposterior and sagittal femoral angles were considered inaccurate in 1.7% and 3.9% of cases, respectively. The anteroposterior and sagittal tibial angles were considered inaccurate in 18.7% and 6.0% of cases, respectively. Overall, a learning curve appears to be present regarding the anteroposterior tibial component angle, with the greatest percentage of inaccuracies occurring within the initial 20 cases.

Barriers to achieving same day discharge following unilateral unicompartmental knee arthroplasty.

BACKGROUND: Evidence suggests that only a minority of unselected patients are able to achieve same day (SD) discharge following unilateral unicompartmental knee arthroplasty (UKA). However, many hospitals continue to classify UKA as an outpatient procedure, creating financial pressure to limit prolonged hospitalizations. To understand and address challenges that decrease patients' likelihood of achieving SD discharge, this study aimed to identify barriers commonly contributing to SD discharge failures with following a rapid discharge protocol (RDP). METHODS: Retrospectively collected data from 158 unselected patients having undergone unilateral UKA between 2018 and 2019 were reviewed. All patients were treated using an established RPD with intended SD discharge. RESULTS: Successful SD discharge was achieved by 84.2% of patient. Overall, those failing to achieve SD discharge were older (p < 0.001), more commonly female (p = 0.037), have multiple functional deficits (p < 0.05) and experience post-operative nausea (p < 0.001). Increased age, the use of an assisted device, and post-operative nausea accounted for 44.8% of the variability for patient not achieving SD discharge. The model was able to classify 95.7% of SD discharge and 38.1% of unsuccessful SD discharge patients, for an overall success rate of 85.1%. CONCLUSIONS: The use of a well-developed, interdisciplinary RDP for unilateral UKA results in high SD discharge success in a community hospital setting. However, with 15.8% of patients still not able to achieve SD discharge, a more efficient RDP may include prioritizing patient scheduling, with lower priority given to older individuals requiring an assisted device, and changes to preventative and symptomatic treatment options for post-operative nausea.

Comparison of early post-operative complications following unilateral or single-stage bilateral unicompartmental knee arthroplasty.

BACKGROUND: Unicompartmental knee arthroplasty (UKA) demonstrates excellent functional outcomes and patient satisfaction with low complication rates for single compartment knee arthritis. For patients with bilateral symptoms, single-stage bilateral UKA (SSBUKA) provides an alternative to staged procedures but may risk increased blood loss and systemic complications. Therefore, the purpose of this study is to compare 90-day postoperative complications between unilateral UKA and SSBUKA without exclusion for comorbidities. METHODS: A retrospective review was completed for 555 consecutive patients having undergone UKA (317 unilateral and 238 bilateral). Data collection included patient demographics and 90-day complications. Independent t-tests (continuous) and Fishers' Exact tests (nominal) were performed to determine differences between unilateral UKA and SSBUKA patients. RESULTS: The SSBUKA group had more male patients than the unilateral group (51.3% and 43.8%, respectively). There was no difference in age, body mass index or comorbidity classification. More SSBUKA patients experienced nausea than unilateral patients (17.6% and 11.0%), however, no significant differences were observed in the overall incidence of wound or systemic complications, and no transfusions were required. Significantly more unilateral patients (96.2%) were discharged home compared to SSBUKA (63.0%) (p < 0.001). Two SSBUKA (1.7%) and two unilateral UKA (0.6%) patients required readmission within 90-days with systemic complications. CONCLUSIONS: SSBUKA did not increase the risk of early postoperative systemic or wound complications, when performed in all patients with symptomatic disease without exclusion criteria as compared to patients undergoing unilateral UKA. Therefore, SSBUKA can safely be performed on the majority of patients who present to experienced high volume community hospitals.

The Clinical Significance of Endometrial Cells Detected on Pap Testing: The Impact of Revisions to the 3rd Edition of the Bethesda System for Reporting Cervical Cytology.

GOALS: This study aims to examine the effects of raising the reporting age for benign endometrial cells (BEC) on Papanicolaou (Pap) tests according to the 2014 3rd edition of the Bethesda System for Cervical Cytology, as well as the sequelae of the 2012 American Society of Colposcopy and Cervical Pathology (ASCCP) guidelines recommending endometrial asessment only for postmenopausal or symptomatic premenopausal women. PROCEDURES: We retrospectively examined clinical and histologic data from 4438 women aged ≥40 with BEC on Pap tests, of whom 608 (14%) were biopsied. RESULTS: Fifty-three (8.7%) histologic abnormalities were discovered upon biopsy. There was no significant difference (p=0.52) in abnormalities found between premenopausal women aged ≥40 and premenopausal women aged ≥45. Furthermore, there were no high-grade cancers in women between ages 40-44. There were also 3 high-grade cancers in patients aged 46, 46, and 49. Each of these women was asymptomatic and premenopausal. CONCLUSION: Our results affirm the raising of the reporting age of BEC on Pap tests from 40 to 45 in our patient population. Because there were 3 asymptomatic, premenopausal patients with high-grade cancers in our 45-49 age group, we cannot completely adhere to the ASCCP guidelines nor can we advocate raising the reporting age further to 50. Other laboratories must review their own follow-up data to validate appropriate reporting criteria for BEC for their patients.