Return-to-play performance after injury in National Basketball Association League basketball players

Prior studies in the National Basketball Association (NBA) and Women's National Basketball Association (WNBA) reported worse player performance after Achilles tendon rupture (ATR). The purpose of this study was to compare time to return to play (RTP) and performance after ATR between NBA and WNBA athletes. It was hypothesized that there would be no relative difference between the NBA and WNBA players. Cohort study; Level of evidence, 3. ATRs in the NBA between 1987 and 2017 and WNBA between 2006 and 2017 were identified through a rigorous online search of articles. Included athletes had no prior leg injuries and had played ≥3 seasons before and after ATR. Sex, age, position, body mass index, height, years of experience, time to RTP, and player efficiency rating (PER) were recorded. Relative performance was measured by matching injured athletes to uninjured controls in the same league in a 1:2 ratio. Relative differences were compared between leagues, with adjustment for baseline features. Multiple regression analysis was employed to identify variables correlating with RTP and PER. Included were 102 professional basketball players, of whom 34 sustained ATR (21 male, 13 female). Sex/league correlated with differences in RTP (P < .001). There was a significant difference between the WNBA and NBA in PER when comparing 1 year pre- and 1 year postinjury (1.49 ± 0.25 vs 3.87 ± 0.43, respectively; mean ± SD P < .001). Compared with intraleague controls, the relative difference in PER postinjury was 0.81 ± 0.11 (WNBA) and 3.9 ± 0.89 (NBA) (P < .001). Multiple regression analysis indicated that when controlling for years of experience, player position, and age, NBA players took 126 days longer than WNBA players to RTP (P < .001) and NBA players had 9.96 times increased odds of taking >200 days to RTP compared with WNBA players (P = .006). Sex/league was a significant predictor of RTP after ATR. When compared with their respective controls, NBA players saw a greater decrease in postinjury performance than WNBA players. NBA players took longer to RTP than WNBA players. ATRs appear to more negatively affect NBA players than WNBA players.

PurposeTo quantify the financial impact of an anterior cruciate ligament (ACL) injury on the remaining career earnings of National Basketball Association (NBA) players.MethodsWe 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.ResultsA 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).ConclusionsOur 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 EvidenceLevel III, retrospective case-control study.

Background:Since the most recent epidemiologic study of injuries in National Basketball Association (NBA) players was completed in 2012, the understanding and diagnosis of intra-articular hip injury has advanced.Purpose:To report the epidemiology of intra- versus extra-articular hip injuries in NBA players with regard to missed games, risk factors for injury, and treatment types.Study Design:Cohort study; Level of evidence, 3.Methods:The NBA injury database was queried for all reported hip and groin injuries from 2013 to 2017. The injuries were then divided into intra-articular and extra-articular types. Variables compared between injury types included player age, NBA tenure, season schedule (preseason or offseason), onset type, injury mechanism, roster position, games missed, time to return to play, and need for surgery.Results:A total of 224 athletes sustaining 353 total hip pathologies were identified. Of these injuries, 216 (61.2%) were sustained during game competition and affected 156 (69.6%) of the athletes. Intra-articular injuries represented 39 (11.0%) cases and involved 36 (16.1%) players. The time to return to play was significantly longer after intra-articular versus extra-articular injury (44.6 ± 96.0 vs 11.8 ± 32.0 days; P = .03), and the number of games missed was significantly greater after intra-articular versus extra-articular injury (8.0 ± 18.7 vs 1.54 ± 4.9 games; P = .03). Patients with intra-articular hip injuries were more likely to undergo surgery (odds ratio, 5.5 [95% CI, 1.8-16.7]; P = .005). There was no statistically significant difference in the number of games missed due to surgery (35.2 ± 8.3 [intra-articular] vs 35.4 ± 11.6 [extra-articular]; P = .42) or nonoperative treatment (4.2 ± 3.4 [intra-articular] vs 1.3 ± 0.5 [extra-articular]; P = .11). Years of NBA tenure were not significantly different between intra-articular and extra-articular injuries (7.1 ± 3.7 vs 6.3 ± 4.0 years). For both types of hip injury, there was no correlation between player age and either days to return to play or number of games missed (R2 = 0.014).Conclusion:NBA players with intra-articular hip injuries underwent surgery more frequently and had a longer return-to-play time compared with those with extra-articular hip injuries. NBA tenure and player age were not correlated with the risk of developing hip injury or the need for surgery.

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. 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. Descriptive epidemiology study. 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. 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). 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.

Frequent air travel and the condensed game schedule typical of a National Basketball Association (NBA) team during the season, often results in accompanying sleep disturbances related to sleep length, sleep quality, and sleep timing (with highly harmful impacts on health, both physical and mental). These issues are not only problematic for NBA players, but also the coaches, training staff, and management support. In this narrative review, we summarize the detrimental effects that this travel and game schedule could have on NBA team members' sleep, as well as their physical and mental health. Multiple peer-reviewed articles address the role of sleep in athletic performance and health; however, to date, the literature focused on sleep-related issues that are unique to the NBA schedule is scarce. Firstly, this review addresses the impact of the NBA schedule, outlining the number of games and the travel involved (number of flights, the timing of flights, timings of arrival at destination and hotel); we also outline a typical daily NBA travel schedule, providing the reader a glimpse of what this encompasses. Secondly, we provide a brief overview of sleep science and discuss specific applications related to the NBA. Finally, we provide comment on the unique current situation of the NBA "bubble". Based on this review, there appears to be considerable scope for further investigation of the acute and chronic effects of sleep disturbances concerning the NBA travel and game schedule. Sleep science recommendations need to inform practice, target sleep interventions, and personalized protocols designed to enhance sleep health that can be incorporated at the organizational level.

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.

Background: Athletes who specialize in their sport at an early age may be at risk for burnout, overuse injury, and reduced attainment of elite status. Timing of sport specialization has not been studied in elite basketball athletes. Hypothesis: National Basketball Association (NBA) players who played multiple sports during adolescence would be less likely to experience injury and would have higher participation rates in terms of games played and career length compared with single-sport athletes. Study Design: Descriptive epidemiology study. Methods: First-round draft picks from 2008 to 2015 in the NBA were included in the study. From publically available records from the internet, the following data were collected for each athlete: participation in high school sports, major injuries sustained in the NBA, percentage of games played in the NBA, and whether the athlete was still active in the NBA. Athletes who participated in sports in addition to basketball during high school were defined as multisport athletes and were compared with athletes who participated only in basketball in high school. Results: Two hundred thirty-seven athletes were included in the study, of which 36 (15%) were multisport athletes and 201 (85%) were single-sport athletes in high school. The multisport cohort played in a statistically significantly greater percentage of total games (78.4% vs 72.8%; P < .001). Participants in the multisport cohort were less likely to sustain a major injury during their career (25% vs 43%, P = .03). Finally, a greater percentage of the multisport athletes were active in the league at time of data acquisition, indicating increased longevity in the NBA (94% vs 81.1%; P = .03). Conclusion: While a minority of professional basketball athletes participated in multiple sports in high school, those who were multisport athletes participated in more games, experienced fewer major injuries, and had longer careers than those who participated in a single sport. Further research is needed to determine the reasons behind these differences.

Category:Sports; TraumaIntroduction/Purpose:For the professional athlete, an Achilles tendon rupture is a devastating and potentially career ending injury. Basketball players with Achilles tendon injuries have among the lowest reported return to play rates for orthopaedic injuries. Among National Basketball Association (NBA) players, Achilles rupture has been shown to result in difficulty with returning to competition and significantly decreased productivity exhibiting a large effect size (0.95). Comparable data regarding Women’s National Basketball Association (WNBA) players is lacking. This study evaluated the impact of Achilles tendon rupture on return to play and post-injury performance among WNBA players in order to test the null hypothesis of equal negative impact as observed in the NBA.Methods:This was an IRB exempt retrospective matched cohort study. Public records indicated 12 WNBA players incurred Achilles tendon ruptures between the 2006 and 2018 seasons. Demographic data and performance statistics were collected for pre and post-injury seasons. A control cohort was matched for age, height, weight, years of experience in WNBA, position, and pre-injury player efficiency rating (PER). Individual pre versus post injury and injury cohort versus control cohort performance statistics were compared using paired and independent samples t-tests, respectively. Injury effect size on performance was calculated. The primary outcome was difference in PER. Secondary outcomes included differences in itemized performance statistics. A priori sample size based on effect size of 0.95 indicated that 12 players per cohort were needed for 80% power to detect a difference in PER at alpha of 0.05.Results:7 (58%) players returned to WNBA play by mean 9.5 months. There was no significant difference in pre injury PER from seasons matched for years of WNBA experience between cohorts (13.7 vs 11.9; P = 0.6). Mean PER significantly decreased in the first year (13.66 vs 9.00; P = .04; Cohen’s d = .99) and approached a significance difference in the second year (14.56 vs 9.95; P =05; Cohen’s d = 1.02) in the injured cohort only. Minutes per game (MPG) significantly decreased only year 1 post-injury (25.84 vs 19.54; P = .04; Cohen’s d = 6.56). Points per game (PPG), field goals attempted per game (FGA), and free throws attempted per game (FTA) significantly decreased in both years post-injury (all p < 0.05).Conclusion::WNBA players incurred Achilles tendon ruptures at a rate of 2% annually. This was associated with a moderate rate of return to play and significantly reduced production (PER, MPG, PPG, FGA, and FTA) in the first year. The second season following injury found players returning closer to pre-injury performance, with persistent significant reduction in PPG, FGA, and FTA. Effect sizes were uniformly large. These data were consistent with NBA results, supporting the null hypothesis. Providers may use this data to counsel high and elite level female basketball players on return to play and performance expectations following Achilles tendon ruptures.

Our aim in performing this study was to evaluate whether fantasy and wins above replacement (WAR) scores of athletes undergoing anterior cruciate ligament (ACL) reconstructive surgery in the National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL), and Major League Baseball (MLB) could be utilized in evaluating their performance post-surgery. We identified publicly accessible data on professional athletes from 1992 to 2015. Fantasy and WAR scores were calculated for each player. A total of 83 professional players met the inclusion criteria for this cross-sectional study. Decreased fantasy scores ranged from 33% to 42% across the four leagues after the index operation. NHL players had the lowest return-to-play (RTP) rate at 11/17 (82%), and MLB players had the highest RTP rate at 14/15 (93%). RTP rates of NBA and NFL players were comparable at 22/26 (85%) and 22/25 (88%), respectively. NFL players had the lowest average career length after surgery at 26 months, while NBA players had the longest average career length at 64 months. MLB players on average required the longest time to return to the pre-surgical level of performance (21 months). NHL players had the shortest average recovery time (eight months), and NBA players had the longest average recovery time (13 months). Approximately, more than half of all the studied players exhibited a decline in fantasy or WAR scores. In addition, NFL players had the lowest average career length, and NBA players enjoyed the longest average career length after surgery. NHL players had the lowest recovery time, while NBA players had the longest recovery time. The strength of this study is the utilization of fantasy points and WAR scores as a single unifying measure of a player’s performance, which acts as an objective measure after ACL reconstruction. The average performance of a professional athlete, as evaluated through their fantasy score output, tends to decrease after undergoing ACL reconstruction. There is an overall long-term performance decline after initial spikes in their performance after surgery. Additional larger studies are needed to fully understand the effects of ACL reconstruction in professional athletes; however, the use of fantasy scores may be an objective tool in measuring the success rate of ACL reconstruction.

Objectives:Several studies have examined the incidence and effects of concussions in professional football, baseball, and hockey, but there has been limited evaluation of the effects of concussions in National Basketball Association (NBA) players. This study aims to evaluate the epidemiologic trends of concussions, as well as the effects of concussions on in-game performance, in NBA players.Methods:Publicly available records were searched to include all players who sustained an in-game concussion while playing in the NBA from the beginning of the 1999 NBA season to the conclusion of the 2018 season. For each player the following variables were collected: date of injury, number of days and games missed before returning to game play, player efficiency rating (PER) in the season of injury, the season preceding the injury, and the season following the injury, position of the injured player, and the incidence of multiple concussions for a single player. Concussion trends before and after the institution of the NBA Concussion Protocol were calculated, as well as the effects on PER after return to play.Results:From the start of the 1999 season to the end of the 2018 season, 185 basketball-related concussions were incurred across 149 NBA players. All players were able to return to play following a first-time concussion after missing an average of 7.7 days and 3.5 games. The NBA Concussion Protocol was instituted ahead of the 2011-2012 season, prior to which there were 5.7 concussions recorded/season, with an average of 6.7 days and 3.0 games missed per first-time concussion. Following the institution of the concussion protocol, there were approximately 11 more concussions recorded/season (16.7 vs. 5.7, P = 0.007), with 1.7 more days missed (8.4 vs. 6.7, P = 0.27) and 0.9 more games missed (3.9 vs. 3.0, P = 0.24) per concussion, compared to prior seasons. Of the 149 players who suffered concussions, 27 were concussed multiple times (18.1%). There was no difference found in the incidence of recurrent concussions within the same season before vs. after the institution of the concussion protocol (4 vs. 5, P > 0.05). PER was almost identical for concussed players in the season prior to the injury, the season in which the injury occurred, and the season following the injury (13.93 vs. 13.94 vs. 13.91, P = 0.998).Conclusion:There has been a significant increase in the incidence of concussions in the NBA player following the institution of a league-wide concussion protocol. This likely reflects more accurate reporting secondary to advances in player education, medical knowledge, national media coverage, and standardized testing protocols. Despite this increase in reported concussions, the amount of time missed following injury has remained relatively constant. Player performance as reported by PER was not significantly affected by sustaining a concussion.Figure I.Incidence of concussions per NBA season from 1999 to 2018, with subsequent games missed by the injured player. The NBA Concussion protocol was instituted prior to the start of the 11-12 season. In the studied time frame, there were as few as two concussions/season, in both 02-03 and 03-04, and as many as 29 concussions/season in 17-18. Average games missed ranged from one game/concussion, in 03-04, to 6.3 games/concussion in 10-11.SeasonConcussions, nGames Missed, Mean ± SDDays Missed, Mean ± SDRepeat Concussions, nConcussions by PositionPoint GuardShooting GuardSmall ForwardPower ForwardCenter99-0041.3 ± 1.33.0 ± 0.800201100-0143.0 ± 1.47.0 ± 4.401021001-0271.4 ± 0.84.6 ± 4.213013002-0322.5 ± 1.54.5 ± 2.500100103-0421.0 ± 0 *3.0 ± 0.0 *00101004-0544.8 ± 4.89.0 ± 7.900120105-0691.5 ± 0.83.0 ± 1.523123006-0741.5 ± 0.54.5 ± 1.502010107-0883.1 ± 2.17.0 ± 5.101122208-09101.8 ± 0.43.8 ± 1.110035209-1053.7 ± 1.39.3 ± 3.301211010-1196.3 ± 7.413.6 ± 14.8014220Before Concussion protocol, aggregate683.0 ± 3.66.7 ± 7.64(5.9%)12(17.6%)13(19.1%)16(23.5%)19(27.9%)8(11.8%)1H2184.2 ± 5.28.7 ± 0.20311163S-13145.8 ± 4.512.9 ± 10.902233442.5 ± 0.55.0 ± 2.001002114-15142.8 ± 2.36.3 ± 5.6005612IKS182.8 ± 1.76.3 ± 3.0145162JH7203.9 ± 5.58.2 ± 10.215352537-10293.8 ± 4.18.7 ± 9.5347387After Concussion protocol, aggregate1173.9 ± 4.48.4 ± 9.15(4.3%)19(16.2%)23(19.7%)22(18.8%)26(22.2%)27(23.1%)Overall from 99-00 to 17-181853.5 ± 4.17.7 ± 8.69(4.9%)31(16.8%)36(19.5%)38(20.5%)45(24.3%)35(18.9%)Summary of NBA concussion incidence and return to play times stratified by season from the 99-00 to 17-18 seasons. Incidence data includes all basketball related concussion within the studied timeframe. Return to play data includes only first-time concussions, and excludes pre-season or post-season injuries, players whose recovery overlapped with the last day of the regular season, and players who suffered concussions concomitantly with other injuries, due to concerns that these parameters would artificially affect the number of games missed.*There were only two concussions in this season, and one was excluded because it was a pre-season injury.

In this work, we present a data set on the survival times and mortality rates of all 4374 professional basketball players who participated in the National Basketball Association (NBA) from its inception in 1946 until July 2019 [1]. It contains the data of 412 active and 3962 former players. The data were recorded from different internet sources and include information on each player's position, ethnicity, handedness, ages at NBA debut and career end, height, weight, or number of NBA games. The results of the analysis of a previous data set with the same variables of all NBA players from 1946 to 2015 were recently published by Martinez et al. in 2019 [2]. The information provided in the data set can be useful to better understand the mortality risk among NBA players.

Background: A complete rupture of the Achilles tendon is a devastating injury. Variables affecting return to competition and performance changes for National Basketball Association (NBA) players are not readily evident. Hypothesis: Players in the NBA who ruptured their Achilles tendons and who underwent surgical repair would have more experience in the league, and the performance of those who were able to return to competition would be decreased when compared with their performance before injury and with their control-matched peers. Study Design: Cohort study; Level of evidence, 3. Methods: Data for 18 basketball players with Achilles tendon repair over a 23-year period (1988-2011) were obtained from injury reports, press releases, and player profiles. Variables included age, body mass index (BMI), player position, and number of years playing in the league. Individual season statistics were obtained, and the NBA Player Efficiency Rating (PER) was calculated for 2 seasons before and after injury. Controls were matched by playing position, number of seasons played, and performance statistics. Univariate and multivariate analyses were performed to assess the effect of each factor. Results: At the time of injury, the average age was 29.7 years, average BMI was 25.6, and average playing experience was 7.6 years. Seven players never returned to play an NBA game, whereas 11 players returned to play 1 season, with 8 of those players returning for ≥2 seasons. Players who returned missed an average of 55.9 games. The PER was reduced by 4.57 (P = .003) in the first season and by 4.38 (P = .010) in the second season. When compared with controls, players demonstrated a significant decline in the PER the first season (P = .038) and second season (P = .081) after their return. Conclusion: The NBA players who returned to play after repair of complete Achilles tendon ruptures showed a significant decrease in playing time and performance. Thirty-nine percent of players never returned to play.

Purpose of ReviewYouth sports are increasingly shifting towards a “pay to play” model which has introduced financial barriers to participation. The Amateur Athletic Union (AAU) is the main organization for club basketball, serving as a platform where young athletes can compete beyond the recreational level. Outside the realm of athletes who have access to state-of-the-art facilities and top-tier coaching, the pathway to playing basketball at the next level may be predominantly available to those who can afford the considerable costs of AAU participation. The objective of this study is to determine the accessibility of AAU teams of active National Basketball Association (NBA) players through use of the Area Deprivation Index (ADI).Recent FindingsWe identified 114 AAU teams with physical addresses for 250 (50%) currently active domestic NBA players. The State ADI of the high schools as well as national and state ADIs of prior AAU teams of active NBA players were significantly skewed toward lower ADI rankings (higher socioeconomic status) (p < 0.05). The mean distance between high school location and AAU location was 170 miles.SummaryPrior AAU teams of currently active NBA players are more frequently located in areas of higher socioeconomic status with nearly 50% being within the top 3rd lower state decile as measured by the area deprivation index. Similarly, we found the high schools these players attended, as a proxy for areas they grew up in, were also more frequently located in areas of higher socioeconomic status.

Objectives:Previous work has shown a high return to sport (RTS) after Anterior Cruciate LigamentReconstruction (ACLR) in National Basketball Association (NBA) players. Data onperformance outcomes after RTS are less clear, with some demonstrating no differencecompared to controls and others showing decreased performance. Two fundamentals ofbasketball are driving the ball to the basket and long-range shooting. Driving involveslateral movement, whereas long-range shooting features vertical movement. Thebiomechanics of these two scoring approaches may affect risk of ACL injury and post-ACLRperformance.The objective of this study was to investigate whether NBA players with higher drivetendency and/or higher tendency to shoot 3-point shots are more likely to tear theirAnterior Cruciate Ligament (ACL) relative to controls and if they experience decreasedstatistical performance after returning to play.Methods:Season-level performance statistics and ACL injuries were aggregated from the 1980-2017NBA seasons. Fifty players with isolated ACL tears during their NBA careers who had gameperformance data before and after injury were identified. Three-point shooting tendencywas measured using the 3-point attempt rate (3PAr) statistic for each player-season. Astatistical model was created to evaluate player’s tendency to drive the ball to thebasket.The driving tendencies of players who underwent ACL reconstruction was compared withthat of other players using an independent sample t-test. The rate of ACL tears amongthose with high driving tendency was compared with that of other players using anindependent sample t-test.To investigate whether driving tendency and three-point shooting tendency areassociated with RTS outcomes, objective case-control matching was performed. The lastfull season before each case player’s ACL injury was matched with similar seasons of twocontrol players without history of ACL injury (figure 1). Total career points andplaying minutes after RTS were compared between cases and controls using pairedz-tests.Changes in driving tendency and three-point shooting tendency before injury vs afterinjury were compared between cases and controls using paired z-tests.Results:Players with career-average driving tendencies more than 1 standard deviation above themean were more likely to tear their ACL than other players (0.0521 vs 0.0275, p =0.0258) (figure 2). This represents a relative risk of 1.896. Players who experienced anACL tear also had higher average drive tendencies than other players (p = 0.0468). Therewas not a significant difference between career-average 3-point attempt rate of ACLRplayers relative to others. There was no significant difference in total post-injurycareer points or career minutes between cases and controls. There was also nosignificant change in driving or 3-point shooting tendency after RTS compared tocontrols. ACL-injured players with higher driving tendency did not fall further belowthe performance of their controls after they returned.Conclusions:NBA players with increased drive tendency are more likely to tear their ACL. However,players who are able to return after ACL reconstruction do not underperformstatistically compared to controls and do not alter their style of play compared to thenormal changes seen with age.

Prior studies have examined return-to-play (RTP) rates and performance outcomes following meniscus surgery in professional basketball players but have largely focused on earlier eras. With advancements in surgical techniques, rehabilitation, and player management strategies, updated insights into postoperative outcomes are needed. We hypothesized that National Basketball Association (NBA) players would demonstrate a higher return-to-play (RTP) rate than the ~80% reported in 2010, with short-term performance declines but recovery by the second postoperative season. We also evaluated the impact of age, body mass index (BMI), and position on outcomes. NBA players who sustained isolated meniscal tears and underwent surgery between 2010 and 2023 were identified through public databases. Performance metrics-including games played, minutes per game (MPG), player efficiency rating (PER), and distance covered per game-were assessed preoperatively and at one and two years postoperatively. Multivariable linear regression analyzed associations between age, BMI, position, and outcomes. Of 47 eligible players, 43 (90.7%) returned to NBA play. Players missed a median of 17 ± 34 games postoperatively and continued their careers for an average of 4.7 ± 3.4 seasons. The percentage of games played per season significantly declined at one (60.9%, p < 0.001) and two years (64.2%, p < 0.01) postoperatively versus pre-injury (79%), a novel finding. MPG and PER declined at one year (22.3 vs. 26.0, p = 0.02; 14.6 vs. 16.4, p = 0.04) but recovered by year two (23.8 MPG, 15.8 PER; both p > 0.1). Older age correlated with reduced games played, MPG, and PER. BMI and position had no significant impact. NBA players demonstrate high RTP rates after meniscus surgery. While playing time and efficiency recover by year two, reduced availability persists, likely reflecting ongoing workload management strategies.