Faculty Bibliography

BACKGROUND:Anterior cruciate ligament (ACL) rupture is a significant injury in National Basketball Association (NBA) players. HYPOTHESES/OBJECTIVE: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/METHODS: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/CONCLUSIONS: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/CONCLUSIONS:There is a high RTS rate in the NBA after ACLR, with no difference in performance upon RTS compared with controls.

BACKGROUND:Anterior cruciate ligament (ACL) rupture is a significant injury in male Major League Soccer (MLS) players in the United States. PURPOSE/OBJECTIVE:To determine (1) return-to-sport (RTS) rate in MLS following ACL reconstruction (ACLR), (2) timing of RTS, (3) performance upon RTS, and (4) the difference in RTS and performance between players who underwent ACL reconstruction (ACLR) and controls. STUDY DESIGN/METHODS:Case-control study; Level of evidence, 3. METHODS:MLS players undergoing ACLR between 1996 and 2012 were evaluated. Player data were extracted from publically available sources. All demographic data were analyzed. A control group of players matched by age, body mass index (BMI), sex, position, performance, and MLS experience (occurred at 2.6 years into career, designated "index year") was selected from the MLS during the same years as those undergoing ACLR. The RTS and performance in the MLS were analyzed and compared between cases and controls. Student ttests were performed for analysis of within- and between-group variables. RESULTS:A total of 52 players (57 knees) that met inclusion criteria underwent ACLR while in the MLS. Mean player age was 25.6 ± 3.98 years. Forty players were able to resume play (77%). Of the 40 players (45 knees), 38 (43 knees; 95%) resumed play the season following ACLR (mean, 10 ± 2.8 months after surgery). Mean career length in the MLS after ACLR was 4.0 ± 2.8 years. The revision rate was 10%. There was a significant increase in the incidence of ACL tears in the MLS by year (P < .001), and there was a significantly (P= .002) greater number of ACL tears on the left knee as opposed to the right. Performance in the MLS upon RTS after ACLR was not significantly different versus preinjury. There was no significant difference in survival in the MLS between cases and controls after ACLR or index year. The only significant performance differences between cases and controls were that cases had significantly greater shots taken per season (P= .005) and assists (P= .005) than did controls after the index year. CONCLUSION/CONCLUSIONS:There is a high RTS rate in the MLS following ACLR. Nearly all players resumed play the season after surgery. Performance was not significantly different from preinjury. Only 2 performance measures (shots taken and assists) were significantly different between cases and controls. A significantly greater number of ACL tears occur in the left versus the right knee.

BACKGROUND:Skiing and snowboarding have become increasingly popular since the inception of the winter X-Games in 1997. PURPOSE/OBJECTIVE:To determine (1) rate of return to sport (RTS) to the winter X-Games following anterior cruciate ligament (ACL) reconstruction and (2) performance upon RTS following ACL reconstruction. HYPOTHESES/OBJECTIVE:There is a high rate of RTS to the winter X-Games in subjects undergoing ACL reconstruction. There is no difference in performance upon RTS following ACL reconstruction versus preinjury. STUDY DESIGN/METHODS:Case series; Level of evidence, 4. METHODS:Skiers and snowboarders competing in the winter X-Games who tore their ACL and underwent ACL reconstruction between 1997 and 2012 were evaluated. Athlete data were extracted from winter X-Games media websites, ESPN, injury reports, player profiles/biographies, and press releases. All athlete, knee, and surgical demographic data were analyzed. RTS and performance as it related to the number of gold, silver, and bronze medals won both pre- and postoperatively in the X-Games were analyzed. RESULTS:Fifteen skiers (19 knees) and 10 snowboarders (10 knees) were analyzed. There were 13 males and 12 females, with a mean subject age of 22.6 ± 4.45 years. The rate of RTS in the X-Games following ACL reconstruction was 80% overall (20/25 subjects). The rate of RTS in winter X-Games following ACL reconstruction in skiers was 87% (13/15 subjects) and in snowboarders was 70% (7/10 subjects). The rate of RTS in winter X-Games following ACL reconstruction in males and females was 85% (11/13 subjects) and 75% (9/12 subjects), respectively. The rate of revision ACL reconstruction due to ACL tear following primary ACL reconstruction was 4% (1/25 subjects). There were more left- than right-sided tears (18 vs 11). Skiers and snowboarders competed in the X-Games for 3.84 ± 2.73 and 3.40 ± 2.84 years prior to ACL reconstruction and 2.56 ± 2.06 and 7.29 ± 3.30 years after ACL reconstruction, respectively. Skiers earned 22 medals prior to ACL reconstruction (9 gold, 5 silver, 8 bronze) and 24 medals after ACL reconstruction (16 gold, 2 silver, 6 bronze). Snowboarders earned 7 medals prior to ACL reconstruction (4 gold, 1 silver, 2 bronze) and 19 medals after ACL reconstruction (7 gold, 7 silver, 5 bronze). CONCLUSION/CONCLUSIONS:Winter X-Games skiers and snowboarders have a high rate of RTS after ACL reconstruction. Skiers earned a similar number of medals preinjury and postsurgery, while snowboarders earned more medals following surgery.

BACKGROUND:Use of microfracture in the knees of National Basketball Association (NBA) players is controversial. HYPOTHESES/OBJECTIVE:(1) There would be a high rate of return to sport (RTS) in NBA players following microfracture, (2) players would RTS the season following surgery, (3) preoperative player performance would not be significantly different on RTS, and (4) there would be no significant difference in RTS rate or postoperative performance in players undergoing microfracture in comparison with an age-, position-, NBA experience-, and performance-matched control group. STUDY DESIGN/METHODS:Cohort study; Level of evidence, 3. METHODS:NBA players undergoing microfracture were evaluated. Age-, body mass index-, position-, NBA experience-, and performance-matched controls were selected from the NBA during the same years as those undergoing microfracture. An index year was selected (controls) to match the number of seasons of NBA experience in microfracture cases. RTS and performance were analyzed and compared between cases and controls. Student t tests were performed for analysis of within- and between-group variables. RESULTS:A total of 41 NBA players underwent microfracture and were compared with 41 demographic- and performance-matched controls. Rate of RTS after microfracture was 73% in the NBA and 83% in professional basketball (NBA, D-league, and International Basketball Federation [FIBA]). Time to RTS in NBA was 9.20 ± 4.88 months. Seventy-one percent (29/41) of players RTS the season following microfracture. Length of NBA career following microfracture (4.10 ± 3.91 years) was not significantly different from controls. After microfracture, case athletes played fewer games per season and with fewer points and steals per game (relative to premicrofracture; P < .05). Performance was better in control (after index year) versus case players (after microfracture) with regard to points per game, games played per season, and field goal and free throw percentage (P < .05). CONCLUSION/CONCLUSIONS:Eighty-three percent of NBA players undergoing microfracture returned to professional basketball. Career length was not significantly different between players undergoing microfracture and controls. However, following microfracture, players competed in fewer games per season with fewer points and steals.