Return to NBA after ACL Reconstruction

Return-to-Sport and Performance After Anterior Cruciate Ligament Reconstruction in National Basketball Association Players. Harris JD, Erickson BJ, Bach BR Jr, Abrams GD, Cvetanovich GL, Forsythe B, McCormick FM, Gupta AK, Cole BJ. Sports Health. 2013 Nov;5(6):562-8.

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.

My comments:
I thought what was most interesting about this study was the NBA players generally had a near complete recovery following ACL reconstruction with 86% able to return to play in the NBA the following season with little performance decrement. This was generally not different from non injured control players, which declined slightly as well apparently due to age. However, research on average populations shows considerable residual muscle weakness in which they sometimes have difficulty getting even normal walking patterns back to normal.  Certainly pre-injury fitness is a factor but likely more important is post injury rehabilitation.  NBA players don’t have to worry about physical therapy being limited by insurance companies looking to cut costs, and when therapy is finished NBA players are returning to strength and conditioning programs which further restore performance levels. The general population often doesn’t have this opportunity.  It does indicate that with optimal physical therapy programs and continued strength and conditioning, knee function following ACL reconstruction if often at or near 100% in athletes at the highest level of performance.

While they reported no significant differences in time of injury during game play they did note that 40% of ACL injuries were in the 4th quarter and 62% in the second half of the game. This might indicate fatigue as a factor predisposing players to increased risk of injury, making the removal of starting players at the end of the game if there is a comfortable lead a prudent move.

Thanks for reading my blog. If you have any questions or comments (even hostile ones) please don’t hesitate to ask/share. If you’re reading one of my older blogs, perhaps unrelated to neck or back pain, and it helps you, please remember SpineFit Yoga for you or someone you know in the future.

Chad Reilly is a Physical Therapist, obtaining his Master’s in Physical Therapy from Northern Arizona University. He graduated Summa Cum Laude with a B.S. Exercise Science also from NAU. He is a Certified Strength and Conditioning Specialist, and holds a USA Weightlifting Club Coach Certification as well as a NASM Personal Training Certificate. Chad completed his Yoga Teacher Training at Sampoorna Yoga in Goa, India.