The incidence rate of ACL injuries and ankle sprains in basketball players: A systematic review and meta-analysis

Impact of anterior cruciate ligament tears on player efficiency ratings and salary in National Basketball Association over the past 20 years: a retrospective case control study

OBJECTIVES

Players in the National Basketball Association (NBA) are at high risk for ACL tears which are detrimental to their career due to the months of rehabilitation. The authors hypothesize that after anterior crucial ligament (ACL) injury, older players will be less likely to return to the NBA, players that do return will have a lower performance efficiency rating (PER), and the decrease in PER will be associated with a lower salary.

METHODS

This case-control study utilized the publicly available database maintained by the NBA, professional basketball players from 2002 to 2022 who suffered an ACL tear were identified. Controls, without ACL tears, were matched by age, BMI, position, race, and average minutes played before the injury date to uninjured controls. Return to NBA, pre-injury and post-return player efficiency ratings (PER), and salary change after injury were analyzed by multivariate analyses.

RESULTS

A total of 67 players suffered an ACL tear. Fifty-six (83.6%) players returned to the NBA at some point after their injury, while 11 (16.4%) did not. Multivariate logistic regression showed that older age and the presence of multi-ligament injury predicted retiring from the NBA (ß = 1.4 and 10.7). Older age and greater minutes played before surgery to be the only significant predictors of decreased PER after return to the NBA (ß = -0.5 and -0.2). Players with a multiyear contract and with improvements in PER after injury tended to have greater salary increases (ß = 6.5 and 0.7). All p < 0.05. PER in players with ACL tears decreased by about 3 points (13.1 to 9.9) compared to controls without ACL tears (13.2 to 12.9).

CONCLUSION

Older age and multiligament injuries are associated with retiring for the NBA; older and increased minutes played are associated with a decreased PER upon return; and, PER decreases are associated with decreased salary. Players with ACL tears, even when case-control matched, showed decreased PER upon return. These results can be attributed to age-related changes in athleticism and health.

The Incidence of Sport-Related Anterior Cruciate Ligament Injuries: An Overview of Systematic Reviews Including 51 Meta-Analyses

Background/Objectives: The number of systematic reviews evaluating the incidence of anterior cruciate ligament (ACL) injuries in sports is increasing. To synthesize pooled incidence and prevalence rates of sport-related ACL injuries based on published systematic reviews with meta-analyses. Methods: An overview of systematic reviews with meta-analysis was conducted. The CINAHL, Embase, PubMed, and SPORTDiscus databases were searched from inception to 17 October 2023. AMSTAR 2 was used to assess the methodological quality of reviews. The degree of overlap between reviews was calculated when possible. Results: Seven systematic reviews including 51 meta-analyses of interest were included. The prevalence of ACL injuries was not meta-analyzed. Meta-analyses mainly showed that ACL injuries may have a high incidence in American football, basketball, European football/soccer, and volleyball, among other sports. In addition, ACL injuries may have a higher incidence in females than males in some sports. For example, the pooled incidence rates of ACL injuries in basketball ranged from 0.091 (95%CI, 0.074-0.111) to 0.110 (95%CI, 0.094-0.128) among female athletes, whereas this incidence ranged from 0.024 (95%CI, 0.016-0.034) to 0.027 (95%CI, 0.019-0.035) among male athletes. Conclusions: Sport-related ACL injuries may have a high incidence in sports such as American football, basketball, European football/soccer, or volleyball and show differences between sexes. Therefore, a sex-specific prevention of these injuries may be needed.

Examining prior injury relative to Achilles tendon ruptures in National Basketball Association players

The purpose of this study is to examine Achilles Tendon (AT) rupture and prior injury in the National Basketball Association (NBA). Publicly available data was sourced via two online databases and filtered to identify those reported as having sustained AT rupture. A full injury history was then generated for those players. A total of 51 AT ruptures were identified. Thirty-five per cent (18) had previously missed at least one game for "Achilles tendinitis" or "Achilles tendon injury" on the side of the affected limb. A further 18% were noted to have suffered plantar fasciitis or foot inflammation (9) or previous ankle injury (9). Seven previous injuries were knee related, and five were described as calf muscle injuries. The remaining three had prior soft tissue injuries to the quadriceps, hamstring or groin. Understanding any potential association between previous small time-loss injuries and large time-loss injuries such Achilles tendon ruptures is an important step in advancing injury risk mitigation strategies in professional basketball.

Injury epidemiology in international basketball: a six-season study of the Great Britain men's basketball team

OBJECTIVES

To report the injury epidemiology of the Great Britain's (GB) men's basketball team games and training over a 6-season period.

METHODS

Non-time loss (NTL) and time-loss (TL) injuries were recorded throughout 14 international windows (2018-2024). Exposure (player-hours) was recorded for team training and games. NTL and TL injury incidence is presented per 1000 player-hours (p/1000 h; 95% CI) for training, games and overall exposure. TL severity (days-lost) and burden (days-lost/1000 h; 95% CI) was calculated, with incidence rate ratios (IRR, 95% CI) comparing game and training incidence for each definition.

RESULTS

Throughout the study period, 113 injuries were recorded, of which 65 were GB related (43 NTL and 22 TL). Game injury incidence was significantly greater than training for TL (96/1000 h; 95% CI 33-159 versus 6/1000 h; 95% CI 2-9; IRR = 17; 95% CI 7-44) and NTL (75/1000 h; 95% CI 10-131 versus 7/1000 h; 95% CI 3-11; IRR = 11; 95% CI 4-28) injury definitions. Overall, most TL injuries occurred at the ankle (36%, 5/1000 h; 95% CI 2-9) and NTL injuries at the knee (19%, 5/1000 h; 95% CI 2-9). 31 overuse injuries were recorded, with 25% lower limb tendinopathies. TL injury severity ranged from 1 to 30 days, with injury burden for games (675/1000 h; 95% CI 234-1116) greater than training (48/1000 h; 95% CI 55-133).

CONCLUSION

The reported game injury incidence is high, with a large prevalence of NTL injuries. Lower limb injuries were most common, particularly overuse knee injuries. Preventative strategies need to be specific in the international basketball context, where camps are short but intense in duration.

Sport-specific differences in ACL injury, treatment and return to sports: Basketball

Basketball is an intense, fast-paced game that is physically, highly demanding. Certain aspects of the game, such as the quick pivoting and cutting movements, predispose the players to serious knee injuries, including anterior cruciate ligament (ACL) tears. While an ACL tear can be a devastating condition for players, multidisciplinary management of the injury can provide the players with a reasonable chance to return to play at the pre-injury level. This article aims to review the general principles and guidelines for the management of ACL injury in basketball players. The diagnosis, surgical treatment, rehabilitation and return to sports are discussed from European and North American perspectives. With a comprehensive and multidisciplinary approach to this condition, medical professionals can provide injured basketball players with a favourable prognosis for returning to play at the pre-injury level. To return to normal life and basketball after ACL reconstruction, the proposed approach includes (1) the selection of the appropriate surgical graft and technique, (2) maintaining a healthy and persistent mental state during rehabilitation, and (3) following a scientific rehabilitation programme based on personalized recovery. LEVEL OF EVIDENCE: Level V.

Patients submitted to re-revision ACL reconstruction present more knee laxity, more complications, and a higher failure rate than patients submitted to the first revision ACL reconstruction

BACKGROUND

Few comparative studies have evaluated patients who underwent two revision anterior cruciate ligament reconstruction (ACLR) and patients who underwent one revision ACLR, and many of them have a short postoperative follow-up and a relatively small number of patients. The objective of this study is to evaluate the functional results, complications, and failure rates of patients who underwent one revision ACLR and patients who underwent two revision ACLRs.

METHODS

This is a retrospective study comparing patients who underwent one revision ACLR (Group 1) with patients who underwent a re-revision ACLR (Group 2). Baseline demographic variables, operative data and post-operative data were evaluated.

RESULTS

Among the 266 patients included, 226 were from Group 1 and 40 from Group 2. Patients in Group 2 had greater rotatory laxity and were more often subjected to associated osteotomy at the time of revision surgery. Postoperatively, patients from Group 2 reported poorer subjective IKDC score and showed greater knee laxity measured with the KT-1000 arthrometer, although both probably not clinically relevant. The complication rate was high in both groups, with a higher incidence in Group 2. Reconstruction failures were also higher in Group 2 (20% vs. 8.8%, p = 0.03).

CONCLUSION

Patients from Group 2 underwent a higher rate of associated osteotomy procedures, present higher complication rates and a higher failure rate compared with patients from Group 1. However, the functional scores (Lysholm and IKDC score) and the physical examination (KT-1000 and pivot-shift) did not show clinically relevant differences between the groups.

LEVEL OF EVIDENCE

III, retrospective comparative therapeutic trial.

Autologous osteoperiosteal transplantation is effective in the treatment of single cystic osteochondral lesions of the talus and the prognostic impact of age should be emphasized

PURPOSE

To investigate the clinical efficacy and prognostic factors associated with autologous osteoperiosteal transplantation for the treatment of single cystic osteochondral lesions of the talus (OLT).

METHODS

The clinical data of patients with single cystic OLT undergoing autologous osteoperiosteal transplantation at the Department of Foot and Ankle Surgery of our hospital between 2018 and 2022, including complete follow-up, were retrospectively analyzed. Imaging data from each patient were imported into Mimics software to measure the surface area, volume and depth of the lesions. Then, the talus nine-compartment partitioning method was used to partition the injury site. Preoperative and final follow-up assessments were performed using the American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) for pain and 36-item Short-Form Health Survey (SF-36) to evaluate treatment efficacy and analyze prognostic factors.

RESULTS

Of the 31 patients with single cystic OLT with a complete set of follow-up data, there were 17 males and 14 females, with a mean age of 43.3 ± 13.6 years, a mean follow-up time of 30.1 ± 14.0 months and a mean illness duration of 30.4 ± 20.0 months. The postoperative final follow-up AOFAS score was 90.7 ± 5.5; this represented significant improvement when compared to the preoperative score of 57.0 ± 8.5 (P < 0.001). The final postoperative follow-up VAS score was 18.5 ± 8.3; this was significantly better than the preoperative score of 57.8 ± 8.7 (P < 0.001). The physical component summary (PCS) score and mental component summary (MCS) score on the SF-36 scale showed significant improvement at the final postoperative follow-up when compared to preoperative scores (p < 0.001). No other complications were observed during follow-up, such as wound infection or pain at the donor site. One of the patients showed less improvement, which may be related to premature weight-bearing or re-sprained ankle after surgery. There was no significant correlation between the duration of illness, gender and the location, depth, surface area and volume of the OLT and the postoperative scores. However, patient age showed a significant negative correlation with the postoperative SF-36 PCS and MCS scores.

CONCLUSION

Autologous osteoperiosteal transplantation for single cystic OLT demonstrated good clinical efficacy with a low incidence of complications. Furthermore, age represents an important factor influencing prognosis.

LEVEL OF EVIDENCE

Level II.

Sure Steps: Key Strategies for Protecting Basketball Players from Injuries-A Systematic Review

Background: Basketball is a high-intensity sport, which includes actions such as jumping, changes of direction, accelerations, and decelerations, which generates fatigue situations that may increase the risk of injury. Specifically, the joints at greatest risk are the ankle and knee, with ankle sprains and anterior cruciate ligament (ACL) tears being the most prevalent injuries. There are several strategies aimed at reducing the incidence, based on training methods or other prophylactic measures. Therefore, the purpose of the study is to perform a systematic review of the different injury prevention strategies in competitive-level basketball players with respect to general injuries, ankle sprains, and ACL injuries. Methods: For this purpose, the PRISMA methodology was applied, performing a search in three databases (PubMed, SPORTDiscus, and Cochrane) between 25 September 2023 and 8 October 2023. Results: A total of 964 articles were identified, out of which 283 were duplicates and 644 were discarded. Out of the remaining 37, 23 were excluded because they did not meet the inclusion criteria; therefore, 14 articles were finally included. With respect to general injuries, 8 out of 14 studies reviewed them. Concerning ankle sprains, 7 studies specifically analyzed them. Finally, 3 studies focused on ACL injuries. Conclusions: Training programs that combine different contents, known as neuromuscular training, including strength work, stabilization or core, mobility, and agility are the most effective for both general injuries and ACL injuries. For ankle sprains, the most effective measures are training programs based on analytical ankle stability exercises and the use of ankle braces. Adherence to prevention programs is essential, so they can be included as part of the warm-up. Other strategies such as training load control, functional assessment, or rule modification are not used in the included articles, so their effectiveness as prophylactic methods could not be justified.

Injury incidence among adolescent and senior basketball players: a prospective study in 19 teams across an entire season

OBJECTIVE

To quantify and compare injury incidence between national-level, adolescent and regional-level, senior, male basketball players competing in Serbia overall and according to injury mechanism (contact, non-contact, or overuse), exposure setting (training or games), and history (new or recurrent).

METHODS

A total of 218 male basketball players from 19 teams (106 senior and 112 adolescent players) volunteered to participate in the study. Descriptive data regarding game and training injury incidence were gathered across all players and reported per 10,000 athlete-exposures (AE) with 95% confidence intervals.

RESULTS

Overall, 26 injuries were reported across 52,509 AE. Ankle (n = 10, incidence rate [IR] = 1.90 [0.97, 3.40]) and knee injuries (n = 8, IR = 1.52 [0.71, 2.89]) accounted for 69% of all reported injuries, with only 1-2 injuries documented for other body regions. Ankle injuries were attributed to contact (60%, IR = 1.14 [0.46, 2.38]) or non-contact mechanisms (40%, IR = 0.76 [0.24, 1.84]). Most knee injuries occurred due to overuse (50%, IR = 0.76 [0.24, 1.84]) or non-contact mechanisms (38%, IR = 0.57 [0.15, 1.56]). Comparisons according to exposure setting revealed significantly higher knee (incidence rate ratio [IRR] = 9.95 [1.85, 53.41], p = 0.004) and ankle (IRR = 39.79 [7.94, 384.67], p < 0.001) injuries per 10,000 AE during games compared to training. Recurrent injuries were most prominent in the ankle (30% of all ankle injuries, p = 0.11). Total contact (p = 0.04), non-contact (p = 0.04), and recurrent IR (p = 0.005) were significantly higher in senior than adolescent players.

CONCLUSION

The players examined were most susceptible to ankle and knee injuries, particularly during games compared to training. Ankle injuries were mostly attributed to player contact, while knee injuries were mostly attributed to overuse and non-contact mechanisms. Senior players were at a greater risk of sustaining contact, non-contact and recurrent injuries than adolescent players.

Medial meniscal lesions increase antero-posterior laxity in knees with anterior cruciate ligament injury

PURPOSE

The aim of this study was to quantify the impact of concomitant meniscal lesions on knee laxity using a triaxial accelerometer in a large population of patients affected by anterior cruciate ligament (ACL) injury.

METHODS

A total of 326 consecutive patients (261 men and 65 women, mean age 31.3 ± 11.3) undergoing primary ACL reconstruction, were preoperatively evaluated through Lachman and pivot shift tests using a triaxial accelerometer to quantify knee laxity. An analysis based on the presence of meniscal tears assessed during surgery was performed to evaluate the impact of meniscal lesions on knee laxity.

RESULTS

The anterior tibial translation (Lachman test) presented significantly higher values in patients with medial meniscal lesions (7.3 ± 1.7 mm, p = 0.049) and both medial and lateral meniscal lesions (7.7 ± 1.6 mm, p = 0.001) compared to patients without concomitant meniscal lesions (6.7 ± 1.3 mm). Moreover, patients with both medial and lateral meniscal lesions presented significantly higher values of anterior tibial translation compared to patients with lateral meniscal lesions (p = 0.049). No statistically significant differences were found between the groups in terms of tibial acceleration (pivot shift test).

CONCLUSION

This study demonstrated that the contribution of concomitant meniscal lesions to knee laxity can be objectively quantified using a triaxial accelerometer in ACL-injured knees. In particular, medial meniscus lesions, alone or in association with lateral meniscus lesions, determine a significant increase of the anterior tibial translation compared to knees without meniscus tears.

LEVEL OF EVIDENCE

Level IV.

Epidemiology of Injuries in Men's Professional and Amateur Football (Part I)

Background (1): Football is the most popular sport among men, associated with a certain risk of injury, which leads to short- and long-term health consequences. While the injury profile of professional footballers is known, little is known about the injury profile of amateur footballers; amateur football is a major and diverse area, the development of which should be a priority for football associations around the world and UEFA. The aim of this study was to perform a systematic review of epidemiological literature data on injuries in professional and amateur football players belonging to certain leagues. Methods (2): A systematic review according to the PRISMA guidelines was performed until June 2023 in the databases PubMed, Web of Science, Google Academic, Google Scholar, and Diva portal. Forty-six studies reporting injury incidence in professional and amateur men's football were selected and analyzed. Two reviewers independently extracted data and assessed study quality using an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): The overall incidence of injuries in professional male football players was 7.75 ± 2.28, 95% confidence interval, injuries/1000 h of exposure and that of amateur football players was 7.98 ± 2.95, 95% confidence interval, injuries/1000 h of exposure. The incidence of match injuries (30.64 ± 10.28, 95% confidence interval, injuries/1000 exposure hours) was 7.71 times higher than the training injury incidence rate (3.97 ± 1.35, 95% confidence interval, injuries/1000 h) in professional football players and 5.45 times higher in amateurs (17.56 ± 6.15 vs. 3.22 ± 1.4, 95% confidence interval, injuries/1000 h). Aggregate lower extremity injuries had the highest prevalence in both categories of footballers, being 83.32 ± 4.85% in professional footballers and 80.4 ± 7.04% in amateur footballers: thigh, ankle, and knee injuries predominated. Conclusions (4): Professional and amateur football players are at substantial risk of injury, especially during matches that require the highest level of performance. Injury rates have implications for players, coaches, and sports medicine practitioners. Therefore, information on football injuries can help develop personalized injury risk mitigation strategies that could make football safer for both categories of football players. The current findings have implications for the management, monitoring, and design of training, competition, injury prevention, especially severe injury, and education programs for amateur football players.