Background:Professional basketball players in the National Basketball Association (NBA) subject their lower extremities to significant repetitive loading during both regular-season and off-season training. Little is known about the incidence of lower extremity bony stress injuries and their impact on return to play and performance in these athletes.Hypothesis:Stress injuries of the lower extremity will have significant impact on performance.Study Design:Case series.Level of Evidence:Level 4.Methods:All bony stress injuries from 2005 to 2015 were identified from the NBA. Number of games missed due to injury and performance statistics were collected from 2 years prior to injury to 2 years after the injury. A linear regression analysis was performed to determine the impact of injury for players who returned to sport.Results:A total of 76 lower extremity bony stress injuries involving 75 NBA players (mean age, 25.4 ± 4.1 years) were identified. Fifty-five percent (42/76) involved the foot, and most injuries occurred during the regular season (82.9%, 63/76), with half occurring within the first 6 weeks. Among players who sustained a fifth metatarsal stress fracture, 42.9% were unable to return to professional play. Players who sustained stress injuries had reduced play performance, specifically related to number of games played (P = 0.014) and number of steals per game (P = 0.004). Players who had surgery had significantly better performance at 2 years than those who were managed nonoperatively, independent of the type of injury (β = 4.561; 95% CI, 1.255-7.868).Conclusion:Lower extremity bony stress injuries may significantly affect both short- and long-term player performance and career length. Stress injuries result in decreased player performance, and surgical intervention results in improved performance metrics compared with those treated using conservative methods.Clinical Relevance:Stress injuries result in decreased player performance, and surgical intervention results in improved performance metrics.

Multiligament knee injuries significantly affect the ability of a football player to return to sport. ACL and MCL tears are associated with better RTP prognosis compared with ACL and PCL/LCL tears.

Our findings suggest that at the NBA level, an athlete's performance in the initial 5 games following injury does not suffer from the after-effects of concussive injury. These results may be useful in counseling professional athletes following a concussion.

Background: Achilles tendon ruptures are devastating injuries for National Basketball Association (NBA) players: prior studies have demonstrated decreased performance following return-to-play, but none have evaluated the effect of injury on rate-adjusted contextual statistics to assess the true change in performance. Additionally, there exists a paucity of data on the independent impact on defensive performance following return. Hypothesis: Compared to both control-matched peers and preoperative careers, we hypothesize that player production based on rate-adjusted contextual statistics will significantly decline following Achilles tendon rupture. Study design: Retrospective Cohort Study Methods: Publicly available NBA injury data on Achilles tendon rupture were reviewed from the 1996 -1997 to the 2016-2017 seasons. Controls were matched based on height, position, age, and rateadjusted statistics. Extracted data included Value over Replacement Player Rating, Box Plus-Minus, Win Shares, offensive rating, defensive rating, and time to return-to-play, and was collected for the season before and two seasons following injury. Results: Twenty-five NBA players with surgically treated complete Achilles ruptures met inclusion and exclusion criteria. The return-to-play rate from Achilles tendon ruptures from 1996-1997 to 2016-2017 was 80%, with a mean recovery period of 311.0 ± 100.9 days. After 2 years, performance significantly declined for Value over Replacement Player Rating, Box Plus-Minus, and offensive rating compared to controls and cases. However, there was no significant effect on defensive rating (P = 0.38). After two seasons, returning players had a Value over Replacement Player Rating that was 24.1% below pre-injury levels, contributed 1.4 fewer points per 100 possessions by Box Plus-Minus, and yielded 2.4 fewer wins by Win Shares. Conclusions: Achilles tendon rupture results in significant decreases in offensive production and career longevity. The injury does not have a significant impact on defensive production. Clinical relevance: Achilles tendon ruptures significantly affect basketball players ability to return-toplay, and their in-game performance.

Objectives:Players in the National Basketball Association (NBA) subject their lower extremities to significant repetitive loading during the season as well as during off-season training. Little is known about the incidence and impact of lower extremity bony stress injuries in these athletes.Methods:Using the player injury database maintained by the NBA Players’ Association, all bony stress injuries from 1992 to May 2016 were identified. Those not involving the lower extremity were excluded from the study. Stress fractures and stress reactions were grouped together. Number of games missed due to the injury as well as player statistics including points per game (ppg), assists per game (apg), steals per game (spg), and blocks per game (bpg) were collected from two years prior to the injury to two years after the injury.Results:76 lower extremity bony stress injuries were identified involving 75 different NBA players with an average player age of 25.4 ± 4.1 years. 55.3% (42/76) involved the foot, 21.1% (16/76) involved the ankle or fibula, 17.1% (13/76) involved the tibia, and 6.6% (5/76) involved either the knee or patella. The majority of injuries occurred in season 82.9% (63/76) with half of the injuries occurring within the first 6 weeks of the season. 38.2% (29/76) of these injuries were managed surgically. An average of 25.1 ± 21.3 games were missed. 19.7% (15/76) of patients who sustained a stress fracture also had a subsequent injury. 29.2% (21/76) of players were not able to return to professional basketball after the season in which the injury was sustained; however, those who were able to return to the same level of play did not see a significant change in performance as measured by ppg, apg, spg, or bpg when comparing the season prior to the injury and either one or two years after the injury. Stress injuries to the foot carried the worst prognosis, 57.1% (12/21) of those unable to return to professional basketball sustained such an injury.Conclusion:While not extremely common in NBA players, lower extremity bony stress injuries may be career-ending. However, if they are able to return to the NBA following this injury, then their level of play should return to their pre-injury level.