Performance After Operative Versus Nonoperative Management of Shoulder Instability in the National Basketball Association

Abstract

Background:Although nonoperative management after shoulder instability injury allows an athlete to return to play sooner than operative intervention, higher rates of recurrence have been observed after nonoperative management. However, no study has investigated the differences in performance of National Basketball Association (NBA) players after index shoulder instability events managed nonoperatively versus operatively.Purpose/Hypothesis:The purpose of this study was to identify shoulder instability events in NBA athletes and assess differences in performance after injury with nonoperative versus operative management. We hypothesized that players who undergo operative intervention have reduced risk of recurrence and are able to continue their elite level of play as opposed to those who undergo nonoperative management.Study Design:Cohort study; Level of evidence, 3.Methods:Publicly available injury data from the 1986-1987 through 2017-2018 seasons were reviewed to identify NBA athletes sustaining a shoulder instability event. In addition to characteristics, player performance information, including games played, player efficiency rating (PER), and win shares, was analyzed before and for 3 seasons after injury. Statistical learning models were applied to identify performance variables that have the greatest predictive value to determine players who would benefit from surgery.Results:A total of 60 players with shoulder instability events were identified between 1986 and 2018. After injury, 37 players (61.7%) eventually underwent surgery and 23 players (38.3%) did not. Players who were treated nonoperatively had significantly decreased PER, games played, and offensive win shares in the season after injury (P < .05). Players who underwent surgery did not see a decline in PER, games played, or win shares. Random forest modeling found that true shooting percentage and win shares per 48 minutes were the performance variables most predictive in determining which players would benefit from surgery after shoulder instability.Conclusion:Players who underwent surgical intervention for shoulder instability maintained their PER, games played, and win share performance characteristics, whereas players who did not undergo surgery had declines in these parameters. Given the demands of shoulder function in basketball and the risk of recurrence after an instability event, surgery enhances a player’s opportunity to maintain a high level of performance after injury.

Systematic Review of Orthopaedic and Sports Medicine Injuries and Treatment Outcomes in Women's National Basketball Association and National Basketball Association Players

“…Performance analysis demonstrated that those with high baseline true shooting percentages and high win shares per 48 minutes were more likely to benefit from surgical stabilization. 30 PER may decrease in those managed nonoperatively in the season after injury (15.2 ± 4.2 vs 11.9 ± 6.9; P = .017) but not by postinjury season 3 (13.5 ± 6.4; P = .20). 30 Other studies did not show differences in performance between patients and controls.…”

“… 30 PER may decrease in those managed nonoperatively in the season after injury (15.2 ± 4.2 vs 11.9 ± 6.9; P = .017) but not by postinjury season 3 (13.5 ± 6.4; P = .20). 30 Other studies did not show differences in performance between patients and controls. 24…”

“… 31 Despite the benefit of early return to sport, there was a trend toward risk of recurrent instability (24%-40.6%) with nonoperative management compared with surgical treatment. 30 , 31 Furthermore, surgical management delayed the time between recurrent episodes (69.6 vs 28.5 weeks; P = .001). 31 …”

“…Three studies specifically discussed shoulder injuries, all of which reported on shoulder instability. 24 , 30 , 31 Injuries to the shoulder may encompass 3% to 4% of injuries to professional basketball athletes. 10 , 50 Shoulder stabilization accounted for 13.2% of orthopaedic surgeries in the NBA between 1984 and 2012 (1.6 per season).…”

“…Shoulder instability may not be career ending or significantly career altering, but the risks of surgery and time taken to return to play should be balanced with the risk of recurrence and risk of playing in fewer games at 1 and 3 years postinjury in nonoperatively managed patients. 30 …”