Chad Starkey

Injury Risk in Professional Basketball Players A Comparison of Women’s National Basketball Association and National Basketball Association Athletes

Background Gender-based differences in injury rates have been reported in scholastic and collegiate basketball. The purpose of this study was to retrospectively compare injury rates in womens and mens professional basketball. Hypothesis Female professional basketball players are injured at a higher rate than are men. Study Design Cohort study (prevalence); Level of evidence, 2. Methods Womens National Basketball Association and National Basketball Association injury data were retrospectively reviewed for 6 full seasons. The frequency of all injuries and the rate of game-related injuries were calculated. Results Complete player profiles were obtained on 702 National Basketball Association athletes and 443 Womens National Basketball Association athletes who competed in their respective leagues during the data collection period. Total game exposures totaled 70 420 (National Basketball Association) and 22 980 (Womens National Basketball Association). Womens National Basketball Association athletes had a higher overall game-related injury rate (24.9 per 1000 athlete exposures; 95% confidence interval, 22.9-26.9; P < .05) when compared with National Basketball Association athletes (19.3 per 1000 athlete exposures; 95% confidence interval, 18.3-20.4) and sustained a higher rate of lower extremity injuries (14.6 per 1000 athlete exposures; 95% confidence interval, 13.1-16.2; P < .05) than seen in the National Basketball Association (11.6 per 1000 athlete exposures; 95% confidence interval, 10.8-12.4). The lower extremity was the most commonly injured body area (65%), and lateral ankle sprain (13.7%) was the most common diagnosis in both leagues. The incidence of game-related knee injury was higher in Womens National Basketball Association players. The incidence of anterior cruciate ligament injury in the National Basketball Association (n = 22, 0.8%) and Womens National Basketball Association (n = 14, 0.9%) accounted for 0.8% of the 4446 injuries reported. Conclusion The lower extremity is the most frequently injured body area in both leagues, and Womens National Basketball Association athletes are more susceptible than are National Basketball Association athletes. There were, however, few statistical differences in the actual injuries occurring between the 2 leagues.

Performance Outcomes of Anterior Cruciate Ligament Reconstruction in the National Basketball Association

PURPOSE The purpose of this study was to determine the rate of return to play and to quantify the effect on the basketball players performance after surgical reconstruction of the anterior cruciate ligament (ACL). METHODS Surgical injuries involving the ACL were queried for a 10-year period (1993-1994 season through 2004-2005 season) from the database maintained by the National Basketball Association (NBA). Standard statistical categories and player efficiency rating (PER), a measure that accounts for positive and negative playing statistics, were calculated to determine the impact of the injury on player performance relative to a matched comparison group. Over the study period, 31 NBA players had 32 ACL reconstructions. Two patients were excluded because of multiple ACL injuries, one was excluded because he never participated in league play, and another was the result of nonathletic activity. RESULTS Of the 27 players in the study group, 6 (22%) did not return to NBA competition. Of the 21 players (78%) who did return to play, 4 (15%) had an increase in the preinjury PER, 5 (19%) remained within 1 point of the preinjury PER, and the PER decreased by more than 1 point after return to play in 12 (44%). Although decreases occurred in most of the statistical categories for players returning from ACL surgery, the number of games played, field goal percentage, and number of turnovers per game were the only categories with a statistically significant decrease. Players in the comparison group had a statistically significant increase in the PER over their careers, whereas the study group had a marked, though not statistically significant, increase in the PER in the season after reconstruction. CONCLUSIONS After ACL reconstruction in 27 basketball players, 22% did not return to a sanctioned NBA game. For those returning to play, performance decreased by more than 1 PER point in 44% of the patients, although the changes were not statistically significant relative to the comparison group. LEVEL OF EVIDENCE Level IV, therapeutic case series.

Injury in the National Basketball Association: A 17-Year Overview

Background: Injury patterns in elite athletes over long periods continue to evolve. The goal of this study was to review of the injuries and medical conditions afflicting athletes competing in the National Basketball Association (NBA) over a 17-year period. Design: Descriptive epidemiological study. Methods: Injuries and player demographic information were reported by each team’s athletic trainer. Criteria for reportable injuries were those that resulted in (1) physician referral, (2) a practice or game being missed, or (3) emergency care. The demographics, frequency of injury, time lost, and game exposures were tabulated, and game-related injury rates and 95% confidence intervals were calculated. Results: A total of 1094 players appeared in the database 3843 times (3.3 ± 2.6 seasons). Lateral ankle sprains were the most frequent orthopaedic injury (n, 1658; 13.2%), followed by patellofemoral inflammation (n, 1493; 11.9%), lumbar strains (n, 999; 7.9%), and hamstring strains (n, 413; 3.3%). The most games missed were related to patellofemoral inflammation (n, 10 370; 17.5%), lateral ankle sprains (n, 5223; 8.8%), knee sprains (n, 4369; 7.4%), and lumbar strains (n, 3933; 6.6%). No correlations were found between injury rate and player demographics, including age, height, weight, and NBA experience. Conclusion: Professional athletes in the NBA experience a high rate of game-related injuries. Patellofemoral inflammation is the most significant problem in terms of days lost in competition, whereas ankle sprains are the most common injury. True ligamentous injuries of the knee were surprisingly rare. Importantly, player demographics were not correlated with injury rates. Further investigation is necessary regarding the consequences and sport-specific treatment of various injuries in NBA players. Clinical Relevance: Knowledge of these injury patterns can help to guide treatments and provide more accurate guidelines for an athlete to return to play.

Epidemiology of Isolated Meniscal Injury and Its Effect on Performance in Athletes From the National Basketball Association

Background: The current incidence and outcomes of meniscal injury have not been quantified in professional athletes. Purpose: To describe the incidence, risk, amount of time lost, and effect on performance for isolated meniscal injury in athletes from the National Basketball Association (NBA). Demographic factors predicting the risk of meniscal tears and the effect of injury in return to play were also investigated. Study Design: Descriptive epidemiology study. Methods: A centralized database was queried to identify meniscal injuries occurring in the NBA over 21 seasons. The frequency of injury, time lost, game exposures, and incidence, rate, and risk were calculated. The preinjury and postinjury player efficiency rating (PER) was used to identify changes in player performance. Results: We identified 129 isolated meniscal tears in NBA athletes during a 21-season span. From this number, 77 (59.7%) involved the lateral meniscus and 52 (40.3%) the medial meniscus. Injuries occurred more frequently in games. The lateral meniscus had a statistically significant higher injury rate. Both left and right knees were equally affected. The number of days missed for lateral meniscal tears and medial meniscal tears was 43.8 ± 35.7 days and 40.9 ± 29.7 days, respectively, and was not statistically different. There was a significant inverse relationship between age and rate of lateral meniscal tears, with lateral meniscal tears more likely to occur up to age 30 years; beyond that medial meniscal tears were more common. Players with a body mass index (BMI) greater than 25 had a significantly increased risk of meniscal tears compared with players with a BMI less than 25, specifically with an increased risk of lateral meniscal tears. Twenty-five players (19.4%) did not return to play. For those who did, upon returning to competition, there was no statistical change in PER from their preinjury status, and the mean number of seasons completed was 4.1 ± 3.7 seasons. Conclusion: The lateral meniscus is more frequently torn than the medial meniscus, but there was no difference in the amount of playing time lost. Both right and left knees were equally affected. There was an inverse relationship between age and the rate of lateral meniscal tears. Risk of tears was increased in players having a BMI greater than 25. Injury did not negatively affect playing performance.

Epidemiology of Hip Injuries in the National Basketball Association A 24-Year Overview

Background: Professional athletes are subject to various injuries that are often dictated by the nature of their sport. Professional basketball players previously have been shown to sustain injuries throughout the musculoskeletal system, most commonly to the ankle and knee. Purpose: The purpose of this study was to report the epidemiology of injuries specific to the pelvis, hip, and thigh and their effect on games missed in professional basketball players. Study Design: Descriptive epidemiological. Methods: Records were recalled from the National Basketball Association epidemiological database for athletic-related pelvis, hip, or thigh injuries that occurred from the 1988-1989 through the 2011-2012 seasons. The primary information collected included anatomic location where the injury occurred, when in the course of the season injury occurred, specific pathology, date, activity at the time of injury, injury mechanism, number of practices and games missed, and whether surgery was required. The number of practices and games missed were summed to yield the number of days missed per episode. Results: There were 2852 cases (14.6% of all athletic-related injuries) involving 967 individual players. In 1746 (61.2%) cases, injuries occurred during game competition. Across the course of this study, clinical incidence of injury to the pelvis, hip, or thigh was 1.50 per 100 players. The mean (±standard deviation) number of days missed per case was 6.3 ± 10.2. The quadriceps group was the most commonly injured structure (contusions and strains) and had a significantly higher game-related injury rate than other structures (0.96 per 100 athletic exposures, 95% confidence interval [CI] = 0.87-1.04). Players had the greatest risk (relative risk = 1.38, 95% CI = 1.26-1.52) of sustaining a strain than any other type of injury, with a game-related injury rate of 1.79 (95% CI = 1.67-1.90). The hamstring muscle group was the most frequently strained. Strains were more likely to occur in the preseason. Conclusion: Pelvis, hip, and thigh injuries in professional basketball players are commonly extra-articular strains and contusions and represent a significant burden of injury. The actual amount of intra-articular hip disorders may be underestimated, as the awareness of these disorders has increased only in the past decade. With the awareness of the types of injuries that occur in this region, focused injury prevention strategies may be beneficial to players and teams at all levels of competition, not only professional athletes.

Validation of the Ottawa Ankle Rules for Acute Foot and Ankle Injuries

UNLABELLED The original and modified Ottawa Ankle Rules (OARs) were developed as clinical decision rules for use in emergency departments. However, the OARs have not been evaluated as an acute clinical evaluation tool. OBJECTIVE To evaluate the measures of diagnostic accuracy of the OARs in the acute setting. METHODS The OARs were applied to all appropriate ankle injuries at 2 colleges (athletics and club sports) and 21 high schools. The outcomes of OARs, diagnosis, and decision for referral were collected by the athletic trainers (ATs) at each of the locations. Contingency tables were created for evaluations completed within 1 h for which radiographs were obtained. From these data the sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated. RESULTS The OARs met the criteria for radiographs in 100 of the 124 cases, of which 38 were actually referred for imaging. Based on radiographic findings in an acute setting, the OARs (n = 38) had a high sensitivity (.88) and are good predictors to rule out the presence of a fracture. Low specificity (0.00) results led to a high number of false positives and low positive predictive values (.18). CONCLUSION When applied during the first hour after injury the OARs significantly overestimate the need for radiographs. However, a negative finding rules out the need to obtain radiographs. It appears the ATs decision making based on the totality of the examination findings is the best filter in determining referral for radiographs.

Mixing Interviews and Rasch Modeling Demonstrating a Procedure Used to Develop an Instrument That Measures Trust

Developing psychometrically sound instruments can be difficult, especially if little is known about the constructs of interest. When constructs of interest are unclear, a mixed methods approach can be useful. Qualitative inquiry can be used to explore a construct’s meaning in a way that informs item writing and allows the strengths of one analysis method to compensate for the weaknesses of the other. Mixing method applications can be complex, however, there are few examples within the literature pertaining to the mix of interviews, Rasch modeling, and classical test theory. This article demonstrates how to mix qualitative inquiry with Rasch modeling (and classical test theory) in order to develop an instrument that measures a complex construct: patient trust.

Improving the memory sections of the standardized assessment of concussion using item analysis

The purpose of the study was to improve the immediate and delayed memory sections of the Standardized Assessment of Concussion (SAC) by identifying a list of more psychometrically sound items (words). A total of 200 participants with no history of concussion in the previous six months (aged 19.60 ± 2.20 years; N = 93 men, N = 107 women) volunteered to participate in this study. An observation research design was used. Participants were tested once with a verbal interview that took approximately five minutes to complete. Classic item analysis including three parts: (1) Item difficulty, (2) item discrimination, and (3) item determination was used to assess the psychometric properties of the new items on the alternative word list for the SAC test. Overall, 80.0% of the items in the immediate memory section were acceptable. In the delayed memory section, 90.0% of the items were acceptable. The mean total SAC scores were 17.96 ± 2.45 (of a possible 30). The majority of new items have acceptable psychometric properties that would improve the validity of baseline SAC score for the assessment of the effects from concussions.