SLR - June 2023 - Zachary Hughes, DPM
Title: Lower Extremity Stress Fractures in the National Basketball Association, 2013-2014 Through 2018-2019Reference: Rizzi, A. M., Baker, H. P., Lee, C. S., & Athiviraham, A. (2022). Lower Extremity Stress Fractures in the National Basketball Association, 2013-2014 Through 2018-2019. Orthopaedic journal of sports medicine, 10(10), 23259671221126485. https://doi.org/10.1177/23259671221126485
Level of Evidence: Level IV
Scientific Literature Review
Reviewed By: Zachary Hughes, DPM
Residency Program: Ascension St. John Hospital, Detroit, MI
Podiatric Relevance: Stress fractures are some of the most common overuse injuries experienced by athletes at all levels, and frequently occur within areas of repetitive stress. As medical professionals, one of the biggest challenges we face is operative vs. nonoperative treatment, and how to tailor treatment to each individual. The purpose of this study was to provide insight on the recognition and management of potential risk factors associated with lower extremity stress fractures in NBA athletes. Secondary objectives included outcomes of operative vs. nonoperative treatment of stress fracture management in NBA players, including differences in average return to play time.
Methods: A retrospective study was conducted using the NBA EMR database for all players on an NBA roster for >1 game from the 2013-2014 through 2018-2019 seasons. Injury data, including onset, mechanism, setting, and type, as well as type of treatment and time lost due to injury were entered into the EMR system by team medical staff for all NBA players on a team roster.
Results: 22 stress fractures were identified in 20 NBA players, with an average of 3.67 stress fractures per year and an incidence of 0.12 stress fractures per 1000 player-games. Of the 22 stress fractures, 10 (45%) were treated operatively. The average time to return to gameplay after operative fixation was 269.2 days, with an average of 59 games missed, while average time to return to play after nonoperative management of high-risk stress fractures was 243.8 days, with 18.1 games missed. No significant difference in time to return to play between high-risk stress fractures treated operatively and nonoperatively were found (P = .82); however, the average number of games missed was significantly lower in the nonoperative group (P = .01).
Conclusions: It was found that the game incidence rate of stress fracture was low in NBA players (0.12 stress fractures per 1000 player-games) compared with previously published incidence rates of stress fractures in the general athlete (approximately 1%). High-risk stress fractures (navicular, tibia, base of the fifth metatarsal) were the only fractures treated operatively. Bone stimulation was utilized for 6 fractures (27%), however it is important to note that it was not specified if bone stimulation was used as an adjunct to surgery or if preoperative failure of bone stimulation led to surgery. There was a statistically significant difference in NBA games missed between players with high-risk stress fractures treated operatively and nonoperatively, favoring nonoperative treatment. These findings will influence how I approach conservative versus surgical management of stress fractures for my own patients, and that surgery may not always be the best option even for elite level athletes.