Advertisement

Performance Is Regained Within 2 Seasons After Quadriceps Tendon Tears in National Basketball Association Players

Open AccessPublished:October 31, 2022DOI:https://doi.org/10.1016/j.asmr.2022.09.009

      Purpose

      To characterize quadriceps tendon injuries over 30 National Basketball Association (NBA) seasons and assess the effects on player performance upon return to play.

      Methods

      Partial and complete quadriceps tendon tears in NBA players between the 1990-1991 and 2021-2022 seasons were queried from a publicly available database. The primary outcomes were changes in player performance statistics obtained from each player’s preindex season and first 2 postindex seasons. These interseason changes were compared with the changes of a healthy control cohort. Each injured player was matched with 2 controls using position, career length and win shares by season. The secondary measure of this study was the rate of return to play.

      Results

      Nine quadriceps tendon tears (6 partial, 3 complete) were identified in NBA players. Seven (78%) of the players returned to play in NBA games, missing 50 ± 30 games and 214 ± 112 calendar days on average. Comparisons between these player’s preindex and first postindex seasons revealed significant declines in games played (73.2 ± 6.6 vs 41.8 ± 10.8, P = .009) and minutes per game (27.2 ± 2.9 vs 23.0 ± 3.7, P = .042). When compared with controls, only the decrease in games played was significant (–31.3 ± 7.6 vs 1.4 ± 8.2, P = .004). These findings were consistent when comparing preindex and second postindex seasons (games played: 79.6 ± 1.9 vs –28.4 ± 5.4, P = .006; minutes per game: 29.3 ± 2.6 vs 51.2 ± 4.6, P = .003). All other player performance metrics including player efficiency rating returned to near-baseline levels in the first 2 seasons after injury.

      Conclusion

      NBA players with quadriceps tendon tears return to play in 78% of cases. These athletes achieved preinjury levels of performance within 1 to 2 seasons, but with reduced games played per season.

      Level of Evidence

      IV, therapeutic case series.
      The quadriceps tendon is the confluence of the 4 quadriceps muscles and is a critical component in extension of the knee.
      • Hak D.J.
      • Sanchez A.
      • Trobisch P.
      Quadriceps tendon injuries.
      This tendon provides substantial biomechanical support to the knee during athletic movement and sustains mechanical loads of up to 1,055 N.
      • Ciriello V.
      • Gudipati S.
      • Tosounidis T.
      • Soucacos P.N.
      • Giannoudis P.V.
      Clinical outcomes after repair of quadriceps tendon rupture: A systematic review.
      ,
      • Mabe I.
      • Hunter S.
      Quadriceps tendon allografts as an alternative to Achilles tendon allografts: A biomechanical comparison.
      However, sudden and eccentric contractions of the quadriceps muscle can overwhelm the extensor mechanism and result in a partial or complete rupture of the quadriceps tendon.
      • Hak D.J.
      • Sanchez A.
      • Trobisch P.
      Quadriceps tendon injuries.
      ,
      • Ilan D.I.
      • Tejwani N.
      • Keschner M.
      • Leibman M.
      Quadriceps tendon rupture.
      In the general population, this injury is most common in medically complex individuals >40 years old through a low-energy mechanism. In addition, these tears also may occur in high-impact athletes who compete on hard surfaces, such as National Basketball Association (NBA) players.
      • Kannus P.
      • Natri A.
      Etiology and pathophysiology of tendon ruptures in sports.
      ,
      • Nori S.
      Quadriceps tendon rupture.
      Repeated explosive vertical and lateral movements in basketball athletes place unique physiologic stresses on the knee joint. More than one third of basketball players suffer from knee tendonitis secondary to overuse inflammation and microtearing within the patellar or quadriceps tendon.
      • Dauty M.
      • Menu P.
      • Garraud T.
      • et al.
      Jumper's knee mechanical consequences in professional basketball players: The "Camel's Back curve".
      ,
      • Lian O.B.
      • Engebretsen L.
      • Bahr R.
      Prevalence of jumper's knee among elite athletes from different sports: A cross-sectional study.
      This condition can predispose individuals to propagation of tears with potential for complete rupture of either tendon.
      • Hak D.J.
      • Sanchez A.
      • Trobisch P.
      Quadriceps tendon injuries.
      ,
      • Ilan D.I.
      • Tejwani N.
      • Keschner M.
      • Leibman M.
      Quadriceps tendon rupture.
      ,
      • King D.
      • Yakubek G.
      • Chughtai M.
      • et al.
      Quadriceps tendinopathy: A review—part 1: Epidemiology and diagnosis.
      Patellar tendon tears in NBA athletes have been associated with good return-to-play outcomes, as measured by performance efficiency rating (PER), but in some cases these injuries are devastating, as 25% of tears are career-ending.
      • Nguyen M.V.
      • Nguyen J.V.
      • Taormina D.P.
      • Pham H.
      • Alaia M.J.
      A comprehensive return-to-play analysis of National Basketball Association players with operative patellar tendon tears.
      Although the prognosis of patellar tendon ruptures in NBA players is well-characterized, little is understood about the recovery and expectations of quadriceps tendon tears in the same population. The purposes of this study were to characterize quadriceps tendon injuries over 30 NBA seasons and assess the effects on player performance upon return to play. We hypothesized that players with tears in the quadriceps tendon would achieve preinjury levels of PER in their first season after returning to play.

      Methods

      Data Collection

      This study is a retrospective review of a publicly available database and was granted an exemption by the by the Mayo Clinic Institutional Review Board under application number 21-009369. Injury data from October 1990 through May 2022 were queried from Pro Sports Transactions (prosportstransactions.com), an online database that tracks (1) player movement on and off each NBA team’s inactive list, (2) description of injury, (3) date of injury, and (4) return-to-play date. This database has been cited previously in numerous NBA-related studies.
      • Belk J.W.
      • Marshall H.A.
      • McCarty E.C.
      • Kraeutler M.J.
      The effect of regular-season rest on playoff performance among players in the National Basketball Association.
      • Bullock G.S.
      • Ferguson T.
      • Vaughan J.
      • Gillespie D.
      • Collins G.
      • Kluzek S.
      Temporal trends and severity in injury and illness incidence in the National Basketball Association over 11 seasons.
      • Chauhan A.
      • Stotts J.
      • Ayeni O.R.
      • Khan M.
      Return to play, performance, and value of National Basketball Association players following Achilles tendon rupture.
      • Jildeh T.R.
      • Meta F.
      • Young J.
      • et al.
      Concussion is associated with increased odds of acute lower-extremity musculoskeletal injury among National Basketball Association players.
      • Martin C.L.
      • Arundale A.J.H.
      • Kluzek S.
      • Ferguson T.
      • Collins G.S.
      • Bullock G.S.
      Characterization of rookie season injury and illness and career longevity among National Basketball Association players.
      • Morse K.W.
      • Hearns K.A.
      • Carlson M.G.
      Return to play after forearm and hand injuries in the National Basketball Association.
      Each injury event recorded was verified through official team press releases and media reports in addition to player game logs on Basketball-Reference (basketball-reference.com). Information from Basketball-Reference is sourced by Sportradar US (Sportradar AG, St. Gallen, Switzerland), the official stats partner of the NBA. The return-to-play date was used to calculate games missed and days missed.
      Team schedules, player demographics, and player statistics were obtained from Basketball-Reference. The season in which an individual was injured was considered the index season. Player statistics were gathered for the season before injury (preindex), first season after injury (postindex season 1), and second season after injury (postindex season 2). Statistics during the index season were not reported in this study. Games played (GP), minutes per game (MPG), and points per game (PPG) were calculated by combining all regular season and playoff statistics. Advanced statistics including PER, usage rate (USG%), and true shooting percentage (TS%) were derived from regular season statistics only. PER is a rating developed by ESPN (ESPN.com) that factors in offensive and defensive performance of a player on a per-minute basis. PER is normalized so that the average PER across all NBA players is 15.0. USG% is a measure of a player’s offensive involvement while on the floor given their shots attempted and turnovers. TS% represents an individual’s overall shooting efficiency, accounting for 2-point field goals, 3-point field goals, and free throws.
      Each player was matched with 2 control subjects using previously reported methods.
      • Begly J.P.
      • Guss M.
      • Ramme A.J.
      • Karia R.
      • Meislin R.J.
      Return to play and performance after jones fracture in National Basketball Association athletes.
      The similarity score provided by Basketball-Reference quantifies the similarity between NBA players based off position, career length, and player performance defined by win shares. Win shares is a numeric value that represents the proportion of team wins that can be attributed to a single player’s contributions. For each injured subject, the 2 players with the highest similarity scores were selected as controls. For further verification, unpaired 2-tailed Student t-tests were performed to rule out any significant differences in age, height, body mass index (BMI), preindex PER, and preindex career minutes played between the injured group and control group. Player statistics from the control group were chosen from the season corresponding to the injured subject’s year in the NBA. For example, if an injured subject’s preindex season was his fourth year in the league, the control subject’s preindex statistics were gathered from his fourth year.

      Statistical Analysis

      No current literature exists reporting changes in player performance, as measured by PER, before and after quadriceps tendon injuries. Therefore, this study conducted a power analysis paralleling methodology of previous studies that explored changes in PER for other NBA knee injuries.
      • Nguyen M.V.
      • Nguyen J.V.
      • Taormina D.P.
      • Pham H.
      • Alaia M.J.
      A comprehensive return-to-play analysis of National Basketball Association players with operative patellar tendon tears.
      ,
      • Hodgens B.H.
      • Geller J.S.
      • Rizzo M.G.
      • Munoz J.
      • Kaplan J.
      • Aiyer A.
      performance outcomes after surgical repair of Achilles tendon rupture in the Women's National Basketball Association.
      A sample size of 6 was deemed acceptable to power this study (⍺ = 0.05, power = 0.8, standard deviation = 3). Three of the 9 injured players were excluded from analysis, with 2 suffering career-ending quadriceps tendon injuries, and the other having sustained his injury during the 2020-2021 season. Of the remaining 6 players, one individual retired after his first postindex season and was excluded from comparisons involving postindex season 2. Univariate comparisons of player statistics between the preindex season vs postindex seasons were conducted using paired 2-tailed Student t-tests. Unpaired 2-tailed Student t-tests were used to evaluate the changes in player statistics between the injured and control cohorts. Linear regression analysis was performed to determine whether the independent variables of age, height, BMI, years in NBA, preindex cumulative career minutes played, or preindex PER influenced the dependent variable of change in PER between the preindex season and postindex season 1. Statistically significant differences were noted if P < .05. All analyses were conducted using R, version 3.6 (R Core Team, Vienna, Austria) and Excel 2021 (Microsoft, Redmond, WA).

      Results

      Nine quadriceps tendon tears (6 partial tears, 3 complete ruptures) in NBA athletes were identified across a 30-year period (Table 1). The average age at the time of injury for partial tears was 28.7 ± 2.8 years, which was slightly younger than that of complete tears (32.0 ± 5.3 years). Height (1.96 ± 8.6 cm vs 193.0 ± 5.0 cm) and BMI (24.2 ± 2.3 vs 26.1 ± 2.8) were similar between the partial-tear and complete-tear cohorts. The majority of injured players (67%) played either the shooting guard or point guard position. No quadriceps tendon tears were noted at the center position. Of the 9 players with a torn quadriceps tendon, 2 (22%) did not return to play and retired. No unique player characteristics were associated with either of these career-ending injuries (Table 2). In those who did return to play, the average number of games missed, and calendar days missed were 50 and 214, respectively (Table 1). Eight players (89%) received operative treatment, including all who sustained a complete rupture. The return-to-play rate of those undergoing surgery was 75% (Table 2).
      Table 1Demographic Information of Quadriceps Tendon Tears in National Basketball Association Players
      Partial TearComplete TearAll Tears
      No. of players639
      Age at Injury,
      Reported as mean ± standard deviation.
      y
      28.7 ± 2.832.0 ± 5.329.8 ± 3.8
      Height,
      Reported as mean ± standard deviation.
      cm
      196.0 ± 8.6193.0 ± 5.0195.0 ± 7.0
      BMI,
      Reported as mean ± standard deviation.
      24.2 ± 2.326.1 ± 2.824.8 ± 2.5
      Position, %
       Center0 (0)0 (0)0 (0)
       Power forward1 (17)1 (33)2 (22)
       Small forward1 (17)0 (0)1 (11)
       Shooting guard2 (33)1 (33)3 (33)
       Point guard2 (33)1 (33)3 (33)
      Operative treatment, %5 (83)3 (100)8 (89)
      Return-to-play, %5 (83)2 (67)7 (78)
       Games missed48 (0-89)57 (27-86)50 (0-89)
       Days missed
      Reported as mean (range).
      185 (67-332)287 (206-368)214 (67-368)
      BMI, body mass index.
      Reported as mean ± standard deviation.
      Reported as mean (range).
      Table 2Injury characterization of Each Quadriceps Tendon Tear in National Basketball Association Players From the 1990-1991 to 2021-2022 Seasons
      Player Age, yCumulative Minutes Played
      TearSurgeryRTPPreinjuryPostinjury
      25PartialYesYes2,1657,210
      Currently active as of the 2021-2022 regular season.
      26PartialNoYes14,90710,074
      Currently active as of the 2021-2022 regular season.
      28PartialYesYes14,453173
      Currently active as of the 2021-2022 regular season.
      30PartialYesNo21,6550
      31PartialYesYes27,6943,321
      32PartialYesYes17,351274
      26CompleteYesYes12,6551,906
      Currently active as of the 2021-2022 regular season.
      34CompleteYesYes42,0982,141
      36CompleteYesNo43,5590
      RTP, return-to-play.
      Currently active as of the 2021-2022 regular season.
      In players who returned to play, there were no significant declines in PER between the preindex season and postindex season 1 (16.6 ± 2.2 vs 12.2 ± 3.5, P = .209) or postindex season 2 (17.5 ± 2.4 vs 15.6 ± 1.4, P = .386) (Table 3). Similar results were identified for PPG, TS%, and USG%. However, there were significant decreases in average games played (73.2 ± 6.6 vs 41.8 ± 10.8, P = .009) and average MPG (27.2 ± 2.9 vs 23.0 ± 3.7, P = .042) between preindex season and postindex season 1. This decline also was seen from the preindex season to postindex season 2 with average games played (79.6 ± 1.9 vs 51.2 ± 4.6, P = .006) and average MPG (29.3 ± 2.6 vs 24.7 ± 3.6, P = .032).
      Table 3Univariate Analysis of Player Performance in the Preindex Season Compared With the First Two Postindex Seasons
      Preindex Season
      Reported as mean ± standard error of the mean.
      Postindex Season 1
      Reported as mean ± standard error of the mean.
      Change
      Reported as mean ± standard error of the mean.
      P Value
      GP73.2 ± 6.641.8 ± 10.8–31.3 ± 7.6.009
      MPG27.2 ± 2.923.0 ± 3.7–4.3 ± 1.6.042
      PPG13.3 ± 3.110.8 ± 3.2–2.5 ± 1.9.235
      Per16.6 ± 2.212.2 ± 3.5–4.4 ± 3.0.209
      TS%0.54 ± 0.010.48 ± 0.06–0.06 ± 0.06.336
      USG%22.35 ± 2.3121.03 ± 2.23–1.32 ± 0.89.200
      Preindex Season
      Reported as mean ± standard error of the mean.
      The sample size of all comparisons involving Postindex Season 2 decreased from n = 6 to n = 5 due to one player retiring after Postindex Season 1.
      Postindex Season 2
      Reported as mean ± standard error of the mean.
      The sample size of all comparisons involving Postindex Season 2 decreased from n = 6 to n = 5 due to one player retiring after Postindex Season 1.
      Change
      Reported as mean ± standard error of the mean.
      The sample size of all comparisons involving Postindex Season 2 decreased from n = 6 to n = 5 due to one player retiring after Postindex Season 1.
      P Value
      GP79.6 ± 1.951.2 ± 4.6–28.4 ± 5.4.006
      MPG29.3 ± 2.624.7 ± 3.6–4.6 ± 1.4.032
      PPG14.7 ± 3.514.1 ± 3.4–0.6 ± 1.8.768
      PER17.5 ± 2.415.6 ± 1.4–1.9 ± 2.0.386
      TS%0.53 ± 0.010.53 ± 0.01–0.02 ± 0.02.288
      USG%22.82 ± 5.1123.80 ± 3.310.98 ± 2.08.662
      GP, games played; MPG, minutes per game; PER, player efficiency rating; PPG, points per game; TS%, true shooting percentage; USG%, usage percentage.
      Reported as mean ± standard error of the mean.
      The sample size of all comparisons involving Postindex Season 2 decreased from n = 6 to n = 5 due to one player retiring after Postindex Season 1.
      Changes in player performance after return to play was compared with matched controls in Table 4. The injured and control groups both demonstrated similar changes in PER for postindex season 1 (–4.4 ± 3.0 vs –1.9 ± 1.3, P = .326) and postindex season 2 (–1.9 ± 2.0 vs –1.2 ± 0.9, P = .651). This finding was consistent when evaluating MPG, PPG, TS%, and USG%. Players returning to play after quadriceps tendon tear exhibited significantly greater declines in games played in their postindex season 1 (–31.3 ± 7.6 vs 1.4 ± 8.2, P = .004) and postindex season 2 (–28.4 ± 5.4 vs 4.2 ± 7.9, P = .005) when compared with matched controls.
      Table 4Univariate Analysis of Changes in Player Performance Compared With Matched Controls
      Change From Preindex Season
      Injured Group
      Reported as mean ± standard error of the mean.
      The sample size of all comparisons involving Postindex Season 2 decreased from n = 6 to n = 5 due to one player retiring after Postindex Season 1.
      Control Group
      Reported as mean ± standard error of the mean.
      The sample size of all comparisons involving Postindex Season 2 decreased from n = 6 to n = 5 due to one player retiring after Postindex Season 1.
      P Value
      GP
       Postindex Season 1–31.3 ± 7.61.4 ± 8.2.004
       Postindex Season 2–28.4 ± 5.44.2 ± 7.9.005
      MPG
       Postindex Season 1–4.3 ± 1.6–3.0 ± 2.3.643
       Postindex Season 2–4.6 ± 1.4–2.5 ± 1.8.351
      PPG
       Postindex Season 1–2.5 ± 1.9–1.7 ± 1.7.716
       Postindex Season 2–0.6 ± 1.8–2.4 ± 1.5.396
      PER
       Postindex Season 1–4.4 ± 3.0–1.9 ± 1.3.326
       Postindex Season 2–1.9 ± 2.0–1.2 ± 0.9.651
      TS%
       Postindex Season 1–0.06 ± 0.06–0.03 ± 0.02.512
       Postindex Season 2–0.02 ± 0.020.00 ± 0.00.528
      USG%
       Postindex Season 1–1.32 ± 0.89–0.28 ± 1.37.506
       Postindex Season 20.98 ± 2.08–1.57 ± 1.47.261
      GP, games played; MPG, minutes per game; PER, player efficiency rating; PPG, points per game; TS%, true shooting percentage; USG%, usage percentage.
      Reported as mean ± standard error of the mean.
      The sample size of all comparisons involving Postindex Season 2 decreased from n = 6 to n = 5 due to one player retiring after Postindex Season 1.
      Linear regression analysis revealed no significant relationship between age, height, BMI, years in NBA, preindex cumulative career minutes played, or preindex PER and change in PER between the preindex and postindex season 1.

      Discussion

      The most important finding of this study is that most NBA players who experience an injury to the quadriceps tendon regain preinjury performance within 2 seasons. Of the 9 quadriceps tendon tears identified, 2 were considered career-ending (22%). This included a 36-year-old player with a complete rupture and 30-year-old player with a partial tear, both of whom received operative treatment (Table 2). Although both players were aged ≥30 years, there were 3 other players aged ≥30 years who sustained quadriceps tendon tears and did return to play after surgery. Further, the cumulative career minutes played between these players were comparable with those that did return to play. Neither age, operative treatment, nor cumulative minutes played appeared to influence the ability to return to NBA games. Consequently, no risk factors were identified for career-ending quadriceps tendon tears. These findings may aid NBA physicians and trainers in forming accurate expectations for players recovering from quadriceps tendon tears.
      In total, 78% of NBA players who returned to play after quadriceps tendon tears achieved preinjury PER levels by their first season back (P = .209) (Table 3). Changes in other player performance measures, including PPG (P = .235), TS% (0.336), and USG% (0.200) were not significant upon return to play. Interestingly, each of these player statistics markedly declined in the first season back, although not significant, and improved to nearly match baseline levels by the second season postinjury. With greater power, this study may have revealed a significant decrease in player performance in postseason index 1. Nonetheless, most NBA players with a torn quadriceps tendon can expect to regain their normal on-court production sometime within their first 2 seasons after returning. However, there appears to be a significant reduction in playing time after this type of injury. This study found significant decreases in GP and MPG within player’s first 2 seasons postinjury. Interestingly, comparisons with matched controls indicate the decline in MPG in injured players was similar to that of healthy players (P = .643, P = .351), and therefore may be an expected change at that point in their careers, independent of a torn quadriceps tendon (Table 4). Despite this, the decrease in GP is notable and likely to be multifactorial and may be attributable to a prolonged and conservative recovery, load management, secondary injuries, and other unknown variables. Overall, these findings suggest that NBA players sustaining a major quadriceps tendon injury will likely experience reductions in games played per season but should be able to return to preinjury performance within 1 to 2 seasons.
      Quadriceps tendon tears in other populations have yielded varied outcomes. In nonathletes with surgically repaired quadriceps tendons, good-to-excellent results have been achieved in 83% to 100% of cases.
      • Ilan D.I.
      • Tejwani N.
      • Keschner M.
      • Leibman M.
      Quadriceps tendon rupture.
      ,
      • Larsen E.
      • Lund P.M.
      Ruptures of the extensor mechanism of the knee joint. Clinical results and patellofemoral articulation.
      • Scuderi C.
      Ruptures of the quadriceps tendon; study of twenty tendon ruptures.
      • Siwek K.W.
      • Rao J.P.
      Bilateral simultaneous rupture of the quadriceps tendons.
      Interestingly, one study noted that 51% of patients were unable to return to their preinjury level of recreational activity after surgery despite a 92% patient satisfaction rate.
      • Konrath G.A.
      • Chen D.
      • Lock T.
      • et al.
      Outcomes following repair of quadriceps tendon ruptures.
      In comparison, in the current study, our results demonstrated that only 22% of players with a similar injury were unable to return to play. It is important to consider that nonathletes sustaining a quadriceps tendon tear are often aged >40 years and are unlikely to have the same goals or rehabilitative resources as NBA athletes. A more appropriate comparison may be between NBA and National Football League players. One study of National Football League players over a 10-year period revealed 14 individuals with quadriceps tendon tears, with only 7 (50%) returning to play in games after recovering.
      • Boublik M.
      • Schlegel T.F.
      • Koonce R.C.
      • Genuario J.W.
      • Kinkartz J.D.
      Quadriceps tendon injuries in National Football League players.
      Of the other 7 players with career-ending quadriceps tendon injuries, 6 were listed as offensive or defensive lineman. The BMI of players at these positions are historically greater than that of an average NBA player and may complicate the recovery of a major lower-extremity injury.
      • Maeda K.
      • Moll G.
      American Football sets players' body mass index.
      In the current study, all NBA players who suffered a quadriceps tendon tear had a BMI ≤29 at the time of injury.
      Outcomes of tears in the quadriceps tendon, as shown in this study, are similar to those reported in for patella tendon tears in basketball athletes. The current study’s findings parallel previous literature on patella tendon tears in NBA players which reported significant declines in GP and MPG between a player’ preindex season and postindex season 1.
      • Nguyen M.V.
      • Nguyen J.V.
      • Taormina D.P.
      • Pham H.
      • Alaia M.J.
      A comprehensive return-to-play analysis of National Basketball Association players with operative patellar tendon tears.
      The RTP rate in patella tendon tears (75%) is also comparable with that of quadriceps tendon tears (78%). Further review of other major knee injuries in NBA players reveal a similar trend in return-to-play rates: ACL tear (74%-78%), meniscus tear (81%), and knee microfracture surgery (79%-83%).
      • Busfield B.T.
      • Kharrazi F.D.
      • Starkey C.
      • Lombardo S.J.
      • Seegmiller J.
      Performance outcomes of anterior cruciate ligament reconstruction in the National Basketball Association.
      • Cerynik D.L.
      • Lewullis G.E.
      • Joves B.C.
      • Palmer M.P.
      • Tom J.A.
      Outcomes of microfracture in professional basketball players.
      • Kester B.
      • Kouk S.
      • Minhas S.V.
      • Azar F.M.
      • Bosco J.
      Effect of shoulder stabilization on career length and performance in National Basketball Association athletes.
      • Namdari S.
      • Baldwin K.
      • Anakwenze O.
      • Park M.J.
      • Huffman G.R.
      • Sennett B.J.
      Results and performance after microfracture in National Basketball Association athletes.
      • Yeh P.C.
      • Starkey C.
      • Lombardo S.
      • Vitti G.
      • Kharrazi F.D.
      Epidemiology of isolated meniscal injury and its effect on performance in athletes from the National Basketball Association.
      Consistent with the current study, no significant differences in PER were noted between preindex and postindex seasons when assessing NBA players with patellar tendon or meniscus tears.
      • Nguyen M.V.
      • Nguyen J.V.
      • Taormina D.P.
      • Pham H.
      • Alaia M.J.
      A comprehensive return-to-play analysis of National Basketball Association players with operative patellar tendon tears.
      ,
      • Yeh P.C.
      • Starkey C.
      • Lombardo S.
      • Vitti G.
      • Kharrazi F.D.
      Epidemiology of isolated meniscal injury and its effect on performance in athletes from the National Basketball Association.
      The prognosis of a quadriceps tendon tear appears to be akin to other traumatic knee injuries in the NBA athlete.

      Limitations

      This retrospective study had several limitations. First, injury data were extracted from a public database and verified through press releases and other public websites. Although this database has been cited by numerous publications, there may be inconsistencies between these data and official team medical records. The lack of access to medical records also prevented reporting of valuable clinical measures, such as range of motion, pain rating, and tear description. Second, the sample size of 9 subjects is small and increases the likelihood of a Type II error. Statistical comparisons between partial and complete quadriceps tendon tears, as well as players receiving operative versus nonoperative treatment were not completed due to the lack of power. This comparison would allow a more extensive prognostication of different quadriceps tendon tears in NBA athletes. Third, the player statistics chosen in this study provide only a partial characterization of a player’s overall performance and may be influenced by unaccounted factors such as team change.

      Conclusions

      NBA players with quadriceps tendon tears return to play in 78% of cases. These athletes achieved preinjury levels of performance within 1 to 2 seasons, but with reduced games played per season.

      Supplementary Data

      References

        • Hak D.J.
        • Sanchez A.
        • Trobisch P.
        Quadriceps tendon injuries.
        Orthopedics. 2010; 33: 40-46
        • Ciriello V.
        • Gudipati S.
        • Tosounidis T.
        • Soucacos P.N.
        • Giannoudis P.V.
        Clinical outcomes after repair of quadriceps tendon rupture: A systematic review.
        Injury. 2012; 43: 1931-1938
        • Mabe I.
        • Hunter S.
        Quadriceps tendon allografts as an alternative to Achilles tendon allografts: A biomechanical comparison.
        Cell Tissue Bank. 2014; 15: 523-529
        • Ilan D.I.
        • Tejwani N.
        • Keschner M.
        • Leibman M.
        Quadriceps tendon rupture.
        J Am Acad Orthop Surg. 2003; 11: 192-200
        • Kannus P.
        • Natri A.
        Etiology and pathophysiology of tendon ruptures in sports.
        Scand J Med Sci Sports. 1997; 7: 107-112
        • Nori S.
        Quadriceps tendon rupture.
        J Family Med Prim Care. 2018; 7: 257-260
        • Dauty M.
        • Menu P.
        • Garraud T.
        • et al.
        Jumper's knee mechanical consequences in professional basketball players: The "Camel's Back curve".
        Eur J Appl Physiol. 2019; 119: 735-742
        • Lian O.B.
        • Engebretsen L.
        • Bahr R.
        Prevalence of jumper's knee among elite athletes from different sports: A cross-sectional study.
        Am J Sports Med. 2005; 33: 561-567
        • King D.
        • Yakubek G.
        • Chughtai M.
        • et al.
        Quadriceps tendinopathy: A review—part 1: Epidemiology and diagnosis.
        Ann Transl Med. 2019; 7: 71
        • Nguyen M.V.
        • Nguyen J.V.
        • Taormina D.P.
        • Pham H.
        • Alaia M.J.
        A comprehensive return-to-play analysis of National Basketball Association players with operative patellar tendon tears.
        Orthop J Sports Med. 2018; 62325967118800479
        • Belk J.W.
        • Marshall H.A.
        • McCarty E.C.
        • Kraeutler M.J.
        The effect of regular-season rest on playoff performance among players in the National Basketball Association.
        Orthop J Sports Med. 2017; 52325967117729798
        • Bullock G.S.
        • Ferguson T.
        • Vaughan J.
        • Gillespie D.
        • Collins G.
        • Kluzek S.
        Temporal trends and severity in injury and illness incidence in the National Basketball Association over 11 seasons.
        Orthop J Sports Med. 2021; 923259671211004094
        • Chauhan A.
        • Stotts J.
        • Ayeni O.R.
        • Khan M.
        Return to play, performance, and value of National Basketball Association players following Achilles tendon rupture.
        Phys Sportsmed. 2021; 49: 271-277
        • Jildeh T.R.
        • Meta F.
        • Young J.
        • et al.
        Concussion is associated with increased odds of acute lower-extremity musculoskeletal injury among National Basketball Association players.
        Arthrosc Sports Med Rehabil. 2020; 3: e219-e225
        • Martin C.L.
        • Arundale A.J.H.
        • Kluzek S.
        • Ferguson T.
        • Collins G.S.
        • Bullock G.S.
        Characterization of rookie season injury and illness and career longevity among National Basketball Association players.
        JAMA Netw Open. 2021; 4e2128199
        • Morse K.W.
        • Hearns K.A.
        • Carlson M.G.
        Return to play after forearm and hand injuries in the National Basketball Association.
        Orthop J Sports Med. 2017; 52325967117690002
        • Begly J.P.
        • Guss M.
        • Ramme A.J.
        • Karia R.
        • Meislin R.J.
        Return to play and performance after jones fracture in National Basketball Association athletes.
        Sports Health. 2016; 8: 342-346
        • Hodgens B.H.
        • Geller J.S.
        • Rizzo M.G.
        • Munoz J.
        • Kaplan J.
        • Aiyer A.
        performance outcomes after surgical repair of Achilles tendon rupture in the Women's National Basketball Association.
        Orthop J Sports Med. 2021; 923259671211030473
        • Larsen E.
        • Lund P.M.
        Ruptures of the extensor mechanism of the knee joint. Clinical results and patellofemoral articulation.
        Clin Orthop Relat Res. 1986; 213: 150-153
        • Scuderi C.
        Ruptures of the quadriceps tendon; study of twenty tendon ruptures.
        Am J Surg. 1958; 95: 626-634
        • Siwek K.W.
        • Rao J.P.
        Bilateral simultaneous rupture of the quadriceps tendons.
        Clin Orthop Relat Res. 1978; 131: 252-254
        • Konrath G.A.
        • Chen D.
        • Lock T.
        • et al.
        Outcomes following repair of quadriceps tendon ruptures.
        J Orthop Trauma. 1998; 12: 273-279
        • Boublik M.
        • Schlegel T.F.
        • Koonce R.C.
        • Genuario J.W.
        • Kinkartz J.D.
        Quadriceps tendon injuries in National Football League players.
        Am J Sports Med. 2013; 41: 1841-1846
        • Maeda K.
        • Moll G.
        American Football sets players' body mass index.
        Glob Pediatr Health. 2018; 52333794X18785540
        • Busfield B.T.
        • Kharrazi F.D.
        • Starkey C.
        • Lombardo S.J.
        • Seegmiller J.
        Performance outcomes of anterior cruciate ligament reconstruction in the National Basketball Association.
        Arthroscopy. 2009; 25: 825-830
        • Cerynik D.L.
        • Lewullis G.E.
        • Joves B.C.
        • Palmer M.P.
        • Tom J.A.
        Outcomes of microfracture in professional basketball players.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 1135-1139
        • Kester B.
        • Kouk S.
        • Minhas S.V.
        • Azar F.M.
        • Bosco J.
        Effect of shoulder stabilization on career length and performance in National Basketball Association athletes.
        Bull Hosp Joint Dis (2013). 2019; 77: 223-229
        • Namdari S.
        • Baldwin K.
        • Anakwenze O.
        • Park M.J.
        • Huffman G.R.
        • Sennett B.J.
        Results and performance after microfracture in National Basketball Association athletes.
        Am J Sports Med. 2009; 37: 943-948
        • Yeh P.C.
        • Starkey C.
        • Lombardo S.
        • Vitti G.
        • Kharrazi F.D.
        Epidemiology of isolated meniscal injury and its effect on performance in athletes from the National Basketball Association.
        Am J Sports Med. 2012; 40: 589-594