| Literature DB >> 26535256 |
Joshua D Harris1, David M Walton2, Brandon J Erickson2, Nikhil N Verma2, Geoffrey D Abrams3, Charles A Bush-Joseph2, Bernard R Bach2, Brian J Cole2.
Abstract
BACKGROUND: Use of microfracture in the knees of National Basketball Association (NBA) players is controversial. HYPOTHESES: (1) There would be a high rate of return to sport (RTS) in NBA players following microfracture, (2) players would RTS the season following surgery, (3) preoperative player performance would not be significantly different on RTS, and (4) there would be no significant difference in RTS rate or postoperative performance in players undergoing microfracture in comparison with an age-, position-, NBA experience-, and performance-matched control group. STUDYEntities:
Keywords: NBA; articular cartilage; basketball; knee; microfracture
Year: 2013 PMID: 26535256 PMCID: PMC4555513 DOI: 10.1177/2325967113512759
Source DB: PubMed Journal: Orthop J Sports Med ISSN: 2325-9671
Premicrofracture Versus Pre–Index Year Comparison
| Cases | Controls |
| 95% CI | |
|---|---|---|---|---|
| Seasons of NBA experience | 6.51 ± 4.54 | 6.51 ± 4.54 | .999 | –2.03 to 2.03 |
| Games played per season | 55.4 ± 15.1 | 61.3 ± 15.4 | .109 | −13.0 to 1.38 |
| Games played overall | 394 ± 303 | 472 ± 301 | .283 | −223 to 67.2 |
| Minutes played per game | 27.3 ± 9.22 | 26.3 ± 7.54 | .606 | −2.86 to 4.87 |
| BMI, kg/m2 | 24.7 ± 1.81 | 24.7 ± 1.63 | .999 | −0.810 to 0.810 |
| Age, y | 27.7 ± 4.73 | 27.7 ± 3.52 | .958 | −1.81 to 1.91 |
| Annual salary, millions of US$ | 4.25 ± 4.20 | 4.08 ± 3.36 | .853 | −1.60 to 1.92 |
| Points/game | 12.3 ± 5.81 | 12.2 ± 5.55 | .922 | −2.47 to 2.73 |
| Rebounds/game | 4.75 ± 2.23 | 4.72 ± 2.38 | .953 | −1.02 to 1.09 |
| Assists/game | 2.86 ± 2.69 | 2.78 ± 2.01 | .890 | −1.01 to 1.17 |
| Blocks/game | 0.560 ± 0.504 | 0.515 ± 0.467 | .690 | −0.178 to 0.267 |
| Steals/game | 1.03 ± 0.575 | 0.858 ± 0.436 | .135 | −0.057 to 0.411 |
| Field goal percentage | 0.454 ± 0.039 | 0.446 ± 0.037 | .353 | −0.009 to 0.026 |
| Free throw percentage | 0.754 ± 0.079 | 0.752 ± 0.077 | .900 | −0.033 to 0.038 |
| Players selected as “All-Stars,” n | 12 | 15 | .482 | −0.277 to 0.131 |
Values are expressed as mean ± standard deviation unless otherwise indicated. NBA, National Basketball Association; BMI, body mass index; CI, confidence interval.
Performance Comparison (Cases) Before and After Microfracture
| Before | After |
| 95% CI | |
|---|---|---|---|---|
| Seasons of NBA experience | 6.51 ± 4.54 | 4.10 ± 3.91 | .036 | 0.161 to 4.67 |
| Games played per season | 55.4 ± 15.1 | 44.3 ± 25.2 | .027 | 1.32 to 20.9 |
| Games played overall | 394 ± 303 | 224 ± 236 | .012 | 35.9 to 276 |
| Minutes played per game | 27.3 ± 9.22 | 23.2 ± 12.6 | .175 | −1.62 to 8.75 |
| Points/game | 12.3 ± 5.81 | 8.92 ± 5.25 | .015 | 0.664 to 6.01 |
| Rebounds/game | 4.75 ± 2.23 | 4.10 ± 2.61 | .259 | −0.492 to 1.89 |
| Assists/game | 2.86 ± 2.69 | 1.86 ± 2.01 | .077 | −0.113 to 2.12 |
| Blocks/game | 0.560 ± 0.504 | 0.494 ± 0.621 | .625 | −0.201 to 0.332 |
| Steals/game | 1.03 ± 0.575 | 0.712 ± 0.425 | .008 | 0.086 to 0.560 |
| Annual salary, millions of US$ | 4.25 ± 4.20 | 6.99 ± 5.44 | .018 | −5.01 to −0.475 |
| Field goal percentage | 0.454 ± 0.039 | 0.417 ± 0.109 | .075 | −0.00393 to −0.0784 |
| Free throw percentage | 0.754 ± 0.079 | 0.683 ± 0.138 | .021 | 0.0104 to 0.123 |
| Players selected as “All-Stars,” n | 12 | 6 | .105 | −0.031 to 0.327 |
Values are expressed as mean ± standard deviation unless otherwise indicated. NBA, National Basketball Association; CI, confidence interval.
Figure 1.Percentage of subjects able to play at least X number of games in the National Basketball Association (NBA) on return to sport (RTS).
Performance Comparison (Controls) Before and After Index Year
| Before | After |
| 95% CI | |
|---|---|---|---|---|
| Seasons of NBA experience | 6.51 ± 4.54 | 5.05 ± 3.43 | .207 | −0.844 to 3.77 |
| Games played per season | 61.3 ± 15.4 | 59.5 ± 11.4 | .306 | −3.08 to 9.66 |
| Games played | 472 ± 301 | 308 ± 244 | .156 | −43.3 to 262 |
| Minutes/game | 26.3 ± 7.54 | 26.7 ± 7.90 | .831 | −4.02 to 3.24 |
| Points/game | 12.2 ± 5.55 | 12.2 ± 6.62 | .994 | −2.88 to 2.85 |
| Rebounds/game | 4.72 ± 2.38 | 4.46 ± 2.45 | .650 | −0.877 to 1.40 |
| Assists/game | 2.78 ± 2.01 | 2.68 ± 2.31 | .841 | −0.913 to 1.12 |
| Blocks/game | 0.515 ± 0.467 | 0.474 ± 0.415 | .694 | −0.167 to 0.249 |
| Steals/game | 0.858 ± 0.436 | 0.830 ± 0.467 | .795 | −0.186 to 0.242 |
| Annual salary, millions of US$ | 4.08 ± 3.36 | 7.58 ± 5.57 | .003 | −5.77 to −1.23 |
| Field goal percentage | 0.446 ± 0.037 | 0.467 ± 0.074 | .167 | −0.047 to 0.008 |
| Free throw percentage | 0.752 ± 0.077 | 0.761 ± 0.087 | .653 | −0.047 to 0.030 |
| Players selected as “All-Stars,” n | 15 | 13 | .640 | −0.156 to 0.254 |
Values are expressed as mean ± standard deviation unless otherwise indicated. NBA, National Basketball Association; CI, confidence interval.
Figure 2.Survival in the National Basketball Association (NBA) following microfracture (or index year in controls).
Postmicrofracture Versus Post–Index Year Comparison
| Cases | Controls |
| 95% CI | |
|---|---|---|---|---|
| Seasons of NBA experience | 4.10 ± 3.91 | 5.05 ± 3.43 | .244 | −2.56 to 0.662 |
| Games played per season | 44.3 ± 25.2 | 59.5 ± 11.4 | .002 | −24.6 to −5.81 |
| Games played overall | 224 ± 236 | 308 ± 244 | .119 | −190 to 22.0 |
| Minutes/game | 23.2 ± 12.6 | 26.7 ± 7.90 | .178 | −8.54 to 1.62 |
| Points/game | 8.92 ± 5.25 | 12.2 ± 6.62 | .029 | −6.20 to −0.337 |
| Rebounds/game | 4.10 ± 2.61 | 4.46 ± 2.45 | .560 | −1.60 to 0.871 |
| Assists/game | 1.86 ± 2.01 | 2.68 ± 2.31 | .126 | −1.89 to 0.238 |
| Blocks/game | 0.494 ± 0.621 | 0.474 ± 0.415 | .875 | −0.235 to 0.276 |
| Steals/game | 0.712 ± 0.425 | 0.830 ± 0.467 | .286 | −0.336 to 0.101 |
| Annual salary, millions of US$ | 6.99 ± 5.44 | 7.58 ± 5.57 | .665 | −3.32 to 2.14 |
| Field goal percentage | 0.417 ± 0.109 | 0.467 ± 0.074 | .014 | −0.107 to −0.013 |
| Free throw percentage | 0.683 ± 0.138 | 0.761 ± 0.087 | .008 | −0.156 to −0.024 |
| Players selected as “All-Stars,” n | 6 | 13 | .066 | −0.354 to 0.012 |
Values are expressed as mean ± standard deviation unless otherwise indicated. NBA, National Basketball Association; CI, confidence interval.
Technical Pearls for Microfracture Surgery in the Knee
|
Removal of all injured articular cartilage |
|
Clean, stable borders of the articular cartilage defect |
|
Vertical walls of the articular cartilage defect |
|
Removal of the calcified cartilage layer at the base of the articular cartilage defect |
|
Selection of appropriate angle of awl to penetrate subchondral plate perpendicular to plate surface |
|
Move inward from peripheral to central |
|
Holes 3-4 mm apart, 3-4 mm deep |
|
Avoid hole convergence |
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Remove all bony debris after hole creation |
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Ensure tourniquet is deflated to observe marrow elements entering joint |
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Immediate postoperative motion (either intermittent active or continuous passive) |
|
Protected weightbearing (for tibiofemoral lesions) |
Years 1 to 5 Following Microfracture (Cases) Versus Index Year (Controls)
| Case Group (Microfracture) | Control Group |
| 95% CI | |
|---|---|---|---|---|
| Year 1 | ||||
| No. of games played | 41.6 ± 25.8 | 67.6 ± 15.1 | <.001 | –36.4 to –15.6 |
| Minutes/game | 22.7 ± 10.3 | 27.5 ± 11.0 | .081 | –10.3 to 0.604 |
| Points/game | 10.1 ± 6.04 | 12.7 ± 8.48 | .172 | –6.43 to 1.17 |
| Rebounds/game | 4.28 ± 2.42 | 4.42 ± 2.53 | .824 | –1.40 to 1.12 |
| Assists/game | 2.09 ± 2.30 | 2.65 ± 2.64 | .375 | –1.83 to 0.700 |
| Steals/game | 0.836 ± 0.773 | 0.839 ± 0.546 | .986 | –0.336 to 0.330 |
| Blocks/game | 0.464 ± 0.621 | 0.411 ± 0.387 | .679 | –0.202 to 0.309 |
| Field goal percentage | 0.437 ± 0.105 | 0.458 ± 0.086 | .385 | –0.069 to 0.027 |
| Free throw percentage | 0.728 ± 0.100 | 0.736 ± 0.128 | .781 | –0.067 to 0.051 |
| Year 2 | ||||
| No. of games played | 52.6 ± 28.6 | 63.1 ± 16.9 | .100 | –23.2 to 2.11 |
| Minutes/game | 24.1 ± 9.74 | 28.2 ± 9.49 | .100 | –9.05 to 0.812 |
| Points/game | 10.0 ± 6.21 | 13.6 ± 8.31 | .063 | –7.38 to 0.207 |
| Rebounds/game | 4.56 ± 3.08 | 4.73 ± 2.74 | .825 | –1.66 to 1.32 |
| Assists/game | 2.06 ± 2.08 | 3.04 ± 2.95 | .140 | –2.31 to 0.334 |
| Steals/game | 0.713 ± 0.556 | 0.882 ± 0.535 | .236 | –0.451 to 0.113 |
| Blocks/game | 0.593 ± 0.830 | 0.419 ± 0.365 | .303 | –0.164 to 0.513 |
| Field goal percentage | 0.430 ± 0.142 | 0.458 ± 0.069 | .325 | –0.084 to 0.028 |
| Free throw percentage | 0.724 ± 0.143 | 0.765 ± 0.111 | .218 | –0.107 to 0.025 |
| Year 3 | ||||
| No. of games played | 55.7 ± 19.6 | 62.7 ± 19.1 | .208 | –18.0 to 4.01 |
| Minutes/game | 24.3 ± 10.3 | 27.6 ± 9.53 | .247 | –9.08 to 2.39 |
| Points/game | 10.0 ± 5.89 | 12.9 ± 7.71 | .147 | –6.77 to 1.05 |
| Rebounds/game | 4.80 ± 2.81 | 4.49 ± 2.47 | .686 | –1.21 to 1.83 |
| Assists/game | 2.23 ± 2.41 | 2.85 ± 2.86 | .428 | –2.17 to 0.936 |
| Steals/game | 0.848 ± 0.558 | 0.972 ± 0.628 | .476 | –0.472 to 0.224 |
| Blocks/game | 0.519 ± 0.604 | 0.514 ± 0.584 | .978 | –0.339 to 0.349 |
| Field goal percentage | 0.676 ± 1.08 | 0.444 ± 0.091 | .341 | –0.263 to 0.725 |
| Free throw percentage | 0.742 ± 0.093 | 0.767 ± 0.130 | .461 | –0.092 to 0.043 |
| Year 4 | ||||
| No. of games played | 63.4 ± 23.5 | 59.2 ± 19.4 | .506 | –8.56 to 17.1 |
| Minutes/game | 26.4 ± 9.06 | 27.9 ± 8.26 | .565 | –6.78 to 3.75 |
| Points/game | 10.6 ± 5.82 | 12.5 ± 7.39 | .359 | –6.10 to 2.26 |
| Rebounds/game | 5.09 ± 2.85 | 4.47 ± 2.50 | .443 | –1.00 to 2.25 |
| Assists/game | 2.50 ± 2.73 | 2.88 ± 2.71 | .649 | –2.05 to 1.29 |
| Steals/game | 0.831 ± 0.513 | 0.912 ± 0.532 | .617 | –0.402 to 0.241 |
| Blocks/game | 0.594 ± 0.722 | 0.572 ± 0.623 | .913 | –0.385 to 0.430 |
| Field goal percentage | 0.455 ± 0.057 | 0.447 ± 0.090 | .725 | –0.040 to 0.057 |
| Free throw percentage | 0.720 ± 0.082 | 0.755 ± 0.107 | .253 | –0.094 to 0.025 |
| Year 5 | ||||
| No. of games played | 63.2 ± 26.3 | 60.6 ± 21.4 | .725 | –12.6 to 17.9 |
| Minutes/game | 25.8 ± 9.98 | 27.6 ± 8.44 | .544 | –7.81 to 4.19 |
| Points/game | 9.52 ± 6.37 | 12.5 ± 8.31 | .228 | –8.02 to 1.98 |
| Rebounds/game | 5.09 ± 3.09 | 4.53 ± 2.86 | .559 | –1.38 to 2.52 |
| Assists/game | 2.49 ± 2.51 | 3.26 ± 2.77 | .382 | –2.53 to 0.991 |
| Steals/game | 0.956 ± 0.689 | 0.805 ± 0.564 | .458 | –0.257 to 0.558 |
| Blocks/game | 0.744 ± 0.760 | 0.455 ± 0.432 | .140 | –0.099 to 0.676 |
| Field goal percentage | 0.447 ± 0.085 | 0.450 ± 0.068 | .892 | –0.053 to 0.046 |
| Free throw percentage | 0.723 ± 0.135 | 0.799 ± 0.117 | .067 | –0.159 to 0.006 |
Values are expressed as mean ± standard deviation. CI, confidence interval.