Concussion Is Associated With Increased Odds of Acute Lower-Extremity Musculoskeletal Injury Among National Basketball Association Players

Abstract

Purpose: To determine the odds of sustaining an acute lower-extremity (LE) musculoskeletal injury during the 90-day period after return-to-play (RTP) from concussion in National Basketball Association (NBA) athletes. Methods: Concussion data for NBA players were collected from the 1999-2000 to 2017-2018 seasons, from publicly available sources. Age, position, injury, time to RTP, and demographic factors were collected. The 90-day period after each case of concussion was reviewed for acute noncontact LE musculoskeletal injury. Control athletes without a documented history of concussion were matched to concussed athletes by age, body mass index, position, and experience. Conditional logistic regression with a calculated odds ratio and a 95% confidence interval were used to assess the association between concussion and subsequent risk of LE injury. Results: In total, 189 concussions were documented in 153 athletes. Of these, 140 cases were the first recorded instance of concussion in players with publicly available data. Thirty-six (25.7%) athletes sustained a LE injury within 90 days of concussion; 26 (20.2%) were non–season-ending and included in RTP analysis. The odds of sustaining an acute LE musculoskeletal injury within the 90-day period after concussion was 4.69 times greater in concussed players compared with controls (95% confidence interval 1.96-11.23, P < .001). There was no significant difference in games (4.2 ± 5.0 vs 4.7 ± 4.7 games, P = .566) or days (18.5 ± 39.1 days vs 10.9 ± 10.6 days, P = .912) missed between concussed players with LE injury and nonconcussed controls. The most common LE injuries in concussed athletes were ligament sprains/tears (65%). Conclusions: Concussed NBA athletes have increased odds for sustaining an acute LE musculoskeletal injury within 90 days of RTP compared with nonconcussed controls. The most common injuries were ligament strains or tears. Changes in neuromotor control and proprioception following a concussion should be evaluated in high-level basketball players returning to sport. Level of Evidence: Level III, Case-Control Study.