Performance After Operative Versus Nonoperative Management of Shoulder Instability in the National Basketball Association

Abstract

Background: Although nonoperative management after shoulder instability injury allows an athlete to return to play sooner than operative intervention, higher rates of recurrence have been observed after nonoperative management. However, no study has investigated the differences in performance of National Basketball Association (NBA) players after index shoulder instability events managed nonoperatively versus operatively. Purpose/Hypothesis: The purpose of this study was to identify shoulder instability events in NBA athletes and assess differences in performance after injury with nonoperative versus operative management. We hypothesized that players who undergo operative intervention have reduced risk of recurrence and are able to continue their elite level of play as opposed to those who undergo nonoperative management. Study Design: Cohort study; Level of evidence, 3. Methods: Publicly available injury data from the 1986-1987 through 2017-2018 seasons were reviewed to identify NBA athletes sustaining a shoulder instability event. In addition to characteristics, player performance information, including games played, player efficiency rating (PER), and win shares, was analyzed before and for 3 seasons after injury. Statistical learning models were applied to identify performance variables that have the greatest predictive value to determine players who would benefit from surgery. Results: A total of 60 players with shoulder instability events were identified between 1986 and 2018. After injury, 37 players (61.7%) eventually underwent surgery and 23 players (38.3%) did not. Players who were treated nonoperatively had significantly decreased PER, games played, and offensive win shares in the season after injury (P