Anterior cruciate ligament (ACL) tears are one of the most detrimental injuries seen commonly in the National Basketball Association (NBA). Despite high rates of recovery after ACL reconstruction, players miss a substantial amount of time after surgery before returning to the court. The purpose of this study was to examine the economic impact of ACL tears on NBA players and teams by calculating costs of recovery (COR) and classifying players based upon pre-injury success level, pre-injury salary, and position. It was hypothesized that players with lower pre-injury salary or primarily a reserve role to have decreased rates of return to NBA play and shorter careers.

Methods

Male NBA players that sustained an ACL injury that required surgery were reviewed from the 2000-2001 season through the 2014-2015 season. Injury data of interest included games missed, return to play in NBA rate, retention of player at 3 years post-injury in NBA, number of years played post-injury, and rate of re-injury to reconstructed ACL. Performance metrics were assessed based upon Player Efficiency Rating (PER), both in the season of injury and post-reconstruction. Salary data (adjusted for inflation) was collected for the season in which injury occurred and for the subsequent 3 seasons.

Results

35 players met inclusion criteria and were included in analysis. We evaluated the pre-injury yearly salary for all players and categorized them; Group C (10 players) was greater than 4 million dollars per year, Group B (13 players) was 1.5 to 4 million per year, Group A (12 players) was less than 1.5 million per year (Figure 1). The cumulative economic loss from ACL injuries in the NBA from 2001-2015 was $99 million. The average COR for an NBA player that sustained an ACL injury was $2.9 million per player. NBA players missed and average of 62 games or 332 days recovering from ACL reconstruction. Our RTP rate was 91%, though at 3 years post-injury only 70% of players were still in the NBA. Players that made a salary less than $1.5 million per season prior to the injury had a significantly lower PER (difference of -7), RTP rate of 63% and at 3 years only 37% remained in the NBA. Recovering All-Star caliber players were associated with a large drop in PER (-6.2) and failure to return to previous success level in the season after ACL reconstruction (0%), though they did have a 100% RTP rate and an average career length of 5.6 seasons post-injury.

Conclusion

In the salary cap era, it is crucial for teams and players to have an understanding of the costs and timing associated with recovery from ACL reconstruction. This study found that players that made less than $1.5 million pre-injury or played primarily a reserve role were associated with lower RTP and retention in the NBA at 3 years. The findings of this study suggest that a player’s reputation within the NBA prior to injury does seem to impact recovery and subsequent performance outcomes.