Injury in High School Basketball Players

Abstract & Commentary

Synopsis: The rate of reportable injuries during a single high school basketball season was 0.56 for boys and 0.49 among girl athletes, and the risk of injury per hour of exposure was not significantly different between genders. However, female athletes had a significantly higher rate of knee injuries. For both sexes, the risk of injury during a game was significantly higher than during practice.

Source: Messina DF, et al. The incidence of injury in Texas high school basketball: A prospective study among male and female athletes. Am J Sports Med 1999;27:294-299.

This is a prospective study of the incidence of injuries among high school basketball players in 100 Texas high schools during two seasons. Both male and female basketball players were analyzed. The athletic trainer at each high school reported injuries to the University Interscholastic League in Austin, Texas. A reportable injury was defined as one that occurred during a game or practice, that resulted in missed practice or game time, required a physician consultation, or involved the head or neck. The rate of injury was 0.56% for boys and 0.49% for girls. The risk of injury per hour was not statistically different between the two groups. In both gender groups, the most common injuries were sprains and the most injured area was the ankle, followed by the knee. Female athletes had a significantly higher rate of knee injuries, including a 3.79 greater risk of anterior cruciate ligament (ACL) injury. For both boys and girls the risk of injury was higher during game play than practice.

Comment by Barry Goldberg, MD, FAAP

This study by Messina and colleagues from the Orthopaedic Department at the University of Texas Health Service in San Antonio presents another example of the issues of gender differences in the frequency, site, and severity of sports-related injuries. Early studies indicated that women had an overall higher injury in sport-specific activities. This difference, if real, may have been related to skill and lack of conditioning. With time and better and more consistent study designs, it has been repeatedly demonstrated that injury rates are, in fact, now similar. This may be related to improved training, conditioning, and skill in girls.

As injury studies became more sport-specific, a rather constant finding has been the higher incidence of ACL injuries in women in basketball and soccer. The previously mentioned differences in conditioning and skill were raised as causes, but also implicated were intrinsic hormonal factors, gender differences in joint laxity, strength differences, as well as variations in bone morphology, such as the size of the intercondylar notch. Though there may be other specific causes that have yet to be determined, it is clear that there are sports-specific gender difference in injuries such as the increased frequency of stress fractures in female runners.

Despite the lack of definitive evidence of causative variables, the physician caring for athletes should be aware of the risks and introduce preventive measures wherever possible. In basketball this will require a careful preparticipation examination of the ankles and knees to ascertain strength and joint laxity and complete rehabilitation from prior injuries. It has been my experience that weakness and joint laxity predispose to significant ligamentous injuries in high-velocity contact sports. The findings of these characteristics should initiate the recommendation of a season-long strength program, as well as the use of external support in extreme circumstances. Of course, conditioning training and skill development should always be a component of the program, as should attention to proper nutrition and appropriate hormonal balance. (Dr. Goldberg is Head of the Sports Medicine Clinic at Yale University.)

True statements about sports-related injuries include all of the following except:

a. They currently are significantly higher in girls than in boys.

b. In the past, gender differences in incidence may have been related to lack of skill and proper conditioning.

c. There is a higher rate of stress fractures in female than in male runners.

d. There is a higher frequency of knee injuries in female than in male athletes.