Abstract
Objectives:
Basketball is a high-intensity sport associated with acute and overuse injuries in both females and males. With the growing popularity of basketball at all levels domestically and globally, there has been an increased emphasis in understanding the injury patterns of these athletes. A large proportion of the current literature on basketball injuries utilize publicly available websites to obtain medical data. Thus, there is a need for prospectively collected data from healthcare professionals as it pertains to basketball injuries. By utilizing a conference-specific injury database, this study sought to characterize the types of injuries affecting elite intercollegiate female and male basketball players. Upon establishing commonly recognized injury patterns as well as associated return to sport data, this study can potentially help guide prevention and treatment protocols.
Methods:
A blinded conference-specific injury database was utilized to perform a retrospective review of injuries for male and female Division I collegiate basketball players from 2017 to 2021. Analysis included musculoskeletal injuries stratified by anatomic location, gender, time missed and injury diagnosis. Time missed was categorized as no time away from sport, less than three weeks away from sport and more than three weeks away from sport. “Estimated athlete risk per year” was used as a surrogate for risk per athlete-year since observation periods were not known for each individual athlete due to the data being blinded. On average, athletes were followed for 2.3 years, which assumes an equal number of freshmen, sophomores, juniors, and seniors per year and no athletes transferring/quitting.
To estimate athlete exposure hours (AEH), total season length in weeks was multiplied by 20 hours per week as this is the maximum duration of sport-related activity according to the National Collegiate Athletic Association bylaws. Team rosters as well as season start and end dates were obtained from publicly available schedules on the Pac-12 website.
Injury rate (IR) per 1000 AEHs was calculated by the following formula:
IR per 1000 AEH= [(Number of total in-season injuries) / (Season length in weeks * 20 hrs / week * number of athletes on the team)] * 1000.
Relative risk (RR) was used to compare estimated athlete risk per year between genders with statistical significance being defined by a 95% confidence interval (CI) not including one (p < 0.05).
Results:
A total of 663 college basketball players out of 853 (77.7%) suffered 4532 total injuries. Significantly more females suffered an injury (314 out of 360, 87.2%) when compared to males (349 of 493, 70.8%; RR: 1.23 [95% CI: 1.15 - 1.32]).
The most common injuries across genders were ankle and hindfoot injuries accounting for 1007 out of 4532 (22.2%), knee injuries accounting for 750 injuries (16.5%), head/face injuries accounting for 532 injuries (11.7%), forefoot injuries accounting for 446 injuries (9.8%) and hand/wrist/forearm injuries accounting for 359 injuries (7.9%). Women were significantly more likely to suffer a knee injury (RR: 1.49 [95% CI: 1.27-1.75]), a head/face injury (RR: 1.32 [95% CI: 1.09-1.60]) or a midfoot/forefoot injury (RR: 1.42 [95% CI: 1.14-1.76]) (Table 1).
Although ankle sprains were the most common injury, 259 ankle sprains out of 660 (39.2%) did not result in any time away from sport and 306 ankle sprains (46.4%) resulted in time away from sport but less than three weeks. One hundred and ninety-one concussions affected 146 out of 853 athletes (17.1%). Eighty-two out of 360 female athletes (22.8%) suffered a concussion as compared to 64 out of 493 male athletes (13.0%; RR: 1.23, [95% CI: 1.15-1.32]). Return to sport data was not specified for 22 out of 191 concussions. Of the remaining 169 concussions, 17 (10.1%) resulted in more than three weeks away from sport (Table 2).
Conclusions:
Lower extremity injuries were expectedly the most common injuries seen in both male and female basketball players, however these injuries did not result in substantial periods of missed playing time. Most current injury prevention strategies and proprioceptive training exercises focus on the lower extremity, with the ankles in particular. The current study, however, demonstrates that basketball players suffer from a variety of injuries suggesting that injury prevention techniques should be expanded to include all areas of the body.
Females suffered significantly more injuries than males. Specifically, females suffered more knee injuries, head/face injuries, midfoot/forefoot injuries and concussions. Variations in anatomy, muscle strength and proprioceptive patterns are all possible rationales for this increased injury rate in females, however the definitive rationale is not completely understood. One additional possible rationale is that psychosocial factors have been shown to cause males to underreport symptoms.
Understanding the injury patterns and the prognoses of such injuries can help physicians guide the expectations of these athletes, optimize the patient-athlete relationship and ultimately keep our collegiate basketball players safe.
