Rates and Patterns of Lower Extremity Sports Injuries in All Gender-Comparable US High School Sports

BACKGROUND: High school athletes with lower extremity sports injuries (LESIs) frequently present to the emergency department in the United States. Previous epidemiological studies have presented rates and mechanisms of LESIs in these athletes. No studies, however, have looked at LESIs in gender-comparable sports in an attempt to evaluate what differences exist between LESIs in boys and girls. PURPOSE: To describe the epidemiology of LESIs among US high school athletes using a large national database of athletes in sports that could be considered gender comparable, given the rules of play and protective equipment. STUDY DESIGN: Descriptive epidemiology study. METHODS: Descriptive data from 2005 to 2016 were collected using the internet-based High School Reporting Information Online (High School RIO), a national high school sports injury surveillance system, for athletes participating in 8 gender-comparable sports (soccer, volleyball, basketball, baseball/softball, swimming and diving, track and field, cross-country, and tennis). Rates and patterns of injury were evaluated, with injury rates calculated as ratio of injuries per 10,000 athlete-exposures. Rate ratios (RRs) were calculated to compare the LESI rates in girls and boys. RESULTS: In both genders, LESI rates (per 10,000 athlete-exposures) were highest in soccer (girls, 15.87; boys, 11.68) followed by basketball (girls, 11.51; boys, 9.35), and were lowest in swimming and diving (girls, 0.70; boys, 0.39). Although injury rates were significantly higher in girls compared with boys in all sports, only in tennis was the RR greater than 2 (RR, 2.03; 95% CI, 1.17-3.54). Girls had a greater proportion of severe LESIs and injuries that received radiographic evaluation, such as magnetic resonance imaging, compared with boys for all sports except volleyball. Consistency in the mechanism of injury was demonstrated between genders within each sport. CONCLUSION: This study demonstrated that LESIs are common among high school athletes and disproportionately affect girls more than boys, especially when looking at severe injuries and resource utilization. Further studies are needed to elucidate the cause of these findings. We hope that the awareness of gender-based differences in LESIs will lead to improvements in targeted efforts to decrease injury rates and injury severity.