Sports Medicine Research: In the Lab & In the Field: High School Knee Injuries (Sports Med Res)


Wednesday, November 14, 2012

High School Knee Injuries

Epidemiology of Knee Injuries Among US High School Athletes, 2005/06 – 2010/11

Swenson DM, Collins CL, Best TM, Flanigan DC, Fields SK, & Comstock RD. Medicine & Science in Sports & Exercise. Published ahead of Print. doi 10.1249/MSS.0b013e318277acca

Sports injury risk increases with greater participation and competitiveness that is occurring at the high school level.  Previous reports have demonstrated that the prevalence of knee injuries is high among the US high school population, however, there is a lack of information reported regarding gender and sport.  The purpose of this observational epidemiologic study was to report knee injury rates in the high school athletic population (including sport & the injured structure).  One hundred schools were randomly selected across varying sizes and socioeconomic status to participate in this injury surveillance study.  High school athletic trainers reported athletic exposure and injury information to the National High School Sports Related Injury Surveillance System, High School Reporting Information Online.  Fifteen percent of all athletic injuries reported between 2005/06 – 2010/11 seasons were knee injuries, with approximately half of these being ligamentous in nature.  Nationally, it was extrapolated that there were over 1.2 million knee injuries in high school athletics during this time frame.  Highest knee injury rates occurred in football (6.29), girls’ soccer (4.53) and girls’ gymnastics (4.23), while the average was 2.98 (knee injuries per 10,000 athletic exposures).  The highest injury rates occurred in competition over practice and in females over males in gender comparable sports.  The most commonly injured structure was the medial collateral ligament, and 21.2% of all knee injuries were treated with surgery.     

Clinically, there is a need for sport specific injury prevention programs at the high school level.  It appears that this study is mirroring some similar findings at the collegiate level (higher number of knee injuries in males, greater rates in females, and significant number treated with surgery).  However, many of the injury prevention programs focus on preventing non-contact ACL injuries, and there may need to be prevention programs more appropriately designed for contact ACL injuries.  Also, athletes in contact sports who may be more susceptible to contact ACL injuries could possibly benefit from a protective brace of some sort.  On another note, these early knee injuries pose a significant financial burden in the short-term, however, could severely affect quality of life in the long-term.  Evidence demonstrates that injuries to the anterior cruciate ligament or meniscus can result in osteoarthritic changes within 10 years of injury.  High school athletes range from the ages of 13 – 18, and as a result of suffering a knee injury so early in life, could be physically hampered in their mid to late twenties.  This could adversely affect their collegiate athletic career or their normal active lifestyles.  Prevention is key.  Does anyone have any ideas of any existing programs that may be successful or where these programs should be worked into a young athlete’s training?  How early should we start trying to utilize any prevention programs?  Does anyone have any opinions on the possibility of a preventative bracing for contact ACL injuries?        

Written by: Nicole Cattano 
Reviewed by: Stephen Thomas

Related Posts:
Swenson DM, Collins CL, Best TM, Flanigan DC, Fields SK, & Comstock RD (2012). Epidemiology of Knee Injuries Among US High School Athletes, 2005/06-2010/11. Medicine and Science in Sports and Exercise PMID: 23059869


Anonymous said...

This is all very interesting, but I can't help but look at the big picture...why are 13 year old getting injuries like ACL tears? What happened to playing outside with your friends, riding bikes, playing tag, etc? At the high school where I work, there are middle schoolers doing off-season conditioning in the weight room everyday. How did we get to this level of competition in children? I am a big proponent of physical activity, but physical activity is not equivalent to competitive sports. I can't help but think there is something wrong with this, and the people who are going to suffer most are the children who are having injuries that used to only be seen in people much older.

Zahida Mitha said...

I agree with Natalie. Children are starting to specialize in sports at younger and younger ages, and the results are troubling. I think the biggest issue is that they are focusing only on one sport and training for movement patterns of that specific sport. This poses a huge risk because they are losing their ability to adapt to different types of stresses and situations and suffering injuries, such as the ones in this article, at alarmingly young ages. I agree that prevention is key. Training these children in different types of sports and activities may be one way to help prevent some of these injuries.

Brian Sabb said...


This is interesting information. I agree with Natalie on a number of points. The competitiveness of sports is mirroring the competitiveness of academics for youngsters. Many youngsters are not given the chance to be kids anymore. This practice will take a physical and mental toll.


Brian Sabb

Nicole Cattano said...

All comments above are great points. Physically you wonder if such an early focus on a specialized sport is more of a hindrance than a help. Kids who used to just "go out and play" may have aided in their physical development. And to Brain's point, I coukdnt agree more. Mentally the intense focus on competitiveness will certainly have some negative effects.

It is so a great point that Natalie brings up. There has been such a shift in the sociocultural aspect of youth sports. With the alarming number of ACL injuries in youth we need to make an adjustment in our preventative care measures so that the youth do not continue to suffer.

William T. said...

I don’t think preventative knee bracing is the way to go. If you consider these kids are young, pre-pubescent, still developing and yet to begin to build strength/girth that, assuming they stick with it through HS and college even. Point being, you’re setting yourself up to have to buy a new brace after a couple years or so and current prophylactic braces like the DonJoy Defiance brace isn’t cheap; run about $900 each. Let’s say you apply this to a middle school football player who goes on to compete in college, you figure they’ll need a new pair sooner than later especially since they’re still developing. In addition, in the NCAA at D-I level for most the top football programs across the board the linemen are the only players you can get to wear them since skilled players view them as being “too bulky” and slow them down. I don’t think it’s realistic to apply prophylactic knee braces at a younger age than college especially due to the funding aspect.

Going off of the psychological aspect I agree, I think too much of anything is not a good thing. I do agree with kids honing their skills early and developing their niche but with that there pressures and scrutiny that come with it. An extreme example would be someone like Todd Marinovich or Chris Herron; both phenomenal high school athletes who were exposed to high pressure situations and limited basically to one sport and one sport only (football and basketball, respectively). Both players ended up making it to the professional level but not without rather difficult personal issues along the way. Both rather interesting and moving stories. The point being that I agree with the aforementioned; I do think kids are getting limited at younger ages however I do feel that if you’re good at something it’s kind of difficult to keep someone from doing it. I don’t think we can assume or view it as kids are being forced or limited to doing one sport in that maybe they do prefer doing something because they’re still with their friends and they’re succeeding therefore having fun. Just a thought.

Nicole Cattano said...

Thanks for your comments William. I agree that prophylactic bracing seems expensive and potentially cumbersome to the athlete. I think the best way to preventitively attack this issue may actually be in exercises or some type of sport specific prevention program. It is possible that without as much cross training or general "playing" (outside or otherwise), these athletes are not developing appropriate musculature or nueromuscular control patterns. Honestly, I only opt for knee bracing for psychological/ confidence reasons or in the instances of football linemen as you mention.

Your points about the psychological effects of specializing early are well made. There are always exceptions to the rules. But the NCAA came out with commercials a few years ago with athletes stating that they will be going pro in something other than their sport. Parental pressure has seemed to drastically increase, with many athletes or parents thinking they may be the next Lebron James, Peyton Manning, or Derek Jeter. When they succeed it is more justified as to why they specialized so early, but seemingly still at some personal difficulties. Even Michael Jordan played more than one sport. :)

Anonymous said...

All are great points....However, there seems to be one lacking point. Many of the "coaches" and staff overseeing the training of these kids do not have the specialized training to teach these kids any different then what they did or do themselves. Harsh reality but the truth.

Anonymous said...

I am commenting on this blog for a Health project.

Why do you think there are so many knee injuries for high school athletes.

Marisa Rizzo said...

I agree with this article. Athletes who receive a knee injury in high school have a long life ahead of them and a lot of things to do still so they don't want to get osteoarthritis. In my opinion it should be a no brainer when it comes to preventative programs especially in high school aged kids who are still growing and their bodies are still maturing.

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