- There is a gender difference with 56–64% of male
injuries occurring to the lower extremity and 65–69%
in females (Messina and DeLee, 1999; Powell, 2000).
This is thought to be due to increase in female knee
injury rates compared to males.
KNEE
•Twelve percent of all injuries in male collegiate
athletes are knee injuries, while the knee accounts
for 19% of injuries in women (Arendt and Dick,
1999).
- Although knee injuries are not the most common type
of lower extremity injury they account for most of the
lost playing time because the nature of the injuries are
more severe (Zvijac, 1996).
•Patellofemoral syndrome is a broad description that
characterizes pain and dysfunction of the extensor
mechanism of the knee resulting from poor biome-
chanics (patella tracks laterally) or inflammation that
in athletes is usually associated with overuse of the
knee. Treatment involves modification of training reg-
imen, ice, NSAIDs, and correction of underlying
muscle or bony mal-tracking with quadriceps
strengthening. The vastus medialis is responsible for
maintaining medial patellar alignment when other
forces act to move the patella laterally. If strength
training does not correct the problem, taping or func-
tional braces can be helpful.
•Two common causes of anterior shin pain in basket-
ball players are medial tibial stress syndrome (shin
splints) and tibial stress fractures. They represent two
points on a continuum of muscle overuse leading to
periostitis and finally bone degradation. These over-
use injuries are characterized with pain on the medial
border of the tibia, typically in the lower mid portion.
Ice, rest, NSAIDs, correcting foot and ankle biome-
chanics, and adjusting training regimens will usually
improve shin splints. - Stress fracture symptoms included worsening of typical
pain beyond the time of activity and prolonged recovery
times from episodes of intense activity or competition.
Plain films can show periostitis and stress fractures, but
delayed phase bone scans and magnetic resonance
imaging (MRI) are much more sensitive. Treatment
involves an initial period of rest that may include use of
removable casts or crutches for pain relief. A very grad-
ual reintroduction of activity with close symptom mon-
itoring will allow for recovery in most cases.
•Patellar tendinitis or Jumpers Knee is common in bas-
ketball, found in 40–50% of high level players (Khan,
2003). It results from excessive forces through the
extensor mechanism on the anterior knee. Symptoms
include anterior knee pain just below the patella that
is worse with sitting, squatting, kneeling, or climbing
stairs. Point tenderness on the superior pole of the
patellar tendon and pain with hyperextension of the
knee are seen. An initial phase of symptom reduction
with relative rest, ice, and NSAIDs can be fol-
lowed by strengthening exercises with postactivity
ice application. Use of infrapatellar straps or taping is
common.- Osgood-Schlatter disease is an inflammatory apo-
physitis resulting from excessive pull by the patellar
tendon on the tibial tuberosity. It appears in young
players typically aged 10 to 15 years during a period
of rapid growth combined with intense physical
activity. Treatment includes relative rest and analge-
sia but pain diminishes when growth ceases.
Rupture is rare so participation in sports should not
be limited. - Anterior cruciate ligament(ACL) injuries account for
10% of male basketball knee injuries while making up
26% of female knee injuries (Sitler et al, 1994). The
majority of ACL injuries are noncontact, and involve
the player planting and pivoting on the knee.
•ACL injury differences between males and females
have been attributed to intrinsic factors such as inter-
condylar notch size and shape, hormone differences,
ACL size, and joint laxity as well as extrinsic factors
such as strength, skill, experience, shoewear, and con-
ditioning. There is ongoing debate as to the true
mechanism and cause of ACL injuries and differences
among the sexes. - The natural history of ACL tears is early degenerative
arthritis to the affected knee. To avoid this, it is gener-
ally recommended for athletes to have ACL recon-
struction using one of many accepted techniques
(patellar autograft, cadaver graft, hamstring autograft,
and the like). If patients are not expecting significant
continued activity on the knee there are times when
rehabilitation and bracing are appropriate.
ANKLE AND FOOT- Ankle injuries make up 87% of lower extremity
injuries and are the most common type seen in bas-
ketball (Sitler et al, 1994). Inversion sprains to the
anterior talofibular ligament comprise 66% of all lig-
amentous ankle injuries. Many injuries result from a
player landing on another player’s foot.
•Ankle taping has been shown to prevent injury
(Garrick, 1973) but the concern exists that support
from taping declines with time and activity. - Lace up and semirigid ankle braces also prevent
injury and decrease the severity of ligamentous sprain
468 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS