Athletic injuries: Comparison by age, sport,
and gender
KENNETH E. DeHAVEN,* MD, and DAVID M. LINTNER
From the University of Rochester,
ABSTRACT
Injuries treated at the University of Rochester Section
of Sports Medicine over a 7 year period were surveyed.
Patients were drawn from professional, intercollegiate
(Division 111), high school, intramural, and unorganized
athletics at the University and the surrounding com-
munity. Data on injury diagnosis was available for 4,551
cases, with data on age, gender, and sport of injury
available for 3,431 of the cases. The average patient
age was 21.6 years, with a peak in the 16 to 19 age
group. Patients with fractures had an average age
below the overall mean, while those with internal
derangement of the knee, patellofemoral pain syn-
drome, and inflammatory injuries were signifcantly older
than average. Males accounted for 80.3% of all injuries.
For both sexes the most common areas injured were
the knee and ankle, with sprains/strains the most com-
mon injuries. Injuries involving the patellofemoral artic-
ulation were significantly more frequent among females.
The most common sport of injury was football, with
greater than 12 times the number of injuries seen in the
next most common
sport.
Participation in athletics entails risk of injury. All sports
are not equal in this risk. Different sports result in qualita-
tively and quantitatively different stresses to different so-
matic locales. As a result, participants in various sports tend
to incur different injuries. At the various stages of physical
maturity, forces transmitted to the body of the athlete are
different due not only to size and strength differences,’ but
also to the changing nature of sports as age increases. For
most athletes, the intensity of athletic competition peaks in
the late teens and early twenties, diminishing thereafter.
Thus, at different age levels the types of injuries may be
expected to vary. Females have become much more athleti-
*
Address correspondence and reprint requests to Kenneth E DeHaven,
MD, University of Rochester School of Medicine and Dentistry, 601 Elmwood
Avenue, Rochester, NY 14642
School of Medicine and Dentistry, Rochester, New York
cally active and now constitute a significant portion of sports
injuries. This study is part of an attempt to quantitate and
evaluate injuries to females, noting differences in the type
or amount of injuries sustained by females compared to
males. The knee is one of the most frequently injured joints
in athletics, and special attention was devoted throughout
this study to injuries involving the knee. We examined the
data regarding knee injuries in particular for differences
between genders, sports, and age groups.
Previous studies have examined injuries in specific sports
or in major university and professional athletic pro-
grams.1-7 This study examines the cases treated by a practice
in athletic medicine which draws patients from a midsize,
nonathletic scholarship institution and the surrounding
community, and will provide the foundation for future stud-
ies.
METHODS
Patient data were stored in computer files at the University
of Rochester University Health Services. Information coded
on patients treated by the Section of Athletic Medicine of
the Department of Orthopaedics included age, sex, sport of
injury, diagnosis, and surgical procedure, if any. The patient
population is drawn from students at the University of
Rochester (enrollment 6,500) and from the community at
large. The University of Rochester is a nonathletic scholar-
ship institution, and the patients include student-athletes
participating in Division III intercollegiate, intramural, and
unorganized athletics. In addition, Dr. DeHaven has been
the team physician for the local minor league baseball and
hockey teams (baseball since 1975, hockey since 1980). In-
juries incurred by these professional athletes are included in
the data. No attempt was made to differentiate between
recurrent injuries or different injuries to the same individual.
The sample population was drawn from the period of May
1975 to July 1983. The sample was stratified into age groups,
gender groups, and sport of injury categories. The data base
consisted of 4,551 total cases, with data on age, gender, and
sport available for 3,431 patients from June 1976 through
218
 219

TABLE 1 TABLE 2
Diagnoses per age group -
Diagnosis category by age

TABLE 3
Frequency of diagnosis by gender

TABLE 4
Commonly mjured areas by gender

July 1983. This sample may not reflect the true incidence of
injuries since data on the number of injuries per 100 partic-
ipants per season is unavailable. Statistical analysis con-
sisted of chi-square and Student t-test evaluations.
220

TABLE 5 TABLE 6
Sprains/strains by gender Knee injuries by gender

° Lateral collateral ligament.

TABLE 7
Fractures by gender

°
Lateral collateral ligament.
b Includes rotator cuff and acromioclavicular, glenohumeral, and
sternoclavicular joints.

RESULTS

Age
The average age of patients seen from June 1, 1976, through
July 1983 was 21.6 years. The peak age group was 16 to 19
years (1,546 cases; 45% of total cases), followed by 20 to 25
years (870, 25%) and 13 to 15 years (542, 16% ).
The most common diagnoses for each age group are shown

in Table 1. During adolescence the frequencies of the patel-
lofemoral pain syndrome and internal derangement of the
knee accelerate, remaining in the top two spots until the
sixth decade. Inflammatory problems such as tendinitis or
bursitis gradually increase in importance after age 30, and
TABLE 8
Dislocations by gender
Basketball and
TABLE 10
Common injuries by sport
221
by the seventh decade three of the top five maladies are
inflammatory in nature.
The average ages for general and specific diagnosis cate-
gories are shown in Table 2. The mean age for fractures
(17.8 years) is less than the mean age for all injuries (P <
0.0005). The mean age for inflammatory diseases (23.5
years) is substantially greater than the mean age for all
injuries (P < 0.0005). The top three specific diagnoses-
internal derangement of the knee, patellofemoral pain syn-
drome, and sprains/strains of the knee joint [medial collat-
eral ligament (MCL) and ACL]-have average ages of 22.9,
25.6, and 22.2, respectively, all above the mean age for all
injuries (P < 0.005).
Gender
The types and numbers of male injuries treated are listed in
Table 3. Males accounted for 80.3% of all cases from June
1976 through July 1983. Of all injuries to males, the most
common were sprains/strains (919; 33.4% of male injuries),
followed by internal derangement of joints (376; 13.7%) and
fractures (347; 12.6%). The joints/areas most often injured
were the knee and ankle (Table 4). The most common male
sprain/strain was to the knee, with the MCL (190; 20.7% of
all sprain/strain) and the ACL (108; 11.8% of male sprain/
strain) suffering the most (Table 5). Internal derangement
of the knee was the second most common male diagnosis, as
well as the most common male knee injury (Table 6). Frac-
TABLE 9
soccer injuries by gender
222

tures of thetibia/fibula were the most common fractures in TABLE 111

males, followed closely by those of the hand phalanges and Ranking of injury by sport (in top 10 sports)
ankle (Table 7). Together these types of fractures accounted
for greater than 56% of all male fractures. Table 8 shows
the data on dislocations.
The types and numbers of the most common diagnoses
for injured females are in Table 3. Of the patients treated,
19.7% were female. The most common injuries to females,
as to males, were sprains/strains (28.7% of female injuries).

However, in contrast to the males, the second most common

diagnosis for females was the patellofemoral pain syndrome
(19.6% of female diagnoses). In the male sample, the patel-
lofemoral pain syndrome is ranked fifth (7.4% of all male
diagnoses). The joints/areas most often injured were, again,
knees and ankles (59.2% and 13.1% of female injuries, Table
4). However, while the most common knee pathology in
males was internal derangement, knee pain in females was
most often diagnosed as the patellofemoral pain syndrome
(33.2% of female knee injuries, 19.6% of all female injuries,
Table 6). Of the 198 female sprains and strains in this
sample, the knee has the most of any joint (Table 5).
Specifically, the knee MCL and ACL were the most common
sprains encountered in females, resulting in 12.1 % of all
female injuries. The relative frequencies of knee internal
derangement and of the various knee sprains/strains do not
differ significantly between the sexes. Also, see Table 8 for
figures on dislocation injuries.
Some notable differences in diagnosis frequencies between
males and females were found in injuries involving the
patella. The patellofemoral pain syndrome accounted for
19.6% of all female injuries (Table 5) compared with 7.4%
of all male injuries. Also, recurrent patellar dislocation was
found in 4.6% of the female patients and only 0.7% of the
males. Similarly, acute patellar dislocations were diagnosed
in 2.7% of female patients and 0.5% of the males. The
differences aresignificant (P < 0.0005).
The most commonly treated male and female injuries for
two sports common to both sexes, basketball and soccer, are
listed in Table 9. Internal derangement of the knee domi-
nates both male groups, but ranks third in both female
groups. However, within each sport the difference between
male and female frequencies of this injury is statistically
insignificant. The frequency of recurrent patellar disloca-
tion/subluxation is significantly greater in female than male
basketball players (P < 0.005), but this difference is not
observed among soccer players.

Sports
As Table 10 shows, the most common sport of injury was
football, with greater than 12 times the number of injuries
seen in the next most common sport basketball. Football
accounted for 63.9% of all injuries in this sample, as well as
60.0% of all knee injuries. Basketball accounted for 5.0% of
all injuries, followed by soccer (3.2%) and track/running
(2.7% ). Thirteen other sports were less frequently seen.
For the major sports of injury, the most frequent diagnoses
are listed in Table 11. As expected, knee injuries were the
most common for the major sports, ranging from 36.9% of
 223

TABLE 12
Knee injuries by sport

° Football knee injuries (809) account for 60.0% of all knee injuries, 17.8% of all injuries, and 36.9% of all football injuries.
’ Soccer knee injuries (65) account for 4.8% of all knee injuries, 1.4% of all injuries, and 58.6% of all soccer injuries.
C
Basketball knee injuries (107) account for 7.9% of all knee injuries, 2.4% of all injuries, and 61.8% of all basketball injuries.
d Track knee injuries (39) account for 2.9% of all knee injuries, 0.9% of all injuries, and 41.9% of all track injuries.
e
Baseball knee injuries (30) account for 2.3% of all knee injuries, 0.7% of all injuries, and 38.5% of all baseball injuries.

football injuries to 61.8% of basketball injuries. Table 12
lists specific knee diagnoses by sport of injury.
Basketball and soccer each demonstrated a higher relative
frequency of recurrent patellar dislocation (RPD)/subluxa-
tion (number of RPD/number of injuries for that sport)
than did football. These differences are significant (P <
0.005). The other patellar injuries did not exhibit this trend.
DISCUSSION
This study identifies several interesting points. First, foot-
ball accounted for the vast majority of injuries in this sample.
The margin of greater than 12 to 1 over the next most
common sport is impressive indeed. However, it is interest-
ing that while the most common injury overall was an
injured knee in a football player, knee injuries made up a
smaller fraction of injuries in football than in the other
major sports of injury (basketball, soccer, track/running,
and baseball). Without means to calculate injury rates (i.e.,
number of injuries/number of participants/season) it is dif-
ficult to determine if this difference is real or an artifact of
sampling error. Thus, further study is warranted.
Knee injuries were more common among injured female
athletes than among the males (P < 0.005). This trend is
observed for sprains/strains involving the knee, injuries
involving the patellofemoral articulation (see below), and
other knee injuries as well (Table 6). Female injuries are
more concentrated about the knee joint than are those of
males. Concordantly, the percentages of male injuries in-
volving the shoulder and hand are higher than observed in
injured females, and the males’ injuries are spread more
evenly around the body.
224
Another point of interest centers on injuries involving the
patellofemoral articulation. Aside from these categories, all
diagnoses show a male predominance, with a ratio of at least
2.4 males/1 female. Recurrent patellar dislocation/subluxa-
tion and acute patellar dislocation depart sharply from this
trend. Females accounted for more cases of RPD and acute
patellar dislocation than did males, despite males constitut-
ing greater than 80% of the patient sample. Each of these
diagnoses accounts for a significantly higher percentage of
injuries to females than of injuries to males (P < 0.005).
Also, sports common to males and females exhibited in-
creased frequencies of RPD/subluxation in comparison to
sports in which only males participate. For example, soccer
and basketball have both male and female participants and
demonstrate significantly higher frequencies of RPD/sub-
luxation than does football (P < 0.005). Among basketball
players, however, females had a significantly higher fre-
quency of RPD/subluxation than did males, but this differ-
ence was not observed among soccer players (the frequency
of acute patellar dislocation did not vary significantly be-
tween the sexes in these sports).
The difference in frequency of RPD between male and
female basketball players may be due to a host of factors. In
view of the lack of a frequency difference between male and
female soccer players, it is unlikely that the difference among
basketball players is due solely to gender. Also, it is unlikely
that basketball by itself predisposes female basketball play-
ers RPD/subluxation since the difference in frequency
to
between basketball and soccer players (controlling for gen-
der) is not statistically significant. Perhaps the nature of
basketball, with its greater amount of jumping than soccer,
coupled with gender differences in lower extremity anatomy,
predisposes to RPD/subluxation.
ACKNOWLEDGMENT
This work was supported in part by HMS Grant Hl-07496
from the National Institutes of Health.
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