Knee Injury Rates Across High School Sports and Genders

knee pain and injuries in US

Knee injuries in high school sports

High school sports participation in the US is still on the rise which is fantastic news for the future health and wellbeing of the next generation. Hopefully this early participation in sports and exercise will continue into each student’s adult life.

However, along with sport often comes injury and injury can mean extended periods out of action which can be devastating in those hoping to make sport a career choice, as well as a financial burden to players and their families.


A new study published this month in Medicine and Science in Sports and Exercise, looked at the Epidemiology of Knee Injuries Amongst US High School Athletes from 2005-2011. The study aimed to observe injury data across 20 high school sports to compare the rates and patterns of knee injuries between sports and genders.

In total, 5116 knee injuries were recorded in the National High School Sports-Related Injury Surveillance System from 2005-2011, across the 100 schools included in the study. Initially, 9 sports were included in the study, which were:

  • Football
  • Boys’ and girls’ soccer
  • Girls’ volleyball
  • Boys’ and girls’ basketball
  • Wrestling
  • Baseball
  • Softball

11 more sports were added for the 2008-2011 seasons which were:

  • Girls’ field hockey
  • Girls’ gymnastics
  • Boys’ ice hockey
  • Boys’ and girls’ lacrosse
  • Boys’ and girls’ swimming and diving
  • Boys’ and girls’ track and field

And finally boys’ volleyball and cheerleading were added between 2009-2011.


The data collected demonstrates that football results in the most knee injuries with a rate of 6.29 per 10,000 athlete exposures. The average rate across all sports was 2.98 per 10,000. This above average result is not surprising due to the heavy contact element of the sport.

The next highest knee injuries rates were in girls’ soccer and girls’ gymnastics.  Across all comparable sports (other than lacrosse), girls had a significantly higher knee injury rate than their male counterparts.

This outcome is backed up by previous research and the reasons behind this are thought to be differences in anatomy and biomechanics between the sexes. You can read more on ACL injury frequency in females here. The reasons why injuries sustained during lacrosse practice or matches did not significantly differ between sexes warrants further investigation as this could help with reducing knee injury risk for girls in other sports.

Of the injuries sustained, the Medial Collateral Ligament was the most commonly involved structure, with 36.1% of injuries affecting this ligament. Next up was the patella and/or patella tendon at 29.5% and the Anterior Cruciate Ligament at 25.4%.

Girls are significantly more likely to sustain Anterior Cruciate ligament injuries in sex-comparable sports and are also are more often treated with surgery for knee injuries than boys, indicating that knee injuries sustained by girls are more serious or complex in nature.


With promising careers at risk, injury prevention strategies should be of top priority. Whilst following rules, guidelines on warm-ups and wearing appropriate protective equipment can all help with this, many injuries are not sustained due to neglecting basic injury prevention procedures. Knee injuries in young female athletes are due to abnormal biomechanics, especially in jumping and landing patterns and cutting manoeuvres.

Neuromuscular training which aims to develop strength and co-ordination between the muscles and nervous system with proprioceptive and jumping drills having been shown to be effective at preventing knee injuries, if started early enough. Those that started neuromuscular training by the age of 14 had a huge 72% reduction in the risk of tearing an ACL! Read more on Neuromuscular training and ACL injuries here.

Finally, further research into the movement patterns, training drills, strengthening and flexibility exercises and warm-up techniques used in high school Lacrosse versus other high school sports should be conducted to help determine the reasons behind the lower relative rate of knee injuries in female lacrosse players. This information may be useful in developing injury prevention strategies for other sports.

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