Demographic Factors and Instantaneous Lower Extremity Injury Occurrence in a National Collegiate Athletic Association Division I Population

Abstract

Context: Temporal prediction of the lower extremity (LE) injury risk will benefit clinicians by allowing them to better leverage limited resources and target those athletes most at risk. Objective: To characterize the instantaneous risk of LE injury by demographic factors of sex, sport, body mass index (BMI), and injury history. Design: Descriptive epidemiologic study. Setting: National Collegiate Athletic Association Division I athletic program. Patients or Other Participants: A total of 278 National Collegiate Athletic Association Division I varsity student-athletes (119 males, 159 females; age ¼ 19.07 6 1.21 years, height ¼ 175.48 6 11.06 cm, mass ¼ 72.24 6 12.87 kg). Main Outcome Measure(s): Injuries to the LE were tracked for 237 6 235 consecutive days. Sex-stratified univariate Cox regression models were used to investigate the association between time to first LE injury and sport, BMI, and LE injury history. The instantaneous LE injury risk was defined as the injury risk at any given point in time after the baseline measurement. Relative risk ratios and Kaplan-Meier curves were generated. Variables identified in the univariate analysis were included in a multivariate Cox regression model. Results: Female athletes displayed similar instantaneous LE injury risk to male athletes (hazard ratio [HR] ¼ 1.29; 95% CI ¼ 0.91, 1.83; P ¼ .16). Overweight athletes (BMI .25 kg/m2) had similar instantaneous LE injury risk compared with athletes with a BMI of,25 kg/m2 (HR ¼ 1.23; 95% CI ¼ 0.84, 1.82; P ¼ .29). Athletes with previous LE injuries were not more likely to sustain subsequent LE injury than athletes with no previous injury (HR ¼ 1.09; 95% CI ¼ 0.76, 1.54; P ¼ .64). Basketball (HR ¼ 3.12; 95% CI ¼ 1.51, 6.44; P ¼ .002) and soccer (HR ¼ 2.78; 95% CI ¼ 1.46, 5.31; P ¼ .002) athletes had a higher risk of LE injury than cross-country athletes. In the multivariate model, instantaneous LE injury risk was greater in female than in male athletes (HR ¼ 1.55; 95% CI ¼ 1.00, 2.39; P ¼ .05), and it was greater in male athletes with a BMI of .25 kg/m2 than that in all other athletes (HR ¼ 0.44; 95% CI ¼ 0.19, 1.00; P ¼ .05), but these findings were not significantly different. Conclusions: In a collegiate athlete population, previous LE injury was not a contributor to the risk of future LE injury, whereas being female or being male with a BMI of .25 kg/m2 resulted in an increased risk of LE injury. Clinicians can use these data to extrapolate the LE injury risk occurrence to specific populations.