Abstract
Purpose
Knowledge of epidemiologic trends of meniscal injuries in young active populations is limited. Better awareness of injury patterns is a first step to lowering injury rates. Our hypothesis was that meniscal injuries in high school athletes would vary by gender, sport, and type of exposure.
Methods
During 2007–2013, a large nationally disperse sample of US high schools reported athlete exposure and injury data for 22 sports by having certified athletic trainers complete an internet-based data collection tool.
Results
1,082 meniscal injuries were reported during 21,088,365 athlete-exposures for an overall injury rate of 5.1 per 100,000 athlete exposures. The overall rate of injury was higher in competition (11.9) than practice (2.7) (RR = 4.4; 95% CI, 3.9–5.0), and 12/19 sports showed significantly higher injury rates in competition compared to practice. Of all injuries, 68.0% occurred in boys, yet among the gender-comparable sports of soccer, basketball, track and field, lacrosse, and baseball/softball injury rates were higher for girls than boys (5.5 and 2.5, respectively, RR = 2.2; 95% CI, 1.8–2.7). Contact injury represented the most common mechanism (55.9%). Surgery was performed for the majority of injuries (63.8%), and 54.0% of athletes had associated intra-articular knee pathology.
Conclusions
Meniscal injury patterns among high school athletes vary by gender, sport, and type of exposure. Overall rates are higher for boys, but this is driven by football; however in gender-comparable sports girls may be at higher risk for meniscal injury. Our study is clinically relevant because recognition of distinct differences in these injury patterns will help drive evidence-based, targeted injury prevention strategies and efforts.
Level of Evidence
Level III
Keywords: meniscus, mechanism of injury, high-school athletes, gender
Introduction
Steady increases in high school athletics participation over the past decade resulted in 7.6 million participants during the 2011–12 academic year [20]. While many health benefits are associated with participation in sports, interscholastic athletics incurs risk of acute injuries which can have long-term consequences [8]. Meniscal injuries are one such injury, with a reported mean annual incidence rate in the general population of 66–70 per 100,000 people [11, 12, 21]. Concurrently, arthroscopic treatment for meniscal injuries is an extremely common orthopaedic procedure in the United States [2, 16, 27]. Recognition of risk factors for the development of meniscal injuries in youth athletes is essential to preserving the long-term health of the knee as meniscal lesions are associated with a 4 to 14 times increase in the risk of knee osteoarthritis [9, 17, 18, 28, 32, 33].
Published epidemiologic studies regarding meniscal pathology leave many questions unanswered, though broad trends have been established. The two most common etiologies are acute trauma and degenerative processes [5, 11, 18]. The mean age of traumatic meniscal injury is 30 years and the mean age for degenerative meniscal lesions is 40 years [18]. The peak incidence of meniscal injuries in males is between 21–30 years and in females between 11–20 years [6, 23]. The incidence of meniscal injury for both genders declines with increasing age [6, 23].
Beyond establishing broad trends, published epidemiologic data on meniscal injuries remains limited. Most studies fail to assess mechanism of injury [5, 23]. There are limited data on specific populations. Some researchers have targeted elite athletic subgroups such as professional basketball players [35] and collegiate soccer players [3] or military populations [15, 31]. Several studies include limited data on meniscal injuries as part of a larger focus on knee injuries [7, 10, 13, 19, 21, 29] or overall sports injuries [14]. However, data on meniscal injuries specifically in children are outdated or lack generalizability [1]. Although some publications report meniscal injury incidence by sport [4, 14, 19, 34] they lack athletic exposure information and thus cannot be used to compare rates by sport or gender.
The objective of this study was to establish the epidemiology of meniscal injuries among U.S. high school athletes in 22 sports; to compare injury rates by sport, gender, and type of athletic exposure; and to delineate injury pattern by mechanism and severity. Defining more comprehensive epidemiological trends regarding meniscal injuries among U.S. high school athletes will lay groundwork for future evidence-based prevention and treatment strategies.
Materials and Methods
Data were evaluated from the National High School Sports-Related Injury Surveillance System, High School Reporting Information Online (RIO), an Internet-based sports injury surveillance system sampling a large national convenience sample, which has been described previously [25]. Beginning in 2005/06, high schools with a National Athletic Trainers’ Association–affiliated certified athletic trainer (AT) were invited to participate. Willing participants were categorized into 8 strata based on school population (enrollment ≤1000 or >1000) and geographic location. From these strata, 100 schools were randomly selected to participate in the nationally representative sample to report data from nine sports. High School RIO has since expanded to include 13 additional sports (Table 1). An insufficient number of schools from each strata volunteered to report for each additional sport to enable random selection, therefore data for these sports were collected from a large national convenience sample. At the end of each study year an internal validity check is conducted among a random 5% sample of reporting high schools. Although the results vary slightly each year, the sensitivity, specificity, positive predictive value, and negative predictive value have each been well over 90% for each internal validity check. This is a strong indication of the accuracy of the data collected by High School RIO.
Table 1.
Sports Included in National High School Sports-Related Injury Surveillance Study, United States, 2007/08 – 2012/13.
| 6 Years of Data a | 5 Years of Data | 4 Years of Data | 3 Years of Data | 1 Year of Data |
|---|---|---|---|---|
| boy’s football, boy’s soccer, boy’s basketball, boy’s wrestling, boy’s baseball, girl’s soccer, girl’s basketball, girl’s volleyball, and girl’s softball track and field | boys’ ice hockey, boy’s lacrosse, boy’s swimming and diving, boy’s track and field, girls’ field hockey, girl’s lacrosse, girls swimming and diving, and girl’s | girls’ gymnastics, co-ed cheerleading | boy’s volleyball | boys’ cross country, and girls’ cross country |
Playing apparatus included items like ball, base, goalpost, etc.
ATs from participating high schools reported injury incidence and athlete exposure weekly for their assigned sports. Beginning with the 2007/08 academic year, ATs were asked to specify structures injured when reporting knee injuries, including the meniscus. Therefore this study utilizes data on all 22 sports included in High School RIO from 2007/08–2012/13. An athlete exposure was defined as one athlete participating in one athletic practice or competition. Reportable injuries (1) occurred during organized practice or competition, (2) required medical attention by an AT or a physician, and (3) resulted in restriction of participation for ≥1 day or (4) resulted in fracture, concussion, or dental injury regardless of whether there was subsequent restriction in participation. For each injury, the AT completed a detailed report on the athlete (age, height, weight, etc), the injury (site, diagnosis, severity, etc), and the injury event (activity, mechanism, etc). Reporters were able to update previously submitted reports as needed. The study was approved by the Institutional Review Board of Nationwide Children’s Hospital, Columbus, OH, protocol IRB08-00003.
Statistical analysis
Data were analyzed using SPSS software, version 21.0 (SPSS Inc, Chicago, Illinois, USA). Rates and proportions were calculated using unweighted case counts. Rate ratios (RRs) and injury proportion ratios (IPRs) were used to measure magnitudes of associations. RRs and IPRs whose 95% confidence intervals did not contain 1.00 were considered statistically significant.
Results
A total of 1,082 meniscal injuries were reported over the course of 6 school years. There were three sports in which no meniscal injuries were reported: boys’ volleyball, boys’ swimming and diving, and boys’ cross country, thus the athlete exposures from these sports were excluded from analysis. The 1,082 meniscal injuries occurred during 21,088,365 athlete exposures for an overall injury rate of 5.1 per 100,000 athlete exposures (Table 2). Boys’ football alone accounted for 42.4% of all injuries. The sports with the highest injury rates were boys’ football, girls’ soccer, girls’ basketball, and boys’ wrestling (Table 3).
Table 2.
Meniscal Injury Rates per 100,000 Athlete-Exposures, National High School Sports-Related Injury Surveillance Study, United States, 2007/2008 – 2012/2013
| Sport | Meniscal Injuries | Athlete-Exposures (AEs) | Rate per 100,000 AEs | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Competition | Practice | Total | Competition | Practice | Total | Competition | Practice | Total | Rate Ratio a (95% CI) | |
| Boys’ football | 279 | 180 | 459 | 685,169 | 3,416,209 | 4,101,378 | 40.7 | 5.3 | 11.2 | 7.7 (6.4, 9.3) |
| Boys’ soccer | 38 | 15 | 53 | 467,046 | 1,095,909 | 1,562,955 | 8.1 | 1.4 | 3.4 | 5.9 (3.3, 10.8) |
| Girls’ soccer | 92 | 25 | 117 | 396,368 | 906,157 | 1,302,525 | 23.2 | 2.8 | 9.0 | 8.4 (5.4, 13.1) |
| Girls’ volleyball | 11 | 16 | 27 | 472,211 | 931,724 | 1,403,935 | 2.3 | 1.7 | 1.9 | 1.4 (0.6, 2.9) |
| Boys’ basketball | 32 | 25 | 57 | 556,635 | 1,306,919 | 1,863,554 | 5.7 | 1.9 | 3.1 | 3.0 (1.8, 5.1) |
| Girls’ basketball | 74 | 37 | 111 | 453,932 | 1,035,355 | 1,489,287 | 16.3 | 3.6 | 7.5 | 4.6 (3.1, 6.8) |
| Boys’ wrestling | 48 | 53 | 101 | 365,742 | 1,025,088 | 1,390,830 | 13.1 | 5.2 | 7.3 | 2.5 (1.7, 3.8) |
| Boys’ baseball | 9 | 7 | 16 | 486,145 | 907,092 | 1,393,237 | 1.9 | 0.8 | 1.1 | 2.4 (0.9, 6.4) |
| Girls’ softball | 15 | 7 | 22 | 355,797 | 683,906 | 1,039,703 | 4.2 | 1.0 | 2.1 | 4.1 (1.7, 10.1) |
| Girls’ field hockey | 8 | 7 | 15 | 150,923 | 327,580 | 478,503 | 5.3 | 2.1 | 3.1 | 2.5 (0.9, 6.8) |
| Girls’ gymnasticsb | 3 | 2 | 5 | 15,026 | 65,713 | 80,739 | 20.0 | 3.0 | 6.2 | 6.6 (1.1, 39.3) |
| Boys’ ice hockey | 8 | 2 | 10 | 101,725 | 210,092 | 311,817 | 7.9 | 1.0 | 3.2 | 8.3 (1.8, 38.9) |
| Boys’ lacrosse | 18 | 9 | 27 | 163,878 | 365,390 | 529,268 | 11.0 | 2.5 | 5.1 | 4.5 (2.0, 9.9) |
| Girls’ lacrosse | 13 | 6 | 19 | 119,506 | 262,834 | 382,340 | 10.9 | 2.3 | 5.0 | 4.8 (1.8, 12.5) |
| Girls’ swimming and diving | 2 | 2 | 4 | 96,302 | 406,775 | 503,077 | 2.1 | 0.5 | 0.8 | 4.2 (0.6, 23.0) |
| Boys’ track and field | 5 | 8 | 13 | 245,343 | 1,042,517 | 1,287,860 | 2.0 | 0.8 | 1.0 | 2.7 (0.9, 8.1) |
| Girls’ track and field | 8 | 13 | 21 | 200,439 | 850,747 | 1,051,186 | 4.0 | 1.5 | 2.0 | 2.6 (1.1, 6.3) |
| Cheerleading c | 1 | 3 | 4 | 210,306 | 592,865 | 803,171 | 0.5 | 0.5 | 0.5 | 0.9 (0.1, 9.0) |
| Girls’ cross country | 0 | 1 | 1 | 19,519 | 93,481 | 113,000 | 0.0 | 1.1 | 0.9 | - |
| Gender-Comparabled | ||||||||||
| Boys’ | 102 | 64 | 166 | 1,919,047 | 4,717,827 | 6,636,874 | 5.3 | 1.4 | 2.5 | 3.9 (2.9, 5.4) |
| Girls’ | 202 | 88 | 290 | 1,526,042 | 3,738,999 | 5,265,041 | 13.2 | 2.4 | 5.5 | 5.6 (4.4, 7.2) |
| Totale | 664 | 418 | 1,082 | 5,562,012 | 15,526,353 | 21,088,365 | 11.9 | 2.7 | 5.1 | 4.4 (3.9, 5.0) |
| Boys’ | 437 | 299 | 736 | 3,071,683 | 9,369,216 | 12,440,899 | 14.2 | 3.2 | 5.9 | 4.4 (3.8, 5.2) |
| Girls’ | 226 | 116 | 342 | 2,280,023 | 5,564,272 | 7,844,295 | 9.9 | 2.1 | 4.4 | 4.8 (3.8, 5.9) |
Practice is referent group; CI denotes Confidence Interval
Caution should be used when interpreting results on tables and figures when considering sports with less than 10 total injuries such as gymnastics
Cheerleading competition category also includes performance injuries and exposures
Gender comparable sports included Soccer, Basketball, Lacrosse, Track and Field, and Baseball/Softball
Cheerleading is included in the total rate but not the gender specific rates, as it is a co-ed sport
Table 3.
Meniscal Injury Mechanism by Sport, National High School Sports-Related Injury Surveillance Study, United States, 2007/08 – 2012/13.
| Sport | Player-player contact | Player-surface contact | Player-playing apparatus contact a | Contact (total) | No contact | Overuse/Chronic | Other | Total |
|---|---|---|---|---|---|---|---|---|
| Boys’ football | 56.8% | 8.0% | 0.4% | (65.2%) | 31.7% | 2.2% | 0.9% | 100.0% |
| Boys’ soccer | 38.5% | 13.5% | 7.7% | (59.7%) | 34.6% | 3.8% | 1.9% | 100.0% |
| Girls’ soccer | 47.9% | 6.8% | 4.3% | (59.0%) | 37.6% | 1.7% | 1.7% | 100.0% |
| Girls’ volleyball | 22.2% | 25.9% | 0.0% | (48.1%) | 48.1% | 3.7% | 0.0% | 100.0% |
| Boys’ basketball | 25.0% | 19.6% | 0.0% | (44.6%) | 42.9% | 10.7% | 1.8% | 100.0% |
| Girls’ basketball | 22.5% | 19.8% | 0.0% | (42.3%) | 45.9% | 7.2% | 4.5% | 100.0% |
| Boys’ wrestling | 44.9% | 14.3% | 1.0% | (60.2%) | 33.7% | 2.0% | 4.1% | 100.0% |
| Boys’ baseball | 12.5% | 18.8% | 18.8% | (50.1%) | 43.8% | 6.3% | 0.0% | 100.0% |
| Girls’ softball | 22.7% | 13.6% | 4.5% | (40.8%) | 45.5% | 9.1% | 4.5% | 100.0% |
| Girls’ field hockey | 6.7% | 13.3% | 0.0% | (20.0%) | 73.3% | 6.7% | 0.0% | 100.0% |
| Girls’ gymnastics | 0.0% | 60.0% | 0.0% | (60.0%) | 40.0% | 0.0% | 0.0% | 100.0% |
| Boys’ ice hockey | 40.0% | 40.0% | 10.0% | (90.0%) | 10.0% | 0.0% | 0.0% | 100.0% |
| Boys’ lacrosse | 38.5% | 0.0% | 0.0% | (38.5%) | 53.8% | 0.0% | 7.7% | 100.0% |
| Girls’ lacrosse | 5.9% | 5.9% | 0.0% | (11.8%) | 76.5% | 11.8% | 0.0% | 100.0% |
| Girls’ swimming and diving | 0.0% | 25.0% | 0.0% | (25.0%) | 50.0% | 0.0% | 25.0% | 100.0% |
| Boys’ track and field | 0.0% | 7.7% | 23.1% | (30.8%) | 61.5% | 7.7% | 0.0% | 100.0% |
| Girls’ track and field | 4.8% | 23.8% | 0.0% | (28.6%) | 52.4% | 19.0% | 0.0% | 100.0% |
| Cheerleading | 25.0% | 50.0% | 0.0% | (75.0%) | 0.0% | 25.0% | 0.0% | 100.0% |
| Girls’ cross country | 0.0% | 0.0% | 0.0% | (0.0%) | 100.0% | 0.0% | 0.0% | 100.0% |
| Boys total | 48.5% | 10.5% | 1.9% | (60.9%) | 34.3% | 3.0% | 1.7% | 100.0% |
| Girls total | 27.9% | 15.3% | 1.8% | (45.0%) | 46.5% | 5.9% | 2.6% | 100.0% |
| Total | 41.9% | 12.1% | 1.9% | (55.9%) | 38.2% | 4.0% | 2.0% | 100.0% |
Playing apparatus included items like ball, base, goalpost, etc.
Boys’ swimming and diving, boys’ volleyball and boys’ cross country reported no meniscal injuries during the study period and were therefore excluded
The overall injury rate per 100,000 athlete exposures was higher for boys than girls (5.9 and 4.4, respectively, RR = 1.4; 95% CI, 1.2–1.5), with 68% of all reported injuries occurring in boys. This overall gender difference was largely driven by the high injury rate in football (11.2), however this trend reversed in gender-comparable sports. In soccer, basketball, track and field, lacrosse, and baseball/softball the overall injury rate per 100,000 athlete exposures was higher for girls than boys (5.5 and 2.5, respectively, RR =2.2; 95% CI, 1.8, 2.7).
The overall injury rate per 100,000 athlete exposures was higher in competition (11.9) than practice (2.7) (RR = 4.4; 95% CI, 3.9–5.0). The highest competition injury rate occurred in boys’ football (40.7 per 100,000 athlete exposures) followed by girls’ soccer (23.2). Meniscal injuries accounted for 15.1% of all knee injuries (Figure 1).
Figure 1.
Meniscal Injuries as a Proportion of All Knee Injuries, National High School Sports-Related Injury Surveillance Study, United States, 2007/08 – 2012/13.
* Buys’ swimming and diving, Boys’ volleyball, and Girls’ cheerleading reported no meniscal injuries during the study period and were therefore excluded from this analysis.
Overall non-contact injury mechanism accounted for 38.2% of meniscal injuries and player-player contact accounted for 41.9% (Table 2). Overall, boys had a higher proportion of injuries caused by player-player contact than girls (IPR = 1.7; 95% CI, 1.4–2.1), while girls had a higher proportion of injuries caused by a non-contact mechanisms (IPR=1.4; 95% CI, 1.2–1.6).
Rotation around a planted foot/inversion was the most common specific action causing injury overall. For soccer athletes, this accounted for the largest proportion at 41.2% in boys and 34.8% for girls. Likewise, for boys’ baseball and girls’ softball, the most common mechanism of injury was rotation around a planted foot/inversion (25.0% and 36.4%, respectively). However, for both boys’ and girls’ basketball the most common specific activity causing injury was jumping/landing (33.9% and 42.3%, respectively). For boys’ football, 23.0% of the injuries occurred while the athlete was being tackled, followed by rotation around a planted foot/inversion with 21.0%. In girls’ volleyball jumping/landing accounted for 37.0% of injuries, followed by rotation around a planted foot/inversion (25.9%). The majority of meniscal injuries reported for boys’ wrestling occurred during takedown (42.4%) followed by sparring (23.2%) and escape (8.1%).
Following meniscal injury, medical disqualification was the most common outcome (29.0%), with an additional 18.0% returning to play in 1–3 weeks. The majority of meniscal injuries required surgical intervention (63.8%) (Figure 2). Among the gender-comparable sports there were no significant differences in the proportion of injuries resulting in surgery. Concomitant injuries were reported in 54.0% of knees with meniscal injuries. The most common additional structures injured included the anterior cruciate ligament [ACL] (36.9%) and the medial collateral ligament [MCL] (24.2%)
Figure 2.
Proportion of Meniscal Injuries Requiring Surgery by Sport, National High School Sports-Related Injury Surveillance Study, United States, 2007/08 – 2012/13.
* Boys’ swimming and diving, Boys’ volleyball, and Boys’ cross country reported no meniscal injuries during the study period and where therefore excluded, as was Girls’ cross county meniscal injury due to missing surgery data for the only meniscal injury.
Analyzing need for surgery based on playing surface revealed no significant differences.
Discussion
The most important finding of the present study was a significantly higher meniscal injury rate for females than males. The highest meniscal injury rates occurred in boys’ football, girls’ soccer, girls’ basketball and boys’ wrestling. These findings are consistent with previous reports identifying sports requiring extensive pivoting and lateral movement as high risk for meniscal injury [3, 4, 5, 14, 19].
Previous studies have reported that between 71% and 79% of sport-related meniscal injuries occur in male athletes [19, 30, 34]. Consistent with those reports this study found that males accounted for 68.0% of all meniscal injuries, and overall injury rates were significantly higher for males than females. However, when analyzing only gender-comparable sports, the injury rate was significantly higher for females than males. Baker et al [4] previously reported that females were at higher risk for meniscal injury than males when participating in the sport of alpine skiing. The present study significantly expands upon those findings, demonstrating that for females participating in high school soccer, basketball, softball, lacrosse, and track and field the risk of meniscal injury is more than double that of their male counterparts. This may have important implications in the development of future injury prevention strategies.
The present study also demonstrated the overall injury rate was significantly higher in competition than practice. The highest competition to practice injury rate ratios occurred in girls’ soccer, boys’ ice hockey, and boys’ football, likely reflecting significant differences in intensity and speed of play between competition and practice. Conversely, the lowest competition to practice injury rate ratios occurred in cheerleading and girls’ volleyball, suggesting the athletic actions and maneuvers required to practice cheerleading and volleyball are more similar to those performed in competition than in other sports.
Overall the most commonly reported injury mechanism injury was player-player contact, accounting for 41.9% of all injuries, followed by non-contact (38.2%). Consistent with previous reports, [11, 24] for most sports, the most common action causing injury was rotation around a planted foot. A study of NBA players reported 31.7% of meniscal injuries occurred via a non-contact mechanism [35]. When looking specifically at basketball the present study demonstrated a higher proportion of non-contact meniscal injuries for both males and females, 42.9% and 45.9%, respectively. This suggests younger basketball players, having not yet reached physical maturity, may be more susceptible to injury by rotation around a planted foot.
Meniscal injuries were found to account for 15.1% of all knee injuries in high school athletes, slightly higher than Majewski et al [19], who reported meniscal injuries constituted 14.4% of all knee injuries in athletes. While these findings are similar, that study analyzed a population that was not age restricted and utilized different clinical surveillance methods, limiting direct comparison.
Meniscal injuries often occur in conjunction with injury to other knee structures [11, 22, 26, 34]. In the present study 54.0% of reported meniscal injuries had at least one concomitant knee injury. The most common associated injury was ACL tear (36.9%), which is similar to previous reports observing 36.6% of meniscal tears having associated ACL tear [23].
The majority of meniscal injuries reported in the present study required surgical intervention (63.8%), though only 29.0% of injuries resulted in disqualification of the athlete for the remainder of the season or their career. There were no significant differences in need for surgery or time to return to play based on sport or gender. By not restricting data to isolated meniscal injuries, this study is limited in that return to play and need for surgery were likely affected by concomitant knee pathology. Multiple knee injuries, particularly those involving the ACL or MCL, are more likely to require surgery and have longer recoveries prior to return to play and thus these injuries may have inflated our reported results on these measures.
Another limitation of this study is that some sports had fewer than 10 reported meniscal injuries. Small sample size limited the ability to analyze trends and determine significant differences in some sports. Continued injury surveillance is needed to better elucidate trends in those sports with low injury rates.
With millions of US high school students annually participating in interscholastic athletics the need for evidence-based injury prevention strategies is clear. The development of injury prevention models is predicated upon an understanding of injury patterns, injury rates, injury mechanisms, and sport specific risk. It has been well established that an intact meniscus is essential to the long-term health and function of the knee. Establishing detailed epidemiologic trends for meniscal injury in young athletes is an essential component of advocating for the long-term health of these young athletes knees.
Conclusions
Meniscal injury patterns among high school athletes vary by gender, sport, and type of exposure. There are a few key clinically relevant findings of this study. The current study clearly defines American football as the greatest sport at risk for meniscus tears in high school athletics. However in gender-comparable sports girls may be at higher risk for meniscal injury. Most athletes with meniscus tears are able to return to sport in season, though often require surgery. Recognizing distinct differences in these injury patterns will help drive evidence-based, targeted injury prevention strategies and efforts.
Footnotes
Disclosure
The content of this report was funded in part by the Centers for Disease Control and Prevention (grant nos. R49/CE000674-01 and R49/CE001172-01) and the National Center for Research Resources (award no. KL2 RR025754). The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention, the National Center for Research Resources, the National Institutes of Health, or the American College of Sports Medicine. The authors also acknowledge the research funding contributions of the NFHS, NOCSAE, DonJoy Orthotics, and EyeBlack. The authors report no conflicts of interest.
References
- 1.Abdon P, Bauer M. Incidence of meniscal lesions in children. Increase associated with diagnostic arthroscopy. Acta Orthop Scand. 1989;60:710–711. doi: 10.3109/17453678909149610. [DOI] [PubMed] [Google Scholar]
- 2.Abrams GD, Frank RM, Gupta AK, et al. Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med. 2013;41:2333–2339. doi: 10.1177/0363546513495641. [DOI] [PubMed] [Google Scholar]
- 3.Agel J, Evans TA, Dick R, et al. Descriptive epidemiology of collegiate men’s soccer injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 through 2002–2003. J Athl Train. 2007;42:270–277. [PMC free article] [PubMed] [Google Scholar]
- 4.Baker BE, Peckham AC, Pupparo F, et al. Review of meniscal injury and associated sports. Am J Sports Med. 1985;13:1–4. doi: 10.1177/036354658501300101. [DOI] [PubMed] [Google Scholar]
- 5.Baker P, Coggon D, Reading I, et al. Sports injury, occupational physical activity, joint laxity, and meniscal damage. J Rheumatol. 2002;29:557–563. [PubMed] [Google Scholar]
- 6.Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008;39:1338–1344. doi: 10.1016/j.injury.2008.06.021. [DOI] [PubMed] [Google Scholar]
- 7.Ferry T, Bergstrom U, Hedstrom EM, et al. Epidemiology of acute knee injuries seen at the Emergency Department at Umea University Hospital, Sweden, during 15 years. Knee Surg Sports Traumatol Arthrosc. 2014;22:1149–1155. doi: 10.1007/s00167-013-2555-3. [DOI] [PubMed] [Google Scholar]
- 8.Franklin BA, Billecke S. Putting the benefits and risks of aerobic exercise in perspective. Curr Sports Med Rep. 2012;11:201–208. doi: 10.1249/JSR.0b013e31825dabd4. [DOI] [PubMed] [Google Scholar]
- 9.Gelber AC, Hochberg MC, Mead LA, et al. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000;133:321–328. doi: 10.7326/0003-4819-133-5-200009050-00007. [DOI] [PubMed] [Google Scholar]
- 10.Granan LP, Inacio MC, Maletis GB, et al. Sport-specific injury pattern recorded during anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41:2814–2818. doi: 10.1177/0363546513501791. [DOI] [PubMed] [Google Scholar]
- 11.Greis PE, Bardana DD, Holmstrom MC, et al. Meniscal injury: I. Basic science and evaluation. J Am Acad Orthop Surg. 2002;10:168–176. doi: 10.5435/00124635-200205000-00003. [DOI] [PubMed] [Google Scholar]
- 12.Hede A, Jensen DB, Blyme P, et al. Epidemiology of meniscal lesions in the knee. 1,215 open operations in Copenhagen 1982–84. Acta Orthop Scand. 1990;61:435–437. doi: 10.3109/17453679008993557. [DOI] [PubMed] [Google Scholar]
- 13.Ingram JG, Fields SK, Yard EE, et al. Epidemiology of knee injuries among boys and girls in US high school athletics. Am J Sports Med. 2008;36:1116–1122. doi: 10.1177/0363546508314400. [DOI] [PubMed] [Google Scholar]
- 14.Iwamoto J, Takeda T, Sato Y, et al. Retrospective case evaluation of gender differences in sports injuries in a Japanese sports medicine clinic. Gend Med. 2008;5:405–414. doi: 10.1016/j.genm.2008.10.002. [DOI] [PubMed] [Google Scholar]
- 15.Jones JC, Burks R, Owens BD, et al. Incidence and risk factors associated with meniscal injuries among active-duty US military service members. J Athl Train. 2012;47:67–73. doi: 10.4085/1062-6050-47.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Katz JN, Martin SD. Meniscus--friend or foe: epidemiologic observations and surgical implications. Arthritis Rheum. 2009;60:633–635. doi: 10.1002/art.24363. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Kujala UM, Kettunen J, Paananen H, et al. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum. 1995;38:539–546. doi: 10.1002/art.1780380413. [DOI] [PubMed] [Google Scholar]
- 18.Lohmander LS, Englund PM, Dahl LL, et al. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;35:1756–1769. doi: 10.1177/0363546507307396. [DOI] [PubMed] [Google Scholar]
- 19.Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: A 10-year study. Knee. 2006;13:184–188. doi: 10.1016/j.knee.2006.01.005. [DOI] [PubMed] [Google Scholar]
- 20.National Federation of State High School Associations. 2011–12 High School Athletics Participation Survey. 2012 http://www.nfhs.org/content.aspx?id=3282.
- 21.Nielsen AB, Yde J. Epidemiology of acute knee injuries: a prospective hospital investigation. J Trauma. 1991;31:1644–1648. doi: 10.1097/00005373-199112000-00014. [DOI] [PubMed] [Google Scholar]
- 22.Piasecki DP, Spindler KP, Warren TA, et al. Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes. An analysis of sex-based differences. Am J Sports Med. 2003;31:601–605. doi: 10.1177/03635465030310042101. [DOI] [PubMed] [Google Scholar]
- 23.Poehling GG, Ruch DS, Chabon SJ. The landscape of meniscal injuries. Clin Sports Med. 1990;9:539–549. [PubMed] [Google Scholar]
- 24.Poulsen MR, Johnson DL. Meniscal injuries in the young, athletically active patient. Phys Sportsmed. 2011;39:123–130. doi: 10.3810/psm.2011.02.1870. [DOI] [PubMed] [Google Scholar]
- 25.Rechel JA, Yard EE, Comstock RD. An epidemiologic comparison of high school sports injuries sustained in practice and competition. J Athl Train. 2008;43:197–204. doi: 10.4085/1062-6050-43.2.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Rennie WJ, Finlay DB. Meniscal extrusion in young athletes: associated knee joint abnormalities. AJR Am J Roentgenol. 2006;186:791–794. doi: 10.2214/AJR.04.1181. [DOI] [PubMed] [Google Scholar]
- 27.Renstrom P, Johnson RJ. Anatomy and biomechanics of the menisci. Clin Sports Med. 1990;9:523–538. [PubMed] [Google Scholar]
- 28.Roos H, Lauren M, Adalberth T, et al. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum. 1998;41:687–693. doi: 10.1002/1529-0131(199804)41:4<687::AID-ART16>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
- 29.Rosa BB, Asperti AM, Helito CP, et al. Epidemiology of sports injuries on collegiate athletes at a single center. Acta Ortop Bras. 2014;22:321–324. doi: 10.1590/1413-78522014220601007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Stracciolini A, Casciano R, Levey Friedman H, et al. Pediatric sports injuries: a comparison of males versus females. Am J Sports Med. 2014;42:965–972. doi: 10.1177/0363546514522393. [DOI] [PubMed] [Google Scholar]
- 31.Stubbe JH, Van Beijsterveldt AM, Van Der Knaap S, et al. Injuries in professional male soccer players in the Netherlands: a prospective cohort study. J Athl Train. 2015;50:211–216. doi: 10.4085/1062-6050-49.3.64. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Sutton AJ, Muir KR, Mockett S, et al. A case-control study to investigate the relation between low and moderate levels of physical activity and osteoarthritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey. Ann Rheum Dis. 2001;60:756–764. doi: 10.1136/ard.60.8.756. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Takeda H, Nakagawa T, Nakamura K, et al. Prevention and management of knee osteoarthritis and knee cartilage injury in sports. Br J Sports Med. 2011;45:304–309. doi: 10.1136/bjsm.2010.082321. [DOI] [PubMed] [Google Scholar]
- 34.Terzidis IP, Christodoulou A, Ploumis A, et al. Meniscal tear characteristics in young athletes with a stable knee: arthroscopic evaluation. Am J Sports Med. 2006;34:1170–1175. doi: 10.1177/0363546506287939. [DOI] [PubMed] [Google Scholar]
- 35.Yeh PC, Starkey C, Lombardo S, et al. Epidemiology of isolated meniscal injury and its effect on performance in athletes from the National Basketball Association. Am J Sports Med. 2012;40:589–594. doi: 10.1177/0363546511428601. [DOI] [PubMed] [Google Scholar]