Several studies have found that ankle injuries sustained in basketball are not only among the most common, they can also be the most severe, so preventing them is key to ensuring a safe and healthy season. Of critical importance is recognizing and addressing the fact that high school- and college-age men and women have entirely different risk factors for first-time ankle ligament injuries -- a finding resulting from a Vermont-based study of 901 young athletes conducted by Bruce Beynnon, Ph.D., associate professor and director of research in orthopaedics and rehabilitation, and colleagues at the University of Vermont.

"Prior to conducting our study, we understood that previous ankle injury was a strong risk factor for a repeated ankle injury," said Beynnon. "Our goal was to study the risk factors that predispose an athlete to suffering their first injury with the hope that we could use this information to develop programs that prevent athletes from ever experiencing an ankle injury in the first place."

Ankle sprains are typically considered one of the most common injuries among athletes. To analyze ankle ligament injury risk factors, Beynnon and colleagues measured factors in 901 Vermont high school and collegiate athletes who logged a total of 50,680 "person-days" of exposure to soccer, basketball, lacrosse or field hockey over four years. In order to clearly isolate which factors put athletes at the most risk for a first ankle injury, the study did not include athletes who suffered prior ankle trauma. Only 43 (4.5 percent) athletes suffered their first ankle sprain during the study period. Risk of ankle injury was highest among female basketball athletes who are at significantly greater risk than male basketball athletes.

The research team found that the women in the study were at increased risk of suffering their first ankle injury when there is a strength imbalance in the muscles that control the side-to-side movement of the ankle. They also identified several non-modifiable risk factors, including alignment of the muscles in the front of the leg with the knee; loose ankles, which are suggestive of weak ligaments or structural problems; and equally dominate legs.

Men in the study who had undergone one or more prior surgeries to their legs were at increased risk of suffering their first injury, as were men who had decreased dorsi-flexion - the ability to point the toe toward the head - and weak muscle strength for motion when the ankle rolls away from the body. Beynnon and colleagues hypothesize that risk of injuries after surgery may be indicative of incomplete healing or a more aggressive physical style.

"Ankle trauma is not the result of bad luck," said Beynnon. "It occurs, not randomly, but in patterns that reflect the operation of underlying causes. Our research determined the underlying causes for this debilitating injury and revealed that combinations of risk factors, which are different for men in comparison to women, are responsible for predisposing an athlete to injury. Based on our findings, we now know that separate programs - in areas such as intervention, screening and injury prevention - must be developed for males and females and this will be the focus of our future research."

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