Risk factors for noncontact ankle sprains in high school football players: the role of previous ankle sprains and body mass index

BACKGROUND: In a previous study, we noted a possible connection between an athlete's weight and risk of ankle sprain. HYPOTHESIS: A high body mass index and a history of a previous ankle sprain increase the risk of a subsequent noncontact sprain. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: One hundred fifty-two athletes from 4 football teams were observed (2 varsity and 2 junior varsity). Two teams were observed for 3 seasons, and 2 teams were observed for 1 season. Before each season, body mass, height, history of previous ankle sprains, and ankle tape or brace use were recorded. RESULTS: There were 24 ankle sprains, of which 15 were noncontact inversion sprains (11 grade I, 3 grade II, 1 grade III; incidence, 1.08 per 1000 athlete-exposures). Injury incidence was higher in athletes with previous ankle injuries (2.60 vs 0.39; P < .001). Body mass index was also a risk factor (P < .05): injury incidence was 0.52 for players with a normal body mass index, 1.05 for players at risk of overweight, and 2.03 for overweight players. Injury incidence was 0.22 for normal-weight players with no previous ankle sprain compared with 4.27 for overweight players who had a previous sprain. CONCLUSION: An overweight player who had a previous ankle sprain was 19 times more likely to sustain a noncontact ankle sprain than was a normal-weight player with no previous ankle sprain. CLINICAL RELEVANCE: Ankle sprain prevention strategies should be targeted at football players with a high body mass index and a history of previous ankle sprains.     

Risk factors for noncontact ankle sprains in high school athletes: the role of hip strength and balance ability

BACKGROUND: Ankle sprains are among the most common sports injuries. HYPOTHESIS: Poor balance as measured on a balance board and weakness in hip abduction strength are associated with an increased risk of noncontact ankle sprains in high school athletes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: One hundred sixty-nine high school athletes (101 male athletes, 68 female athletes) from football, men's basketball, men's soccer, women's gymnastics, women's basketball, and women's soccer were observed for 2 years. Balance in single-limb stance on an instrumented tilt board and hip flexion, abduction, and adduction strength (handheld dynamometer) were assessed in the preseason. Body mass, height, generalized ligamentous laxity, previous ankle sprains, and ankle tape or brace use were also documented. RESULTS: There were 20 noncontact inversion ankle sprains. Balance ability (P = .72), hip abduction strength (P = .66), hip adduction strength (P = .41), and hip flexion strength (P = .87) were not significant risk factors for ankle sprains. The incidence of grade II and grade III sprains was higher in athletes with a history of a previous ankle sprain (1.12 vs 0.26 per 1000 exposures, P < .05). A higher body mass index in male athletes was associated with increased risk (P < .05). The combination of a previous injury and being overweight further increased risk (P < .01). CONCLUSION: Balance as measured on a balance board and hip strength were not significant indicators for noncontact ankle sprains. The apparent high injury risk associated with the combination of a history of a previous ankle sprain and being overweight in male athletes warrants further examination.     

Comparison of 3 preventive methods to reduce the recurrence of ankle inversion sprains in male soccer players

BACKGROUND: Ankle sprains are frequent injuries in soccer. Several strategies can be used to prevent further ankle sprains in athletes: the most common are proprioceptive training, strength training, and orthoses. OBJECTIVE: To investigate which of these 3 interventions is the most effective in preventing ankle sprains in athletes with previous ankle inversion sprain. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS AND MEASURES: Eighty male soccer players (age, 24.6 +/- 2.63 years; height, 175.60 +/- 4.36 cm; weight, 64.26 +/- 8.37 kg) in the first division of a men's league who had experienced previous ankle inversion sprain were randomly selected from an original population of 120 players. The subjects were individually and randomly assigned to 4 study groups: group 1 (n = 20) followed the proprioceptive program, group 2 (n = 20) followed the strength program, group 3 (n = 20) used orthoses, and group 4 (n = 20) was the control group. Data on the frequency of ankle sprain reinjury were collected at the end of the session. RESULTS: There were no significant differences among the groups in the number of exposures. The incidence of ankle sprains in players in the proprioception training group was significantly lower than in the control group (relative risk of injury, 0.13; 95% confidence interval, 0.003-0.93; P = .02). The findings with respect to the strength and orthotic groups in comparison with the control group were not significant (relative risk of injury, 0.5; 95% confidence interval, 0.11-1.87; P = .27 for strength; relative risk of injury, 0.25; 95% confidence interval, 0.03-1.25; P = .06 for orthotic group). CONCLUSION: Proprioceptive training, compared with no intervention, was an effective strategy to reduce the rate of ankle sprains among male soccer players who suffered ankle sprain.     

The effect of a proprioceptive balance board training program for the prevention of ankle sprains: a prospective controlled trial

BACKGROUND: Ankle sprains are the most common injuries in a variety of sports. HYPOTHESIS: A proprioceptive balance board program is effective for prevention of ankle sprains in volleyball players. STUDY DESIGN: Prospective controlled study. METHODS: There were 116 male and female volleyball teams followed prospectively during the 2001-2002 season. Teams were randomized by 4 geographical regions to an intervention group (66 teams, 641 players) and control group (50 teams, 486 players). Intervention teams followed a prescribed balance board training program; control teams followed their normal training routine. The coaches recorded exposure on a weekly basis for each player. Injuries were registered by the players within 1 week after onset. RESULTS: Significantly fewer ankle sprains in the intervention group were found compared to the control group (risk difference = 0.4/1000 playing hours; 95% confidence interval, 0.1-0.7). A significant reduction in ankle sprain risk was found only for players with a history of ankle sprains. The incidence of overuse knee injuries for players with history of knee injury was increased in the intervention group. History of knee injury may be a contraindication for proprioceptive balance board training. CONCLUSIONS: Use of proprioceptive balance board program is effective for prevention of ankle sprain recurrences.     

The effect of a balance training program on the risk of ankle sprains in high school athletes

BACKGROUND: Ankle sprains are the most common musculoskeletal injuries that occur in athletes, and they have a profound impact on health care costs and resources. HYPOTHESIS: A balance training program can reduce the risk of ankle sprains in high school athletes. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: Seven hundred and sixty-five high school soccer and basketball players (523 girls and 242 boys) were randomly assigned to either an intervention group (27 teams, 373 subjects) that participated in a balance training program or to a control group (28 teams, 392 subjects) that performed only standard conditioning exercises. On-site athletic trainers recorded athlete exposures and sprains. RESULTS: The rate of ankle sprains was significantly lower for subjects in the intervention group (6.1%, 1.13 of 1000 exposures vs 9.9%, 1.87 of 1000 exposures; P = .04). Athletes with a history of an ankle sprain had a 2-fold increased risk of sustaining a sprain (risk ratio, 2.14), whereas athletes who performed the intervention program decreased their risk of a sprain by one half (risk ratio, 0.56). The ankle sprain rate for athletes without previous sprains was 4.3% in the intervention group and 7.7% in the control group, but this difference was not significant (P = .059). CONCLUSION: A balance training program will significantly reduce the risk of ankle sprains in high school soccer and basketball players.     

Ankle sprains in players of the field-games Gaelic football and hurling

BACKGROUND: The objectives of the study were to determine the most common injuries in Gaelic football and hurling and to quantify contributory factors. Hypothesis: The hypothesis tested was "Ankle sprains are a common injury in Gaelic football and hurling and their incidence can be linked to physical characteristics of the players". METHODS: Experimental design: prospective study over four years. Subjects: eighty male players of Gaelic football, and hurling, aged 18-27 years. Measures: the injuries sustained over a four-year period. Physical fitness tests and examination at the start of the study which included assessment of: anthropometric variables, lower-limb proprioception, lung function, six aspects of flexibility, 15 aspects of posture and body mechanics. RESULTS: 962 significant sports injuries which included: 218 strains and 184 sprains. 122 were ankle sprains; 79 to the left ankle and 43 to the right. 104 ankle sprains represented a recurrence of this injury in a particular individual. In 26 out of 34 of these subjects both ankles were involved. This suggests that recurrence is not primarily due to previous injury but to intrinsic factors in the subjects that predispose them to ankle sprain. The subjects who sustained ankle sprains had (1) greater height, (2) lower body mass index (3) a higher incidence of posture defects of the ankle and knee, (4) more clinical defects (5) a higher incidence of defective lower-limb proprioception. CONCLUSIONS: Ankle sprains are a common injury. Their incidence is linked to the five intrinsic factors listed above.     

The identification of risk factors for ankle sprains sustained during netball participation

ObjectivesAnkle sprains account for a large percentage of injuries sustained in netball. The identification of risk factors for ankle sprain is the preliminary action required to inform future prevention strategies.DesignProspective study.ParticipantsNinety-four netball players from club and inter-district teams.MethodsPreseason data were collected for; vertical jump height, perceived ankle instability, sprain history, arthrometry inversion-eversion angles, star excursion balance test reach distances, the number of foot lifts during unilateral stance and demi-pointe balance test results. Participants were followed for the duration of one netball season and ankle sprains were recorded.ResultsEleven sprains were recorded for eleven players using a time-loss definition of injury. Ankle sprains occurred at an incidence rate of 1.74/1000 h of netball exposure. One risk factor was identified to increase the odds of sustaining an ankle sprain during netball participation – a reach distance in the posterior-medial direction of the star excursion balance test of less than or equal to 77.5% of leg length (OR = 4.04, 95% CI = 1.00–16.35).ConclusionsThe identified risk factor can be easily measured and should be considered for preseason injury risk profiling of netball players. Netball players may benefit from training programs aimed at improving single leg balance.     

Syndesmotic ankle sprains

In this study we reviewed ankle sprains in a professional football team over a 6 year period. Fifteen players who sustained syndesmotic ankle sprains were compared with 28 players who sustained significant lateral ankle sprains. Players with syndesmotic sprains missed significantly more games and practices and they received substantially more treatments than players with lateral ankle sprains. Physical examination findings, results of radiographic evaluations, and etiologic factors are discussed. The external rotation stress test, a clinical method for diagnosis of this type of sprain at the time of injury, is described. Results of this study clearly demonstrate a prolonged recovery time for syndesmotic ankle sprains. Physicians and trainers who are aware of this injury can differentially diagnose these two types of sprains in the early postinjury period by the method described.     

Intrinsic predictive factors for ankle sprain in active university students: A prospective study

The ankle is the joint most affected among the sports‐related injuries. The current study investigated whether certain intrinsic factors could predict ankle sprains in active students. The 125 participants were submitted to a baseline assessment in a single session were then followed‐up for 52 weeks regarding the occurrence of sprain. The baseline assessment were performed in both ankles and included the questionnaire Cumberland ankle instability tool – Portuguese, the foot lift test, dorsiflexion range of motion, Star Excursion Balance Test (SEBT), the side recognition task, body mass index, and history of previous sprain. Two groups were used for analysis: one with those who suffered an ankle sprain and the other with those who did not suffer an ankle sprain. After Cox regression analysis, participants with history of previous sprain were twice as likely to suffer subsequent sprains [hazard ratio (HR) 2.21 and 95% confidence interval (CI) 1.07–4.57] and people with better performance on the SEBT in the postero‐lateral (PL) direction were less likely to suffer a sprain (HR 0.96 and 95% CI 0.92–0.99). History of previous sprain was the strongest predictive factor and a weak performance on SEBT PL was also considered a predictive factor for ankle sprains.     

Single leg balance test to identify risk of ankle sprains

Background

Ankle sprains are a common and potentially disabling injury. Successful prediction of susceptibility to ankle sprain injury with a simple test could allow ankle sprain prevention protocols to be initiated and help prevent disability in the athletic population.

Objective

To investigate the ability of the single leg balance (SLB) test, carried out at preseason physical examination, to predict an ankle sprain during the autumn sports season.

Design

Prospective cohort study

Setting

High school varsity athletics and intercollegiate athletics.

Main outcome measure

Ankle sprains in athletes with positive SLB tests.

Results

The association between a positive SLB test and future ankle sprains was significant. Controlling for confounding variables, the relative risk for an ankle sprain with a positive SLB test was 2.54 (95% confidence interval, 1.02 to 6.03). Athletes with a positive SLB test who did not tape their ankles had an increased likelihood of developing ankle sprains. The relative risk for ankle sprain for a positive SLB test and negative taping was 8.82 (1.07 to 72.70). A history of previous ankle injury was not associated with future ankle sprains in this study. The κ value for interrater reliability for the SLB test was 0.898 (p<0.001).

Conclusions

An association was demonstrated between a positive SLB test and ankle sprain. In athletes with a positive SLB test, not taping the ankle imposed an increased risk of sprain. The SLB test is a reliable and valid test for predicting ankle sprains.     

Comparison of three preventive methods in order to reduce the incidence of ankle inversion sprains among female volleyball players

BACKGROUND: Ankle sprains are the most common form of acute injury in volleyball. A prevention programme consisting of technical training, proprioceptive training, and external support was previously designed to reduce the rate of ankle sprains in volleyball players. OBJECTIVE: To investigate which of these three interventions is the most effective in preventing ankle sprain in female volleyball players. METHODS: Participants were 52 players who suffered ankle sprains during the season 1998-1999. They were divided randomly into three preventive groups: group 1 (n = 18) followed the technical training programme; group 2 (n = 17) followed the proprioceptive programme; group 3 (n = 17) used orthosis. The players followed their respective programmes for the whole of the 1999-2000 season. Data were collected at the end of the season. RESULTS: The three preventive strategies were all effective in preventive further ankle sprain. Technical training was slightly more effective than the other two methods. Orthosis was not effective in athletes who had suffered ankle sprains more than three times during their careers. Under those circumstances, technical training and proprioceptive training were equally effective at preventive further sprains. CONCLUSIONS: Technical training and proprioceptive training are effective methods of preventing ankle sprain in volleyball players who have suffered this injury four or more times during their career. Orthosis appears effective only in players with fewer than four previous sprains.     

Dynamic postural stability differences between male and female players with and without ankle sprain

ObjectivesTo evaluate dynamic stability index (DSI) differences between males and females for different jump directions. To examine both preseason DSI differences between players with and without a history of ankle sprain, and between players with and without an ankle sprain during the subsequent season.DesignProspective cohort design.SettingLaboratory.Participants47 male (22.9 ± 3.9 y) and 19 female (21.5 ± 2.9 y) sub-elite and elite team sport players.Main outcome measuresAnkle sprain history was collected using an injury history questionnaire. DSI of a single-leg hop-stabilization task measured preseason was collected using force plates and calculated using a Matlab program. Ankle sprains were reported during the subsequent season.ResultsMale players demonstrated larger DSI than female players on forward medial/lateral stability index (MLSI) and vertical stability index (VSI), diagonal VSI, and lateral anterior/posterior stability index (APSI) and VSI. Forward, diagonal and lateral dynamic postural stability indices (DPSI) were larger for males (p < 0.001). No significant differences were found between players with and without a previous ankle sprain nor between players with and without an ankle sprain during the subsequent season.ConclusionMale players showed larger DSI scores than female players, indicating lower dynamic stability. Sex-specific training sessions or prevention programs should be developed.     

An economic evaluation of a proprioceptive balance board training programme for the prevention of ankle sprains in volleyball

Objectives: To evaluate the cost effectiveness of a proprioceptive balance board training programme for the prevention of ankle sprains in volleyball.

Methods: A total of 116 volleyball teams participated in this study which was carried out during the 2001–2002 volleyball season. Teams were randomly allotted to an intervention group (66 teams, 628 players) or a control group (52 teams, 494 players). Intervention teams followed a prescribed balance board training programme as part of their warm up. Control teams followed their normal training routine. An ankle sprain was recorded if it occurred as a result of volleyball and caused the subject to stop volleyball activity. The injured player completed a cost diary for the duration of the ankle sprain. Analyses were performed according to the intention to treat principle. Mean direct, indirect, and total costs were calculated and were compared between the two groups.

Results: The total costs per player (including the intervention material) were significantly higher in the intervention group (€36.99 (93.87)) than in the control group (€18.94 (147.09)). The cost of preventing one ankle sprain was approximately €444.03. Sensitivity analysis showed that a proprioceptive balance board training programme aimed only at players with previous ankle sprains could be cost effective over a longer period of time.

Conclusions: Positive effects of the balance board programme could only be achieved at certain costs. However, if broadly implemented, costs associated with the balance board programme would probably be lower.

     

A one season prospective cohort study of volleyball injuries

Objective: To estimate the overall incidence of acute and overuse volleyball injuries, and to describe factors associated with ankle sprains.

Methods: 486 players from the second and third Dutch national volleyball divisions participated in the study and were followed prospectively during a whole season. Three measurements were made during the season (baseline, follow up 1, and follow up 2), where all players completed a questionnaire on demographic variables (only at baseline), sports participation, use of preventive measures, and previous injuries. Volleyball exposure during training and matches was recorded for each individual player by the coach on a weekly exposure form. In case of injury the coach provided the injured player with an injury registration form, which had to be completed within one week after the onset of injury.

Results: 100 injuries were reported, resulting in an overall injury incidence of 2.6 injuries/1000 hours. The incidence of acute injuries was 2.0/1000 hours. Ankle sprains (n = 41) accounted for most of the acute injuries, and 31 (75%) of all players with an ankle sprain reported a previous ankle sprain. Twenty five overuse injuries were reported. The overall incidence of overuse injuries was 0.6/1000 hours; the back and the shoulder were the most common sites.

Conclusions: Ankle sprain is the most common injury in volleyball, accounting for 41% of all volleyball related injuries. Previous injury seems to be an important risk factor for an ankle sprain. Injury prevention programmes should focus on ankle sprains and concentrate on players with previous ankle sprains.

     

Risk of injury in elite football played on artificial turf versus natural grass: a prospective two-cohort study

Objective

To compare injury risk in elite football played on artificial turf compared with natural grass.

Design

Prospective two‐cohort study.

Setting

Male European elite football leagues.

Participants

290 players from 10 elite European clubs that had installed third‐generation artificial turf surfaces in 2003–4, and 202 players from the Swedish Premier League acting as a control group.

Main outcome measure

Injury incidence.

Results

The incidence of injury during training and match play did not differ between surfaces for the teams in the artificial turf cohort: 2.42 v 2.94 injuries/1000 training hours and 19.60 v 21.48 injuries/1000 match hours for artificial turf and grass respectively. The risk of ankle sprain was increased in matches on artificial turf compared with grass (4.83 v 2.66 injuries/1000 match hours; rate ratio 1.81, 95% confidence interval 1.00 to 3.28). No difference in injury severity was seen between surfaces. Compared with the control cohort who played home games on natural grass, teams in the artificial turf cohort had a lower injury incidence during match play (15.26 v 23.08 injuries/1000 match hours; rate ratio 0.66, 95% confidence interval 0.48 to 0.91).

Conclusions

No evidence of a greater risk of injury was found when football was played on artificial turf compared with natural grass. The higher incidence of ankle sprain on artificial turf warrants further attention, although this result should be interpreted with caution as the number of ankle sprains was low.     

The Football Association Medical Research Programme: an audit of injuries in professional football-analysis of preseason injuries

OBJECTIVES: To conduct a detailed analysis of preseason football injuries sustained in English professional football over two competitive seasons. METHODS: Club medical staff at 91 professional football clubs annotated player injuries. A specific injury audit questionnaire was used together with a weekly form that documented each club's current injury status. RESULTS: 17% (1025) of the total number of injuries over the two seasons were sustained during the preseason, the mean number of days absent per injury was 22.3 days. Younger age groups (17-25 yrs) were more likely to sustain a preseason injury than more experienced players (26-35+) (p<0.01). There were relatively more "slight" and "minor" injuries (as defined in the methodology), overuse, and tendon related injuries sustained during preseason compared to the in season (p<0.01). The thigh (23%), knee (17%), and ankle (17%) were the most common locations for injuries during the preseason, there was a relatively greater number of lower leg injuries (15%) during the preseason (p<0.05). Achilles tendonitis was most prevalent in the preseason, with 33% of all Achilles related injuries sustained during this period (p<0.01). Muscle strains were the most common injury during preseason (37%). Rectus femoris muscle strains were observed twice as frequently during the preseason relative to the in season (p<0.01). Ligament sprains were the second most common injury during preseason (19%). Non-contact mechanisms were the cause of significantly more injuries during the preseason (p<0.01), with relatively more preseason injuries sustained while running or shooting (p<0.01). For 70% of the injuries reported during the preseason, the ground condition was described as dry. CONCLUSIONS: Players are at a greater risk of slight and minor injuries, overuse injuries, lower leg injuries (especially the Achilles tendon) and rectus femoris strains during the preseason period. Prevention of preseason injury is important to ensure availability of players for the commencement of the season and to decrease the risk of injury later in the season, we recommend the implementation of a risk management policy for this purpose. Areas requiring further investigation include methods of prevention for the common preseason injuries that have been identified, a detailed analysis of preseason and closed season training programmes, and a smaller study involving exposure data.     

Teaching landing skills in elite junior Australian football: evaluation of an injury prevention strategy

Objective

To evaluate the effectiveness of a preseason physical training programme that taught landing and falling skills in improving landing skills technique and preventing injury in junior elite Australian football players.

Methods

723 male players who participated in an under 18 elite competition were studied prospectively in a non‐randomised controlled trial over two consecutive football seasons. There were 114 players in the intervention group and 609 control players. The eight session intervention programme taught players six landing, falling, and recovery skills, which were considered fundamental for safe landing in Australian football. Landing skills taught in these sessions were rated for competence by independent and blinded assessors at baseline and mid‐season.

Results

Evaluation of landing skills found no significant differences between the groups at baseline. Evaluation after the intervention revealed overall improvement in landing skills, but significantly greater improvement in the intervention group (z  =  −7.92, p  =  0.001). Players in the intervention group were significantly less likely (relative rate 0.72, 95% confidence interval 0.52 to 0.98) to sustain an injury during the season than the control group. In particular, the time to sustaining a landing injury was significantly less for the intervention group (relative rate 0.40, 95% confidence interval 0.17 to 0.92) compared with the control group.

Conclusions

Landing and falling ability can be taught to junior elite Australian football players. Players in the intervention group were protected against injury, particularly injuries related to landing and falls.     

Intrinsic predictors of lateral ankle sprain in adolescent dancers: a prospective cohort study.

OBJECTIVE: To identify intrinsic predictors of lateral ankle sprain. DESIGN: Prospective cohort study. SETTING: A performing arts secondary school and a dance school. PARTICIPANTS: One hundred fifteen adolescent dancers (94 female and 21 male) entered the study. One ankle of each dancer was randomly assigned to a test group (n = 114), and the other was assigned to a validation group (n = 112). PREDICTORS: Eighteen measures, including age, dance history, previous ankle sprain, ankle and foot laxity and range of motion, and balance from test ankles were entered into a backwards stepwise Cox regression model. The model generated with the test group was used to predict ankle sprains in the validation group. MAIN OUTCOME MEASURE: Time to first lateral ankle sprain. RESULTS: An increased risk of sprain in the test group was predicted by younger age [hazard ratio (HR) = 0.65, 95% CI 0.45-0.94], previous sprain of the contralateral ankle (HR = 3.76, CI 1.24-11.40), increased passive inversion range (HR = 1.06, CI 1.00-1.12), and inability to balance on demipointe (HR = 3.75, CI 1.02-13.73). Of these predictors, only previous sprain of the contralateral ankle significantly predicted ankle sprain in the validation group (HR = 3.90, CI 1.49-10.22). The predictive accuracy of this variable was not strong (positive likelihood ratio of 2.01 and negative likelihood ratio of 0.45). CONCLUSION: A history of previous lateral ankle sprain is associated with an increase in the risk of future sprain of the contralateral ankle.     

Hormonal therapy: ACL and ankle injury

BACKGROUND: No definitive explanation for the difference in rate of male and female noncontact ACL injury has been found. The hormonal environment, known to be different in men and women has been hypothesized as a possible source for this difference in injury rate. PURPOSE: To confirm earlier work looking at periodicity of noncontact ACL injury. To increase sample size by adding ankle sprains. To determine the rate of noncontact ACL injury and ankle sprains in collegiate basketball and soccer. To determine if the use of oral contraceptives affects the rate of noncontact ACL injury and ankle sprains. METHODS: Data was collected from a sample of NCAA schools over the 2000-2001 basketball and the 2001-2002 basketball and soccer seasons. RESULTS: Recall and prospective data collection of length of menstrual cycle did not produce equivalent results. Periodicity was present only in the recall group of "off pill" users. The rate of noncontact ACL injury and noncontact ankle sprains was twice as high in basketball as in soccer. There was no difference in rate of injuries between those athletes using hormonal therapy and those athletes not using hormonal therapy. CONCLUSIONS: Noncontact ACL injuries and ankle sprains occurred at significantly higher rates in basketball than in soccer but this rate difference was not linked to hormonal therapy usage. The overall rate of noncontact ACL injury and ankle sprain to women's collegiate basketball and soccer players is very low.