Hand and wrist injuries among collegiate athletes vary with athlete division

Abstract Background The rates, severity and consequences of hand and wrist injuries sustained by National Collegiate Athletic Association athletes are not well characterized. This study describes the epidemiology of hand and wrist injuries among collegiate athletes competing in different divisions. Methods The National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) was accessed from 2004 to 2015 for the following sports: baseball, basketball, football, ice hockey, lacrosse, soccer, wrestling, field hockey, gymnastics, softball and volleyball. The data were used to identify all hand and wrist injuries, the specific injury diagnosis, mean time loss of activity following injury, and need for surgery following injury. These were then stratified by gender. Descriptive statistics were performed to examine the association between sports, event type and division. Student's t test was used to calculate p-values for independent variables. Chi-Square test was used to calculate odds ratio. P < 0.05 was considered significant. Results 103,098 hand and wrist injuries were reported in in the studied NCAA sports from 2004 to 2015. Male athletes sustained 72,423 injuries (6.01/10,000 athlete exposure) and female athletes sustained 30,675 injuries (4.13/10,000 athlete exposure). Division I athletes sustained significantly more injuries compared to divisions II and III. Overall, 3.78% of hand and wrist injuries required surgical intervention. A significantly higher percentage of division I athletes (both male and female) underwent surgical intervention compared to divisions II and III. The mean time lost due to hand and wrist injury was 7.14 days for all athletes. Division I athletes missed the fewest days due to injury at 6.29 days though this was not significant. Conclusions Hand and wrist injuries are common among collegiate athletes. Division I athletes sustain higher rates of injuries and higher surgical intervention rates, while tending to miss fewer days due to injury. Improved characterization of divisional differences in hand and wrist injuries can assist injury management and prevention.

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Hand and Wrist Injuries Among Collegiate Athletes Vary with Athlete Division

10.21203/rs.3.rs-519733/v1 ◽

2021 ◽

Author(s):

Kathleen Holoyda ◽

Daniel Donato ◽

David Magno-Padron ◽

Andrew Simpson ◽

Jayant Agarwal

Keyword(s):

National Collegiate Athletic Association ◽

Female Athletes ◽

Surgical Intervention ◽

Collegiate Athletes ◽

Division I ◽

Surveillance Program ◽

Wrist Injuries ◽

Male And Female ◽

And Gender ◽

Division I Athletes

Abstract Background: The rates, severity and consequences of hand and wrist injuries sustained by NCAA athletes are not well characterized. This study describes the epidemiology of hand and wrist injuries among collegiate athletes competing in different divisions. Methods: The National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) was accessed for various sports from 2004 to 2015. Data was stratified by hand and wrist injuries sustained, mean loss of activity time following the injury, male and female sport, need for surgery following injury and division. Descriptive statistics were performed to examine the association between sports, event type and gender. P < 0.05 was considered significantResults 103,098 hand and wrist injuries were reported in all NCAA sports from 2004-2015. Male athletes sustained 72,423 injuries (6.01/10,000 athlete events) and female athletes sustained 30,675 injuries (4.13/10,000 athlete events). Division I athletes sustained significantly more injuries compared to divisions II and III. Overall, 3.78% of hand and wrist injuries required surgical intervention. A significantly higher percentage of division I athletes (both male and female) underwent surgical intervention compared to divisions II and III. The mean time lost due to hand and wrist injury was 7.14 days for all athletes. Division I athletes tended to miss fewer days due to injury, though this was not significant.Conclusions Hand and wrist injuries are common among collegiate athletes. Division I athletes sustain higher rates of injuries and higher surgical intervention rates, while tending to miss fewer days due to injury. Improved characterization of divisional differences in hand and wrist injuries can assist injury management and prevention

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Hand and Wrist Injuries Among Collegiate Athletes: The Role of Sex and Competition on Injury Rates and Severity

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120964622 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096462

Author(s):

Andrew M. Simpson ◽

Daniel P. Donato ◽

Jacob Veith ◽

David Magno-Padron ◽

Jayant P. Agarwal

Keyword(s):

National Collegiate Athletic Association ◽

Collegiate Athletes ◽

Wrist Fracture ◽

Ice Hockey ◽

National Database ◽

Surveillance Program ◽

Wrist Injuries ◽

Collegiate Sports ◽

Cross Sectional ◽

Using Data

Background: There is a high incidence of hand and wrist injuries in athletes participating in collegiate sports, but there is little information published characterizing them. Purpose: To characterize hand and wrist injuries in collegiate athletes using a large national database. Study Design: Descriptive epidemiology study. Methods: This retrospective cross-sectional analysis was designed using data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program database to identify hand and wrist injuries (exclusive of any radial or ulnar fractures) in male and female collegiate athletes participating in NCAA Division I, II, and III sports from 2004 to 2015. Descriptive analyses were performed on stratified data to examine the associations between these injuries and sport, event type, and sex. Results: Men’s ice hockey (8.25 per 10,000 athlete-exposures [AEs]) and women's ice hockey (8.21 per 10,000 AEs) had the highest rate of hand and wrist injuries in all exposures. In every sport except women’s gymnastics ( P = .107), injuries were more commonly sustained during competition rather than during practice. Ligamentous injury to the phalynx was the most commonly sustained injury overall (1.416 per 10,000 AEs), and a metacarpal fracture was the most commonly sustained hand or wrist fracture (0.507 per 10,000 AEs). Injuries sustained during men’s wrestling (14.08 days) and women’s gymnastics (10.39 days) incurred the most time lost from sport. Surgery for hand and wrist injuries was most commonly required for men’s football (0.413 per 10,000 AEs) and women’s field hockey (0.404 per 10,000 AEs). Conclusion: Hand and wrist injuries were common among collegiate athletes. Male athletes experienced injuries with more frequency and severity. Injuries occurred more commonly during competition. While the majority of injuries were minor and did not require surgery, certain sports conferred a much higher risk of significant injuries requiring a surgical intervention.

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Characteristics of Operative Shoulder Injuries in the National Collegiate Athletic Association, 2009-2010 Through 2013-2014

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118790764 ◽

2018 ◽

Vol 6 (8) ◽

pp. 232596711879076

Author(s):

Joseph A. Gil ◽

Avi D. Goodman ◽

Steven F. DeFroda ◽

Brett D. Owens

Keyword(s):

National Collegiate Athletic Association ◽

Collegiate Athletes ◽

Injury Surveillance ◽

Ice Hockey ◽

Surveillance Program ◽

Shoulder Injuries ◽

Level Of Evidence ◽

Cross Sectional ◽

Glenoid Labrum ◽

Significant Difference

Background: Injuries to the upper extremity among collegiate athletes are reported to account for approximately 20% of all injuries; however, little is known about the proportion of these injuries that require surgery. Purpose/Hypothesis: The purpose of this study was to examine all shoulder injuries that required a surgical intervention and were recorded in the National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP). We hypothesized that contact would be the mechanism causing injuries most at risk for needing surgery and that dislocations would be the injuries most likely to require an operative intervention. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Injury surveillance data between 2009-2010 and 2013-2014 for operative collegiate shoulder injuries and their associated sport exposures were analyzed. Results: A total of 185 operative shoulder injuries occurred over 3,739,004 athlete-exposures (AEs), for an overall incidence of 0.49 per 10,000 AEs. The sports with the highest incidence of operative injuries were men’s football (1.31/10,000 AEs), men’s wrestling (1.14/10,000 AEs), men’s ice hockey (0.60/10,000 AEs), women’s gymnastics (0.44/10,000 AEs), and men’s swimming (0.41/10,000 AEs). Men were significantly more likely than women to sustain operative injuries for all sports combined. Of the injuries that required surgical treatment, superior labrum from anterior to posterior (SLAP) tears (46.4%), other non-SLAP glenoid labrum tears (46.2%), anterior shoulder dislocations (33.3%), and posterior shoulder dislocations (30.0%) were seen most often. There was no significant difference in injury proportion ratios (IPRs) for injuries requiring surgery when comparing contact versus noncontact mechanisms of injury (IPR, 1.0 [95% CI, 0.6-1.6]). The incidence of operative injuries sustained during competition was significantly higher compared with during practice. Conclusion: The sports with the highest incidence of operative shoulder injuries were men’s football, men’s wrestling, men’s ice hockey, and women’s gymnastics. Operative shoulder injuries were more likely to occur during competition. SLAP tears, other non-SLAP glenoid labrum tears, and anterior shoulder dislocations had the highest incidence of requiring surgery. Athletes sustaining these injuries, along with their coaches and medical providers, may benefit from identifying collegiate sport participants who are at highest risk for sustaining an operative injury. This may assist in planning medical care and setting expectations, which may be critical to a young athlete’s career.

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Comparison of Concussion Rates Between NCAA Division I and Division III Men’s and Women’s Ice Hockey Players

The American Journal of Sports Medicine ◽

10.1177/0363546517710005 ◽

2017 ◽

Vol 45 (11) ◽

pp. 2622-2629 ◽

Cited By ~ 10

Author(s):

John M. Rosene ◽

Bryan Raksnis ◽

Brie Silva ◽

Tyler Woefel ◽

Paul S. Visich ◽

...

Keyword(s):

Ncaa Division I ◽

National Collegiate Athletic Association ◽

Injury Rate ◽

Ice Hockey ◽

Division I ◽

Surveillance Program ◽

Division Iii ◽

Convenience Sample ◽

Hockey Players ◽

Rate Ratios

Background: Examinations related to divisional differences in the incidence of sports-related concussions (SRC) in collegiate ice hockey are limited. Purpose: To compare the epidemiologic patterns of concussion in National Collegiate Athletic Association (NCAA) ice hockey by sex and division. Study Design: Descriptive epidemiology study. Methods: A convenience sample of men’s and women’s ice hockey teams in Divisions I and III provided SRC data via the NCAA Injury Surveillance Program during the 2009-2010 to 2014-2015 academic years. Concussion counts, rates, and distributions were examined by factors including injury activity and position. Injury rate ratios (IRRs) and injury proportion ratios (IPRs) with 95% confidence intervals (CIs) were used to compare concussion rates and distributions, respectively. Results: Overall, 415 concussions were reported for men’s and women’s ice hockey combined. The highest concussion rate was found in Division I men (0.83 per 1000 athlete-exposures [AEs]), followed by Division III women (0.78/1000 AEs), Division I women (0.65/1000 AEs), and Division III men (0.64/1000 AEs). However, the only significant IRR was that the concussion rate was higher in Division I men than Division III men (IRR = 1.29; 95% CI, 1.02-1.65). The proportion of concussions from checking was higher in men than women (28.5% vs 9.4%; IPR = 3.02; 95% CI, 1.63-5.59); however, this proportion was higher in Division I women than Division III women (18.4% vs 1.8%; IPR = 10.47; 95% CI, 1.37-79.75). The proportion of concussions sustained by goalkeepers was higher in women than men (14.2% vs 2.9%; IPR = 4.86; 95% CI, 2.19-10.77), with findings consistent within each division. Conclusion: Concussion rates did not vary by sex but differed by division among men. Checking-related concussions were less common in women than men overall but more common in Division I women than Division III women. Findings highlight the need to better understand the reasons underlying divisional differences within men’s and women’s ice hockey and the need to develop concussion prevention strategies specific to each athlete population.

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Sex Differences in Reported Concussion Injury Rates and Time Loss From Participation: An Update of the National Collegiate Athletic Association Injury Surveillance Program From 2004–2005 Through 2008–2009

Journal of Athletic Training ◽

10.4085/1062-6050-51.3.05 ◽

2016 ◽

Vol 51 (3) ◽

pp. 189-194 ◽

Cited By ~ 97

Author(s):

Tracey Covassin ◽

Ryan Moran ◽

R. J. Elbin

Keyword(s):

Sex Differences ◽

National Collegiate Athletic Association ◽

Female Athletes ◽

Epidemiologic Studies ◽

Injury Surveillance ◽

Ice Hockey ◽

Surveillance Program ◽

Time Loss ◽

Basketball Players ◽

Injury Rates

Epidemiologic studies have identified differences in concussion incidence between the sexes. However, few authors to date have updated injury rates (IRs) and time loss between male and female concussed athletes.Context: To examine sex differences in IRs and time loss in concussed National Collegiate Athletic Association (NCAA) athletes.Objective: Descriptive epidemiologic study.Design: National Collegiate Athletic Association athletics.Setting: A total of 1702 concusssed NCAA athletes, consisting of 903 females and 779 males participating in soccer, basketball, ice hockey, lacrosse, softball, or baseball over a 5-year period from 2004–2005 through 2008–2009.Patients or Other Participants: Using the NCAA Injury Surveillance Program, athletic trainers reported concussions, athlete-exposures (AEs), and time loss across 10 NCAA sports. An IR is the number of injuries in a particular category divided by the number of AEs in that category.Main Outcome Measure(s): During the study period, 1702 concussions were reported during 4 170 427 AEs for an overall total of 5.47 per 10 000 AEs. In sex-comparable sports, females had a 1.4 times higher overall concussion IR than males (IRs = 4.84 and 3.46, respectively), with greater rates in women's baseball/softball, basketball, ice hockey, and soccer than men. Female soccer and basketball players also displayed more time loss after concussion compared with male basketball and soccer players.Results: Female athletes sustained a higher rate of concussion and, in all sports except lacrosse, had greater time loss from concussion than male athletes. Additional research is needed on sex differences in time loss after concussions.Conclusions:

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Epidemiological Patterns of Patellofemoral Injuries in Collegiate Athletes in the United States From 2009 to 2014

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119840712 ◽

2019 ◽

Vol 7 (4) ◽

pp. 232596711984071 ◽

Cited By ~ 4

Author(s):

Jeffrey D. Trojan ◽

Joshua A. Treloar ◽

Christopher M. Smith ◽

Matthew J. Kraeutler ◽

Mary K. Mulcahey

Keyword(s):

Sports Medicine ◽

National Collegiate Athletic Association ◽

Female Athletes ◽

Collegiate Athletes ◽

The United States ◽

Surveillance Program ◽

Injury Incidence ◽

Patellar Subluxation ◽

Rate Ratios ◽

Women's Volleyball

Background: As many as 30% of patients with knee pain seen in sports medicine clinics have complaints related to the patellofemoral joint. There is a paucity of research available regarding patellofemoral injuries, mechanism of injury, and playing time lost in collegiate athletes. Purpose: To describe the rates, mechanisms, severity, and potential sex-based differences of patellofemoral injuries in collegiate athletes across 25 National Collegiate Athletic Association (NCAA) sports. Study Design: Descriptive epidemiology study. Methods: Data from the 2009-2010 through the 2013-2014 academic years were obtained from the NCAA Injury Surveillance Program and were analyzed to calculate patellofemoral injury rates, mechanisms of injury, time lost, and need for surgery. Rate ratios and injury proportion ratios were used to quantify discernible differences between sex-comparable sports and timing of injury (ie, practice vs competition), respectively. Results: The overall patellofemoral injury incidence rate was 16.10 per 100,000 athlete-exposures (AEs). Women’s volleyball had the highest incidence of all sports (39.57 per 100,000 AEs). Injuries were 66% more likely to occur in competition than during practice. Female athletes experienced significantly more patellofemoral injuries than males in similar sports. Patellar tendinitis accounted for 49.2% of all patellofemoral injuries and was the most common injury in 20 of 25 studied sports. Patellar subluxation accounted for the most total days missed, and patellar dislocation had the highest mean days missed per injury (11.42 days). Patella fracture was the most likely injury to require surgery (80%). Conclusion: Patellofemoral injuries were most common in sports that require jumping and quick changes of direction, specifically women’s volleyball, men’s and women’s basketball, and women’s soccer. The majority of patellofemoral injuries in this cohort were classified as patellar tendinitis caused by overuse. Most injuries resulted in no competition or practice time lost. This information may contribute to the development of prevention programs aimed at addressing the most prevalent types and mechanisms of injury in each sport to reduce the incidence of patellofemoral injury in these athletes.

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Return to Sport After Anterior Cruciate Ligament Reconstruction in a Cohort of Division I NCAA Athletes From a Single Institution

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120982281 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712098228 ◽

Cited By ~ 1

Author(s):

Biagio Zampogna ◽

Sebastiano Vasta ◽

Guglielmo Torre ◽

Akhil Gupta ◽

Carolyn M. Hettrich ◽

...

Keyword(s):

Acl Reconstruction ◽

National Collegiate Athletic Association ◽

Cruciate Ligament ◽

Return To Sport ◽

Collegiate Athletes ◽

Division I ◽

Sport Activities ◽

Anterior Cruciate ◽

Division I Athletes

Background: Anterior cruciate ligament (ACL) tears are common in collegiate athletes. The rate of return to the preinjury level of sport activities after ACL reconstruction continues to evolve. Purpose/Hypothesis: The purpose was to determine the return-to-sport rate after ACL reconstruction in a cohort of National Collegiate Athletic Association Division I athletes in different sports. It was hypothesized that, with intensive supervision of rehabilitation, the return-to-sport rate would be optimal. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the records of 75 collegiate athletes from a single institution who had undergone unilateral or bilateral ACL reconstruction between 2001 and 2013 and participated in an extensive supervised rehabilitation program. Prospectively collected athlete data as well as data about preinjury exposure, associated lesions, surgical technique, time lost to injury, number of games missed, time to return to full sport activity or retire, and subsequent surgical procedures were extracted from the medical and athletic trainer records. Results: The 75 patients (40 male, 35 female; mean age, 20.1 years) underwent 81 reconstruction procedures (73 primary, 8 revision). The mean follow-up was 19.3 months. The overall return-to-sport rate was 92%. After reconstruction, 9 athletes (12%) retired from collegiate sports, but 3 of them returned to sport activities after graduation. Overall, 8 athletes (11%) experienced an ACL graft retear. Conclusion: The return-to-sport rate in our National Collegiate Athletic Association Division I athletes compared favorably with that reported in other studies in the literature. The strict follow-up by the surgeon, together with the high-profile, almost daily technical and psychological support given mainly by the athletic trainers during the recovery period, may have contributed to preparing the athletes for a competitive rate of return to sport at their preinjury level.

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Preliminary Scale of Reference Values for Evaluating Reactive Strength Index-Modified in Male and Female NCAA Division I Athletes

Sports ◽

10.3390/sports6040133 ◽

2018 ◽

Vol 6 (4) ◽

pp. 133 ◽

Cited By ~ 3

Author(s):

Christopher Sole ◽

Timothy Suchomel ◽

Michael Stone

Keyword(s):

Reference Values ◽

Ncaa Division I ◽

National Collegiate Athletic Association ◽

Collegiate Athletes ◽

Division I ◽

Strength Index ◽

Male And Female ◽

Significant Difference ◽

Males And Females ◽

Division I Athletes

The purpose of this analysis was to construct a preliminary scale of reference values for reactive strength index-modified (RSImod). Countermovement jump data from 151 National Collegiate Athletic Association (NCAA) Division I collegiate athletes (male n = 76; female n = 75) were analyzed. Using percentiles, scales for both male and female samples were constructed. For further analysis, athletes were separated into four performance groups based on RSImod and comparisons of jump height (JH), and time to takeoff (TTT) were performed. RSImod values ranged from 0.208 to 0.704 and 0.135 to 0.553 in males and females, respectively. Males had greater RSImod (p < 0.001, d = 1.15) and JH (p < 0.001, d = 1.41) as compared to females. No statistically significant difference was observed for TTT between males and females (p = 0.909, d = 0.02). Only JH was found to be statistically different between all performance groups. For TTT no statistical differences were observed when comparing the top two and middle two groups for males and top two, bottom two, and middle two groups for females. Similarities in TTT between sexes and across performance groups suggests JH is a primary factor contributing to differences in RSImod. The results of this analysis provide practitioners with additional insight as well as a scale of reference values for evaluating RSImod scores in collegiate athletes.

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Epidemiology of Hip and Groin Injuries in Collegiate Athletes in the United States

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118771676 ◽

2018 ◽

Vol 6 (5) ◽

pp. 232596711877167 ◽

Cited By ~ 17

Author(s):

Yehuda E. Kerbel ◽

Christopher M. Smith ◽

John P. Prodromo ◽

Michael I. Nzeogu ◽

Mary K. Mulcahey

Keyword(s):

National Collegiate Athletic Association ◽

Injury Rate ◽

Collegiate Athletes ◽

The United States ◽

Ice Hockey ◽

Surveillance Program ◽

Prevention Measures ◽

Collegiate Sports ◽

Treatment And Prevention ◽

Rate Ratios

Background: Hip and groin pain is a common complaint among athletes. Few studies have examined the epidemiology of hip and groin injuries in collegiate athletes across multiple sports. Purpose: To describe the rates, mechanisms, sex-based differences, and severity of hip/groin injuries across 25 collegiate sports. Study Design: Descriptive epidemiology study. Methods: Data from the 2009-2010 through 2013-2014 academic years were obtained from the National Collegiate Athletic Association Injury Surveillance Program (NCAA ISP). The rate of hip/groin injuries, mechanism of injury, time lost from competition, and need for surgery were calculated. Differences between sex-comparable sports were quantified using rate ratios (RRs) and injury proportion ratios (IPRs). Results: In total, 1984 hip/groin injuries were reported, giving an overall injury rate of 53.06 per 100,000 athlete-exposures (AEs). An adductor/groin tear was the most common injury, comprising 24.5% of all injuries. The sports with the highest rates of injuries per 100,000 AEs were men’s soccer (110.84), men’s ice hockey (104.90), and women’s ice hockey (76.88). In sex-comparable sports, men had a higher rate of injuries per 100,000 AEs compared with women (59.53 vs 42.27, respectively; RR, 1.41 [95% CI, 1.28-1.55]). The most common injury mechanisms were noncontact (48.4% of all injuries) and overuse/gradual (20.4%). In sex-comparable sports, men had a greater proportion of injuries due to player contact than women (17.0% vs 3.6%, respectively; IPR, 4.80 [95% CI, 3.10-7.42]), while women had a greater proportion of injuries due to overuse/gradual than men (29.1% vs 16.7%, respectively; IPR, 1.74 [95% CI, 1.46-2.06]). Overall, 39.3% of hip/groin injuries resulted in time lost from competition. Only 1.3% of injuries required surgery. Conclusion: Hip/groin injuries are most common in sports that involve kicking or skating and sudden changes in direction and speed. Most hip/groin injuries in collegiate athletes are noncontact and do not result in time lost from competition, and few require surgery. This information can help guide treatment and prevention measures to limit such injuries in male and female collegiate athletes.

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The Epidemiology of Stress Fractures in Collegiate Student-Athletes, 2004–2005 Through 2013–2014 Academic Years

Journal of Athletic Training ◽

10.4085/1062-6050-52.8.01 ◽

2017 ◽

Vol 52 (10) ◽

pp. 966-975 ◽

Cited By ~ 25

Author(s):

Katherine H. Rizzone ◽

Kathryn E. Ackerman ◽

Karen G. Roos ◽

Thomas P. Dompier ◽

Zachary Y. Kerr

Keyword(s):

Stress Fracture ◽

National Collegiate Athletic Association ◽

Female Athletes ◽

Injury Rate ◽

Collegiate Athletes ◽

The United States ◽

Stress Fractures ◽

Ice Hockey ◽

Ncaa Athletes ◽

Cross Country

Context: Stress fractures are injuries caused by cumulative, repetitive stress that leads to abnormal bone remodeling. Specific populations, including female athletes and endurance athletes, are at higher risk than the general athletic population. Whereas more than 460 000 individuals participate in collegiate athletics in the United States, no large study has been conducted to determine the incidence of stress fractures in collegiate athletes. Objective: To assess the incidence of stress fractures in National Collegiate Athletic Association (NCAA) athletes and investigate rates and patterns overall and by sport. Design: Descriptive epidemiology study. Setting: National Collegiate Athletic Association institutions. Patients or Other Participants: National Collegiate Athletic Association athletes. Main Outcome Measure(s): Data were analyzed from the NCAA Injury Surveillance Program for the academic years 2004–2005 through 2013–2014. We calculated rates and rate ratios (RRs) with 95% confidence intervals (CIs). Results: A total of 671 stress fractures were reported over 11 778 145 athlete-exposures (AEs) for an overall injury rate of 5.70 per 100 000 AEs. The sports with the highest rates of stress fractures were women's cross-country (28.59/100 000 AEs), women's gymnastics (25.58/100 000 AEs), and women's outdoor track (22.26/100 000 AEs). Among sex-comparable sports (baseball/softball, basketball, cross-country, ice hockey, lacrosse, soccer, swimming and diving, tennis, indoor track, and outdoor track), stress fracture rates were higher in women (9.13/100 000 AEs) than in men (4.44/100 000 AEs; RR = 2.06; 95% CI = 1.71, 2.47). Overall, stress fracture rates for these NCAA athletes were higher in the preseason (7.30/100 000 AEs) than in the regular season (5.12/100 000 AEs; RR = 1.43; 95% CI = 1.22, 1.67). The metatarsals (n = 254, 37.9%), tibia (n = 147, 21.9%), and lower back/lumbar spine/pelvis (n = 81, 12.1%) were the most common locations of injury. Overall, 21.5% (n = 144) of stress fractures were recurrent injuries, and 20.7% (n = 139) were season-ending injuries. Conclusions: Women experienced stress fractures at higher rates than men, more often in the preseason, and predominantly in the foot and lower leg. Researchers should continue to investigate biological and biomechanical risk factors for these injuries as well as prevention interventions.

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