- Where, When and Why? -
Where Does Injury Occur on the Court?
It has been reported that approximately half of all basketball injuries occur in the key, where crowding, jumping, and body contact are common. It was found that injuries in this region accounted for 44.7% of reportable injuries. 
When Does Injury Occur?
More injuries are sustained during competition than during training sessions. In a 16-year review of men's and women's college basketball in the USA, it was found that the rate of injuries in games was two times greater than in practice.  The increased frequency of injuries in games contrary to practice is caused by high intensity level of competition and because of the maximum effort that is expended during games. The athlete is at maximum risk, which might make athletes more vulnerable to injury. As well it was reported that 3.7 times more serious injuries occurred in games. Opposite to that in professional American basketball, it was reported that male and female players were injured more frequently at practices then at games. Over a 10-year period 56.8% of injuries in male players occurred during a training session. 
Few studies have investigated the time during a game at which injury occurs, and it was found no significant relationship.
Investigating the time during a basketball season during which injury is most common it was shown higher rate in the preseason as compared with later in the season for both practice and games. Among Australian basketball players the highest injury rate was found at the start of the season and then significantly declined by the end of the fifth month.
Why Does Injury Occur? (Risk Factors)
Risk factors are traditionally divided into two main categories: internal (or intrinsic) athlete-related risk factors and external (or extrinsic) environmental risk factors.
Although some studies have found a higher overall rate of injury in female players as compared with male players (predominantly for ACL damage), most have reported no significant differences.
Age, height, weight
There is conflicting information about the influence of age and/or level of development on injury in young players. Regarding the risk for ankle injury the most studies have reported no significant correlation to be found with and factors that players could not change, such as age, and height. 
Some authors have observed increased body mass index as a risk factor for ACL injuries. It was postulated that an increased body mass index would result in a more extended lower extremity position with decreased knee flexion upon landing. Unfortunately, conflicting results do exist when completing a further review of the literature, and other authors found no impact of body mass index on ACL injuries in female athletes. 
It was shown that foot size with increased width increase risk to sustain ankle sprain, as well as increased ankle eversion to inversion strength, plantarflexion strength, ratio between dorsiflexion and plantarflexion strength, and limb dominance. 
Anatomical factors that are recognized to increase risk of suffering an ACL injury are: decreased intercondylar notch width, weak or small ACL, increased knee abduction moment, increased anterior-posterior laxity of the knee joint, pelvic position, navicular drop, and subtalar joint pronation. Even though these factors may not be easy to correct, they are important to understand if we are going to identify who is at risk. 
The most commonly documented intrinsic risk factor for ankle injury is a history of ankle sprain. It was reported that players with a history of ankle sprain were almost five times more likely to injure their ankle as those without a history of ankle injury. Evidence shows that combinations of intrinsic risk factors may have a cumulative effect on the risk of ankle injury. For example, overweight male athletes (body-mass index >95th percentile) with a previous ankle sprain were 9.6 times to 19 times more likely to sustain a noncontact ankle sprain as compared with normal-weight players without a history of ankle sprain. 
White female players were 6.6 times more likely to injure their ACL than were black female players. 
Although balance has been examined as a risk factor in youth and adolescent basketball injury no such studies have involved adult players. People with inferior single leg balance were 2.4 times more likely to have sprain injury. 
Level of Competition
Few studies in USA showed that the higher the level of play, the higher the risk of sustaining injuries. The injury rate among NBA players was twice that experienced by collegiate players.  There was reported significantly higher game-related injury rates in Division I men's collegiate basketball than in Division III. In contrast, one prospective cohort study on European basketball players of professional, national and regional level showed that the lower the level of play, the higher the risk of sustaining injuries, while an Australian study reported no difference in the game-related injury rate between elite and recreational players. [6, 7]
Limited research has investigated whether playing position is a risk factor for injury. Early studies were descriptive in nature but concluded no such relationship. In contrast, Meeuwisse et al. (2003) showed that centers had a higher injury rate for knee, ankle and foot injuries as compared with forwards, who had the lowest rate, but could not prove a statistically significant difference. [6, 1]
It was reported that basketball players wearing more expensive shoes, which had air cells in the heel, were 4.3 times more likely to injure their ankle than those wearing less expensive shoes. [1, 2] The role of shoe in ankle sprain prevention was less clear. One expert group suggested that high-top shoe limited extreme range of motion, reduced the external stress, and enhanced proprioception of the ankle joint, while opposite attitude argued that modern athletic footwear impaired proprioception. 
1. Caine DJ, Harnmer PA,Shiff M. Epidemiology of injuries in Olympic sports. 2010. Blackwell Publishing Ltd
2. McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 2001;35:103-108
3. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, La´zaro-Haro K, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 2009: 7:705-729
4. Fong DTP, Chan YY, Mok KM, Yung PSH, Chan KM. Understanding acute ankle ligamentous sprain injury in sports. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology 2009, 1:14
5. Maffulli N, Caine DJ. Epidemioogy of pediatric sports injuries. Team sports. Med and Sci Sport 2005; 49
6. Cumps E, Verhagen E, Meeusen R. Prospective epidemiological study of basketball injuries during one competitive season: Ankle sprains and overuse knee injuries J Sports Sci and Med 2007; 6: 204-211
7. Junge A, Engebretsen L, Alonso JM, Renström P, Mountjoy ML, Aubry M, Dvorak J. Injury surveillance in multi-sport events - the IOC approach. Br. J. Sports Med. published online 7 Apr 2008; doi:10.1136/bjsm.2008.046631
Prepared by: Dr. Jelena Oblakovic-Babic