Could High Game Volume over a Shorter Season Increase Noncontact Knee Injury Risk among Kentucky High School Girls'...

A retrospective review of high school, college, and professional female basketball team game number and season duration comparisons was performed. The objective was to compare group differences with consideration of the possible relationship between game volume per season duration and noncontact anterior cruciate ligament injury risk from accumulated microtrauma. The study hypothesis was that the professional women's basketball team would display the most rigorous game schedule.

For the 2024-2025 playing seasons, the top 10 high school girls' basketball teams in the state of Kentucky, 10 university or college women's basketball teams in the state of Kentucky, and 10 Women's National Basketball Association professional teams were compared for number of players on the roster, number of regular season games, season duration, frequency of two games per week, frequency of three or more games per week, total games, and average number of games per week.

Professional athletes played two games per week (mean 14.4, 95% confidence interval [CI] 13.6-15.2 weeks) more frequently than high school (mean 11.6, 95% CI 10.8-12.4 weeks) and university-college athletes (mean 12.4, 95% CI 11.8-13.0 weeks, P < 0.001). Professional athletes played three or more games per week (mean 7.6, 95% CI 6.8-8.4 weeks) more frequently than university-college (mean 2.0, 95% CI 1.0-3.0 weeks) and high school athletes (mean 5.4, 95% CI 4.5-6.3 weeks; P < 0.002), and high school athletes played three or more games per week more frequently than university-college athletes (P < 0.001). Teams had comparable roster sizes (P = 0.10). Professional athletes played more games per season (mean 40, 95% CI 40-40) than university-college (mean 30.2, 95% CI 29.3-31.1, P = 0.028) and high school (mean 28.5, 95% CI 27.1, 27.1, 29.9; P < 0.001) athletes. Professional (mean 2.4, 95% CI 2.3-2.6) and high school (mean 2.4, 95% CI 2.2-2.6) athletes played more games per week than university-college athletes (mean 1.9, 95% CI 1.8-1.97; P < 0.001). Professional athletes also played more games per week than university-college athletes (P < 0.001). Professional athletes (mean 44.9, 95% CI 42.3-47.5) played more total games/season than high school (mean 33.7, 95% CI 32.0-35.4; P < 0.001) and university-college (mean 32.4, 95% CI 31.4-33.4; P < 0.001) athletes. Season duration was shorter for high school athletes (mean 14.1, 95% CI 13.3-14.9 weeks) than for university-college (mean 17.1, 95% CI 16.2-18.0 weeks) and professional (mean 18.0, 95% CI 18-18 weeks; P < 0.001) athletes.

The combination of high game volume over a shorter season duration may put high school girls' basketball players at particularly high risk for mechanical fatigue-related anterior cruciate ligament injury from noncontact mechanisms. To mitigate this risk, increasing season duration or reducing the number of games played within the current season may be indicated. In either case, greater dedication to active rest and recovery in conjunction with neuromuscular control training is recommended.