Risk factors for anterior cruciate ligament injury: The female gender | Les facteurs de risques de rupture du ligament croisé antérieur: Le genre féminin (original) (raw)
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2021
Anterior cruciate ligament (ACL) injury is one the most common knee injuries in the young and middle age population. Large numbers of studies have examined the anatomy, biomechanics, management and rehabilitation of ACL injuries in the general population and athletes. Contemporary medical technology has facilitated new treatment paradigms and lead to the exponential growth in knowledge in this fundamental area of knee surgery and sports medicine. The objective of this narrative review was to identify studies that examined certain intrinsic and extrinsic factors contributing to ACL injury risk in female athletes. Participation in sports by females is increasing globally and the burden of disease in relation to ACL injuries is expected to increase in association with these increased participation rates. There is a paucity of literature that clearly delineates the intrinsic and extrinsic risk factors for ACL injury among different populations, especially higher-level female athletes. To facilitate the best possible care for knee injured patients, it is essential to understand the key factors that may underpin different injury patterns, especially in the context of dramatically increased participation in high risk sports, including Australian Rules Football, rugby union and rugby league, basketball, netball, soccer and skiing; focusing on those identifiable risk factors that have a female predilection will be the focus of this review and an attempt has been made to broadly review the most pertinent scientific literature.
Anterior cruciate ligament injury in female athletes: epidemiology
Journal of Athletic Training, 1999
Objective: To present epidemiologic studies on anterior cruciate ligament (ACL) injuries in female athletes. Data Sources: MEDLINE was searched from 1978 to 1998 with the terms "anterior cruciate ligament" and "female athlete," among others. Additional sources were knowledge base and oral, didactic, and video presentations. Data Synthesis: Epidemiologic studies have focused on level of participation, specific sports, sex differences and contributing factors, injury mechanism, prevention programs, Although the medial collateral ligament is the most commonly injured ligament, the anterior cruciate ligament (ACL) is the most frequently injured single ligament associated with limited range of motion.1-3 In 1985, it was estimated that 50000 knee surgeries were performed each year in the United States.4 One study showed an incidence of 60 knee ligament injuries per 100000 health members per plan year.1 Males accounted for 72% and females for 28%; 65% of the injuries occurred during sports activities. The true incidence of noncontact ACL injuries and the actual numbers of athletes affected are difficult to determine; determination would require following a large number of athletes participating on different levels over several seasons. In studying the incidence of this injury, the numerator is the number of ACL tears, and the denominator can be, for example, the number of athletic exposures (ie, number of hours of practices and games) or the number of participants. For valid comparisons of statistically significant numbers, epidemiologic studies must involve a large number of subjects over an appropriate number of years. Epidemiologic studies have focused on level of participation,5-23 specific sports,* sex differences and contributing factors, injury mechanism, prevention programs,26-34 and outcomes studies.3'35-49 A significantly increased risk of noncontact ACL injury has been noted in female soccer and basketball athletes when compared with male athletes in the same sports.'3"19 I believe that appropriate intervention programs can reduce these alarming rates and allow female athletes to participate with less risk of ACL injury. In this paper, the and outcomes studies. Female athletes have a significantly increased risk of noncontact ACL injuries over male athletes in soccer and basketball. ConclusionslRecommendations: I believe that appropriate intervention programs can reduce these alarming rates of ACL injuries.
The female ACL: why is it more prone to injury?
Orthopedic Clinics of North America - ORTHOPED CLIN N AMER, 2002
Female athletes tear their anterior cruciate ligaments (ACL) at an alarmingly higher rate in certain sports that involve rapid stopping, cutting, and changing direction, including basketball, team handball, and soccer. The participation in sports by girls has increased dramatically since the National Federation of State High School Associations began recording the numbers [1]. For the 1999-2000 season, total participation by high school athletes for males was 3,861,749, females 2,675,874, and coed 19,289. For sports in which both males and females compete, the basketball numbers for males was 541,130 compared to females 451,600, track-males 480,791, females 405,305, and soccer-males 330,044 and females 270,273. The growth and ratios of male to female
Gender Differences in Noncontact Anterior Cruciate Ligament Injuries
Clinics in Sports Medicine, 2000
After the passage of Title IX in 1972, women began competing in organized sports in large numbers. There was concern that women would have significantly higher injury rates than men. For the most part, these fears were unfounded. Sports injury rates between men and women are similar and, in general, seem to be sport-specific rather than gender-specifi~.~~, 37, 94, 99 There is, however, an increased predisposition (two to eight times) to anterior cruciate ligament (ACL) rupture in women., There are many theories and much research devoted to explaining why this difference in injury rate exists. Research has focused on intrinsic and extrinsic factors. Intrinsic factors are those that are individual, physical, and psychosocial.6 Intrinsic factors include joint laxity, hormonal influences, limb alignment, notch dimensions, and ligament size. The intrinsic causes tend to be more sex-specific and may not be modifiable. Most research into the cause of ACL injuries has been directed toward intrinsic causes. Extrinsic factors are those related to the type of sport, the environmental conditions, the conditioning of the athlete, and the equipment used.6 Unlike most intrinsic factors, extrinsic factors are potentially controllable or changeable. Extrinsic factors include conditioning, experience, skill, strength, muscle recruitment patterns, and landing techniques. Extrinsic
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2007
The literature has shown that anterior cruciate ligament (ACL) tear rates vary by gender, by sport, and in response to injury-reduction training programs. However, there is no consensus as to the magnitudes of these tear rates or their variations as a function of these variables. For example, the female-male ACL tear ratio has been reported to be as high as 9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate accurate estimates of the true incidences of ACL tear as a function of gender, sport, and injury-reduction training. Methods: A PubMed literature search was done to identify all studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to identify additional articles. Meta-analytic principles were applied to generate ACL incidences as a function of gender, sport, and prior injury-reduction training. Results: Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67; lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08, respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03, with no gender variance. The two volleyball studies had no ACL tears. Training reduced the ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball. Conclusions: Female subjects had a roughly 3 times greater incidence of ACL tears in soccer and basketball versus male subjects. Injury-reduction programs were effective for soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear, whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender difference for ACL tear rate. Year-round female athletes who play soccer and basketball have an ACL tear rate of approximately 5%. Level of Evidence: Level IV, therapeutic case series.
Anterior Cruciate Ligament (ACL) injuries are a prevalent concern in athletic population, particularly among female athletes who are disproportionately affected. The increased incidence of ACL injuries in females is attributed to a combination of anatomical, physiological, and biomechanical factors that influence knee stability. This review comprehensively explores these contributing factors, highlighting genderspecific anatomical differences such as wider pelvis, increased quadriceps (Q) angle, and steeper tibial slopes, all of which predispose females to greater knee valgus during dynamic activities.
British Journal of Sports Medicine, 2008
The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate highquality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the ''knee over toe position'' when cutting.
Journal of Women's Sports Medicine, 2022
Our understanding of the anterior cruciate ligament (ACL) has advanced to the point where we understand female-specific predisposing factors to injuries; we have begun to alter surgical reconstructive procedures for women; and we can leverage enhanced sex-specific understandings to improve rehabilitation and even to prevent injuries. While study of sex-specific differences in posterior cruciate ligament (PCL) injuries has just begun, it is our responsibility within the field of sports medicine to continue to advance our understanding of sex differences in PCL and other orthopaedic injuries and to promote future studies examining this topic.