Anterior Cruciate Ligament Injury in the Female Athlete (original) (raw)
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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.
Play at Your Own Risk: Sport, the Injury Epidemic, and ACL Injury Prevention in Female Athletes
Journal of Intercollegiate Sport, 2009
This article focuses on describing anterior cruciate ligament (ACL) injury in athletes and the efficacy of implementing a neuromuscular and proprioceptive sports-specific training program to reduce the incidence of ACL ligament injuries. This article will discuss the role of the ACL, epidemiology and etiology, and the four categorical risk factors for incurring an ACL injury: anatomical, environmental, hormonal, and biomechanical. In addition, this article will discuss the mechanisms ACL injuries, as well as a comprehensive review of all of the literature that has been published with regard to the prevention or reduction of ACL injury. The article concludes that a neuromuscular training program might have a direct benefit in decreasing the number of ACL injuries in athletes.
2014
ABSTRACT Introduction Ligament reconstruction of the anterior cruciate ligament (ACL) is one of the most frequent arthroscopic procedures. According to the Technical Agency for Information on Hospitalizations (ATIH) 41,122 ligament reconstructions were performed in France in 2012. Treatment of the injury is costly and not always successful at returning patients to their preinjury activity level. Identification of all factors associated with increased risk of ACL injury during sport is important to provide an appropriate level of counseling and programs for prevention. These factors have been categorized as intrinsic (inherent to the individual athlete) or extrinsic (external to the athlete). Risk of ACL injury in female athletes depending on sports Female athletes have been identified at increased risk of injuring their ACL during certain sports, with reported injury rates that are 3.6 times greater for basketball and 5.1 times greater for handball when compared with male athletes who participate in these sports at similar levels of play. Extrinsic risk factors Several extrinsic factors seem increase the risk of ACL injury in both female and male athletes with a slightly increased risk in female: competition, wet and rainy weather, the type and number of cleats, the design of the shoe, the type of grass, artificial grass or floor surface and previous ACL reconstruction. Intrinsic risk factors Several anatomic risk factors have been identified, mainly an increased anterior-posterior knee laxity, a smaller intercondylar notch width with a shorter ACL, and a greater condyle offset ratio. Neuromuscular and biomechanical risk factors are also involved as increased dynamic valgus and muscle and proprioceptive deficit of the non-dominant leg in female. The hormonal theory is based on several reports of elevated ACL tear rates in pre- as compared to postovulatory phase. Other risk factors were evocated: a familial predisposition to noncontact ACL tears, genetic factors and a higher body mass index. Multivariate risk factor analysis Given the multiplicity of risk factors it seems important to develop multivariable models but very few studies have followed this approach. Conclusion Several intrinsic factors may explain the sex-ration in ACL tear but intrinsic and extrinsic risk factors act in combination to increase the risk of ACL injury. The identification of these factors has led to the development of appropriate prevention programs with good but still insufficient results. Optimizing prevention requires the organization of large cohort studies for each sport, involving all participants. A generalization of multivariate statistical analyzes would take into account the possible interactions and to quantify the risk for each factor. Comprehensive prevention programs specific to each sport, incorporating all the factors, could then be developed.
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
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.
Orthopaedic Journal of Sports Medicine
Background: Anterior cruciate ligament (ACL) tears are common among high school athletes, with sex-based differences accounting for higher injury rates in girls. Previous epidemiological studies on ACL injuries focusing on adolescent athletes have looked at injuries across multiple sports, but few have analyzed ACL tears in solely high school soccer athletes. Purpose: To examine sex-based differences in the epidemiology of ACL injuries among high school soccer players in the United States (US). Study Design: Descriptive epidemiological study. Methods: ACL injury data for US high school soccer players were obtained from the internet-based National High School Sports-Related Injury Surveillance Study’s High School RIO (Reporting Information Online) system. Athletic trainers from a random sample of 100 high schools from 8 strata based on US Census geographic region reported data for athlete-exposures (AEs) (practice or competition) and ACL injuries from 2007 through 2017. Injury rates ...
Risk of Anterior Cruciate Ligament Injury in Female Soccer Athletes: A Review
Journal of orthopedics and orthopedic surgery, 2021
Soccer is becoming an increasingly popular sport amongst women. Common movements during play, such as jumping and cutting, require rapid acceleration and deceleration of multiple lower-limb joints. The anterior cruciate ligament (ACL), which contributes to stabilization of the knee, is often injured during these events. ACL injury typically requires costly surgery, extended time away from sports, and jeopardizes long-term joint health. Due to sex-specific factors such as menstruation and anatomical disadvantages, women are more susceptible to tearing their ACL. Injury often occurs in non-contact scenarios during rapid acceleration or deceleration movements. Research has examined these movements and established several kinematic and kinetic mechanisms as well as muscle activation patterns that frequently occur at the time of injury, however results tend to vary based on population. This article summarizes recent and relevant literature of ACL injury mechanisms and highlights the lack of specific research in the high-risk female soccer athlete population. Due to inconclusive risk factors, injury prevention programs within this population have been inconsistent. ACL injury risk for female soccer athletes should be closer examined so that more specific injury risks can be established, and effective protective measures can be taken. Raised awareness of this need may capture attention in the research and medical communities and potentially stimulate the development of strategies that limit future ACL injury and thus the challenges it brings to the high-risk female soccer athlete.
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.
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