Anterior cruciate ligament injury risk in sport: A systematic review and meta-analysis of injury incidence by sex and sport classification

Objective To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact). Data Sources A systematic review was performed using the electronic databases PubMed (1969–January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969–January 20, 2017) and the search terms anterior cruciate ligament AND injury AND (incidence OR prevalence OR epidemiology). Study Selection Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English. Data Extraction Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis. Data Synthesis We conducted IR and IR ratio (IRR) meta-analyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10?000 versus 1.12/10000 AEs, IRR = 1.14, P = .63), limited contact (0.71/10000 versus 0.29/10000 AEs, IRR = 1.21, P = .77), and noncontact (0.36/10000 versus 0.21/10000 AEs, IRR = 1.49, P = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10000 versus 0.87/10?000 AEs, IRR = 3.00, P < .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10000 versus 1.75/10?000 AEs, IRR = 5.51, P < .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories. Conclusions Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports.
© Copyright 2019 Journal of Athletic Training. National Athletic Trainers' Association. All rights reserved.

Subjects: sports medicine injury knee ligament relation sex female male sport sports game combat sport boxing soccer handball icehockey rugby wrestling basketball land hockey American football baseball fencing softball volleyball alpine skiing dancing running long distance running apparatus gymnastics
Notations: biological and medical sciences sport games combat sports
Tagging: Kreuzband Lacrosse Cheerleading Flickerball Floorball Frisbee
DOI: 10.4085/1062-6050-407-16
Published in: Journal of Athletic Training
Published: 2019
Volume: 54
Issue: 5
Pages: 472-482
Document types: article
Language: English
Level: advanced