Materiały źródłowe

• #1 Anterior Cruciate Ligament Injury: Practice Essentials, Background, Functional Anatomy

  https://emedicine.medscape.com/article/89442-overview

  An estimated 200,000 ACL-related injuries occur annually in the United States, with approximately 95,000 ACL ruptures. Approximately 100,000 ACL reconstructions are performed each year. The incidence of ACL injury is higher in people who participate in high-risk sports such as basketball, football, skiing, and soccer. When the frequency of participation is considered, a higher prevalence of injury is observed in females over males at a rate 2.4-9.7 times greater for females. A study by Gornitzky et al found that there is an approximately 1.6-fold greater rate of ACL tears per athletic exposure in high school female athletes than males. […] In a study of 101,125 ACL reconstructions in Denmark, Luxembourg, Norway, Sweden, the United Kingdom, and the United States, soccer injuries were the most common cause of these procedures, with the rate ranging from 14.1-42.3%.

• #2 Why Female Athletes Injure Their ACL’s More Frequently? What can we do to mitigate their risk? | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/25467-why-female-athletes-injure-their-acl-s-more-frequently-what-can-we-do-to-mitigate-their-risk

  Anterior Cruciate Ligament (ACL) injuries are one of the most deleterious knee injuries reported in sport. They continue to confound the sports medicine community, particularly with respect to the high rates reported in girls and women. There are approximately 200,000 to 250,000 ACL injuries that occur in the United States annually, a rate that has doubled over the last 20 years. Approximately 25% of these injuries occur in youth athletics; and this rate has been increasing by a rate of 2.5% annually in the United States and has increased by 147.8% over a 10 year period in Victoria, Australia. Although the overall rate of ACL injury is higher in males, primarily due to greater opportunity(s) to participate in contact sports, the relative risk of ACL injury in women is 3 to 8 times greater than males. In the National Collegiate Athletic Association (NCAA), the rate of ACL injuries incurred by collegiate females is three times higher compared to men. In high school aged athletes (13-18 years), there is approximately 1.6-fold greater rate of ACL tears in females, and a multisport female athlete is estimated to have a nearly 10% risk of incurring an ACL injury during her high school or secondary school career.

• #3 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  The ACL is the most commonly injured ligament in the knee, almost half of all knee injuries. The annual reported incidence in the United States alone is approximately 1 in 3500 people. There are approximately 400,000 ACL reconstructions every year in the united states. However, data may not be accurate as there is no standard surveillance. […] There is no age or gender bias; however, it has been suggested that women are at an increased risk of ACL injury secondary to a multitude of factors. In athletes, the female-to-male ratio has been reported to be 4.5: 1. Female athletes tend to get ACL ruptures at a younger age and more in the supporting leg versus the kicking leg in males. […] Among the factors increasing the female risk, as suggested by some studies that females may have weaker hamstrings (more quadriceps dominant) and preferential recruitment of the quadriceps muscle group while decelerating. Engaging the quadriceps musculature while slowing down places abnormally increased stresses on the ACL, as the quadriceps muscles are less effective at preventing anterior tibial translation versus the hamstring muscles. Additionally, females have weaker core stability than males.

• #4 Anterior cruciate ligament injury – UpToDate

  https://www.uptodate.com/contents/anterior-cruciate-ligament-injury

  The anterior cruciate ligament (ACL) is an important stabilizing ligament of the knee that is frequently injured by athletes and trauma victims. There are between 100,000 and 200,000 ACL ruptures per year in the United States alone. […] Sports associated with increased risk of ACL injury.

• #5

  https://crimsonpublishers.com/oproj/fulltext/OPROJ.000562.php

  Anterior cruciate ligament, or ACL, injuries are among the most common athletic injuries that occur in the world. […] This paper reviews the studies that have examined ACL injury rates in different countries, to help understand whether there may be genetic or geographic contributions to differences in these rates. […] It is estimated that in the United States of America (USA), there are 200,000 ACL injuries, half of which require reconstructive surgeries. However, currently only Norway, Denmark, and Sweden have national web-based registries that accurately record nationwide ACL reconstructions, which are presumed to reflect the incidences of ACL injuries. […] Based on reviews of these registries since their first entries, the incidences of ACL injuries were 34 per 100,000 people in Norway, 38 per 100,000 people in Denmark, and 32 per 100,000 people in Sweden.

• #6 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  The ACL is the most commonly injured ligament in the knee, almost half of all knee injuries. The annual reported incidence in the United States alone is approximately 1 in 3500 people. There are approximately 400,000 ACL reconstructions every year in the united states. However, data may not be accurate as there is no standard surveillance. […] There is no age or gender bias; however, it has been suggested that women are at an increased risk of ACL injury secondary to a multitude of factors. In athletes, the female-to-male ratio has been reported to be 4.5: 1. Female athletes tend to get ACL ruptures at a younger age and more in the supporting leg versus the kicking leg in males. […] Among the factors increasing the female risk, as suggested by some studies that females may have weaker hamstrings (more quadriceps dominant) and preferential recruitment of the quadriceps muscle group while decelerating. Engaging the quadriceps musculature while slowing down places abnormally increased stresses on the ACL, as the quadriceps muscles are less effective at preventing anterior tibial translation versus the hamstring muscles. Additionally, females have weaker core stability than males.

• #7

  https://www.orthobullets.com/knee-and-sports/3008/acl-tear

  ACL tears are common athletic injuries leading to anterior and lateral rotatory instability of the knee. […] Incidence: ~400,000 ACL reconstructions / year. […] account for half of all knee injuries. […] more common among female athletes (4.5:1 ratio) […] females sustain ACL injuries at a younger age than males. […] females get more ACL injuries on the supporting leg (males get more ACL injuries on the kicking leg). […] Risk factors: female participation in soccer, male participation in basketball. […] valgus moment at knee and adduction moment at hip upon landing. […] previous concussion.

• #8

  https://link.springer.com/article/10.1007/s40279-022-01697-w

  Not all anterior cruciate ligament (ACL) injuries are preventable. […] Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts. […] The overall proportion of non-contact to total ACL injuries was 55% (95% CI 4862, I2=82%; females: 63%, 95% CI 5371, I2=84%; males: 50%, 95% CI 4258, I2=86%). […] This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes.

• #9

  https://opal.latrobe.edu.au/articles/journal_contribution/Non-contact_Anterior_Cruciate_Ligament_Injury_Epidemiology_in_Team-Ball_Sports_A_Systematic_Review_with_Meta-analysis_by_Sex_Age_Sport_Participation_Level_and_Exposure_Type/23916528

  Not all anterior cruciate ligament (ACL) injuries are preventable. […] Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts. […] The overall proportion of non-contact to total ACL injuries was 55% (95% CI 4862, I2 = 82%; females: 63%, 95% CI 5371, I2 = 84%; males: 50%, 95% CI 4258, I2 = 86%). […] The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.050.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.030.07, I2 = 97%). […] Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.100.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.030.07, I2 = 48%), and this difference was significant. […] Non-contact ACL injuries represented over half of all ACL injuries sustained. […] The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. […] Injuries mostly occurred in competition settings.

• #10

  https://link.springer.com/article/10.1007/s40279-022-01697-w

  Not all anterior cruciate ligament (ACL) injuries are preventable. […] Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts. […] The overall proportion of non-contact to total ACL injuries was 55% (95% CI 4862, I2=82%; females: 63%, 95% CI 5371, I2=84%; males: 50%, 95% CI 4258, I2=86%). […] This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes.

• #11 Epidemiology, Injury Mechanism, and Etiology of ACL Injuries | SpringerLink

  https://link.springer.com/10.1007/978-3-031-29430-3_30

  With an estimated annual incidence of 120,000 in the United States, anterior cruciate ligament (ACL) injuries are commonly encountered in athletes of all skill levels. […] The majority of ACL tears are noncontact injuries occurring during landing, pivoting, or cutting. […] The etiology of ACL tears is multifactorial, with varying contributions from variations in landing mechanics, anatomy of the ACL and intercondylar notch, hormonal effect on ligamentous laxity, as well as neuromuscular control and strength of the core muscles, hip abductors, and hamstrings. […] This chapter will explore the epidemiology, mechanism of injury, and underlying etiology of this devastating injury.

• #12 Epidemiology of Primary Anterior Cruciate Ligament Ruptures in Men and Women

  https://clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise-medicine-ijsem-5-114.php?jid=ijsem

  In the practice of sports that require impact and pivot movements such as football or skiing, knee injuries are common and among these is important to underline the rupture of the Anterior Cruciate Ligament (ACL). […] The rupture of the anterior cruciate ligament is one of the most common injuries among athletes. […] The ACL lesion is usually produced by non-contact movements, which means that is caused by biomechanical errors and a poor neuromuscular control. It has been demonstrated that the incidence of this type of injury is greater in women than in men. Female athletes have a 4 to 6 times higher risk than men to suffer this kind of injury. […] From the comparison of the different articles, we have observed that there is an agreement in affirming that women have a greater risk in suffering ruptures of the anterior cruciate ligament.

• #13 ACL injuries in men’s and women’s football: So many factors equal so much uncertainty – The Athletic

  https://www.nytimes.com/athletic/5120100/2023/12/08/acl-crisis-premier-league-wsl/

  The main reason for any increase would be the increased demands on players as the distance covered, sprint distances, decelerations in games continues to rise. […] One study, published in 2020 analysed 134 ACL injuries across 10 seasons of professional football in Italy and found that 56 per cent of them involved contact of some sort mostly indirect i.e. to the shoulder, with a small percentage being direct contact to the knee. […] That leaves 44 per cent of ACL injuries as non-contact injuries (other studies have put this closer to 65 per cent), which is where things get more complicated. […] The most obvious risk factor for ACL injuries by far, says Dr Kaeding, is being female. […] Depending on where you read, females are anywhere from two to eight times as likely to suffer an ACL injury than males.

• #14 What sports have the most ACL tears? | CurovateDocument

  https://curovate.com/blog/in-what-sports-do-most-acl-injuries-occur/

  The highest risk of anterior cruciate ligament injuries or ACL injuries are for people who play sports where there is a lot of changing directions, pivoting and jumping. Females have a 2-8 times higher chance of injuring their ACL’s compared to males. With most ACL injuries occurring between the ages of 15 and 45. […] Studies consistently list basketball and soccer as sports that cause ACL injuries. However, it is possible to injure the ACL in other sports that require a lot of pivoting, cutting (changing directions quickly), jumping and contact sports. Female athletes tend to be more at risk of ACL injuries. […] Using data from the National Collegiate Athletics Association (NCAA) Injury Surveillance System (ISS) 5000 ACL injuries were recorded from 1988 to 2004.

• #15 ACL injuries in men’s and women’s football: So many factors equal so much uncertainty – The Athletic

  https://www.nytimes.com/athletic/5120100/2023/12/08/acl-crisis-premier-league-wsl/

  The main reason for any increase would be the increased demands on players as the distance covered, sprint distances, decelerations in games continues to rise. […] One study, published in 2020 analysed 134 ACL injuries across 10 seasons of professional football in Italy and found that 56 per cent of them involved contact of some sort mostly indirect i.e. to the shoulder, with a small percentage being direct contact to the knee. […] That leaves 44 per cent of ACL injuries as non-contact injuries (other studies have put this closer to 65 per cent), which is where things get more complicated. […] The most obvious risk factor for ACL injuries by far, says Dr Kaeding, is being female. […] Depending on where you read, females are anywhere from two to eight times as likely to suffer an ACL injury than males.

• #16 Anterior Cruciate Ligament Injury: Practice Essentials, Background, Functional Anatomy

  https://emedicine.medscape.com/article/1252414-overview

  An estimated 200,000 ACL-related injuries occur annually in the United States, with approximately 95,000 ACL ruptures. Approximately 100,000 ACL reconstructions are performed each year. The incidence of ACL injury is higher in people who participate in high-risk sports such as basketball, football, skiing, and soccer. […] A study by Gornitzky et al found that there is an approximately 1.6-fold greater rate of ACL tears per athletic exposure in high school female athletes than males. […] In a study of 101,125 ACL reconstructions in Denmark, Luxembourg, Norway, Sweden, the United Kingdom, and the United States, soccer injuries were the most common cause of these procedures, with the rate ranging from 14.1-42.3%.

• #17 ACL Injury Prevention — Recognize to Recover

  http://www.recognizetorecover.org/acl-injury-prevention

  ACL injuries are one of the most common knee injuries in sports, specifically in soccer athletes. As many as 250,000 ACL injuries occur each year in the United States with a majority results from non-contact injuries when attempting to land from a jump, decelerating while running, or changing direction. […] Given the significance of ACL injuries, it is important to understand various factors that may increase an athletes risk of ACL injury and to highlight programs that have proven to decrease injury risk. […] ACL injury rates among female athletes are consistently higher across playing levels compared to male athletes. […] The female injury rate in collegiate soccer also exceeds the male rate three-fold. […] Injury history can also influence ACL injury risk. Up to 30% of athletes who incur an ACL injury will experience another one. […] Monitoring psychological state and confidence during this rehabilitation period may also be important as both low and high psychological readiness have been associated with ACL reinjuries following return to sport.

• #18 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  Landing biomechanics in females may increase the risk of ACL injury with increased valgus angulation and extension of the knee. One study utilizing video analysis demonstrated that female athletes are more likely to place their knees in increased valgus angulations when changing directions suddenly, which increases the stress on the ACL ligament, in addition to decreased hip and knee flexion and decreased fatigue resistance. […] Other risk factors that might increase the risk of injury include anatomical risk factors such as increased body mass index, smaller femoral notch, impingement on the notch, smaller ACL, hypermobility, joint laxity, and previous ACL injury. […] Certain risk factors related to specific sports participation were reported, such as soccer and basketball, with increased risk in females and males, respectively.

• #19 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  Landing biomechanics in females may increase the risk of ACL injury with increased valgus angulation and extension of the knee. One study utilizing video analysis demonstrated that female athletes are more likely to place their knees in increased valgus angulations when changing directions suddenly, which increases the stress on the ACL ligament, in addition to decreased hip and knee flexion and decreased fatigue resistance. […] Other risk factors that might increase the risk of injury include anatomical risk factors such as increased body mass index, smaller femoral notch, impingement on the notch, smaller ACL, hypermobility, joint laxity, and previous ACL injury. […] Certain risk factors related to specific sports participation were reported, such as soccer and basketball, with increased risk in females and males, respectively.

• #20 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  Moreover, hormones were reported to affect coordination, especially the preovulatory phase of the menstrual cycle. Females on OCP were noted to be less affected. Estrogen effects on the strength and flexibility of tissues such as ligaments may play a role and predispose females to injury; however, this remains controversial and has yet to be proven. […] Collagen production (COL5A1 gene) was noted to be associated with lower injury risk in females.

• #21 Collegiate ACL Injury Rates Across 15 Sports: National Collegiate…: Ingenta Connect

  https://www.ingentaconnect.com/content/wk/jsm/2016/00000026/00000006/art00013

  Objective: To present data on the rate of anterior cruciate ligament (ACL) injury in 15 collegiate sports from 2004 to 2005 through 2012 to 2013 updating the 1988-1989 to 2003-2004 data. […] Results: Most ACL injuries to women occurred by a noncontact mechanism (60%) versus a contact mechanism for men (59%). The highest average annual rate of ACL injury for men was found in football (0.17 per 1000 athlete-exposure [A-E]). The highest average annual rate of ACL injury for women was found in lacrosse (0.23 per 1000 A-E). There were statistically significant increases in average annual injury rate for men’s (P = 0.04) and women’s soccer (P= 0.01) and a statistically significant decrease in women’s gymnastics over the 9 years (=0.009). Controlling for exposures, there were statistically significant increases in the average annual number of injuries for men’s and women’s basketball, ice hockey, field hockey, football, and volleyball and a decrease in the average annual number of injuries for baseball and women’s gymnastics. Women continue to sustain ACL injuries at higher rates than men in the comparable sports of soccer, basketball, and lacrosse.

• #22 Collegiate ACL Injury Rates Across 15 Sports: National Collegiate…: Ingenta Connect

  https://www.ingentaconnect.com/content/wk/jsm/2016/00000026/00000006/art00013

  Objective: To present data on the rate of anterior cruciate ligament (ACL) injury in 15 collegiate sports from 2004 to 2005 through 2012 to 2013 updating the 1988-1989 to 2003-2004 data. […] Results: Most ACL injuries to women occurred by a noncontact mechanism (60%) versus a contact mechanism for men (59%). The highest average annual rate of ACL injury for men was found in football (0.17 per 1000 athlete-exposure [A-E]). The highest average annual rate of ACL injury for women was found in lacrosse (0.23 per 1000 A-E). There were statistically significant increases in average annual injury rate for men’s (P = 0.04) and women’s soccer (P= 0.01) and a statistically significant decrease in women’s gymnastics over the 9 years (=0.009). Controlling for exposures, there were statistically significant increases in the average annual number of injuries for men’s and women’s basketball, ice hockey, field hockey, football, and volleyball and a decrease in the average annual number of injuries for baseball and women’s gymnastics. Women continue to sustain ACL injuries at higher rates than men in the comparable sports of soccer, basketball, and lacrosse.

• #23 ACL Epidemiology : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/joints/acl-epidemiology/

  Female soccer and basketball players have the highest rates of ACL injuries. […] Female soccer players have more non contact ACL injuries than male soccer players. […] Male and female basketball players have similar rates of contact and non contact ACL injuries. […] The rates of ACL injuries can be reported as injuries/1000 hrs of exposure or injuries/exposure. […] NCAA data is reported as injuries/exposure. […] Athletes have a higher rate of injury and a greater number of injuries during match play as compared to practice or training time. […] Rates of injuries in NCAA have not changed significantly despite awareness and modifications in training techniques over the past 19 years: […] The rate of anterior cruciate ligament injury for male soccer players was 0.11 compared to 0.08 for male basketball players (P = .002).

• #24 ACL Epidemiology : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/joints/acl-epidemiology/

  Female soccer and basketball players have the highest rates of ACL injuries. […] Female soccer players have more non contact ACL injuries than male soccer players. […] Male and female basketball players have similar rates of contact and non contact ACL injuries. […] The rates of ACL injuries can be reported as injuries/1000 hrs of exposure or injuries/exposure. […] NCAA data is reported as injuries/exposure. […] Athletes have a higher rate of injury and a greater number of injuries during match play as compared to practice or training time. […] Rates of injuries in NCAA have not changed significantly despite awareness and modifications in training techniques over the past 19 years: […] The rate of anterior cruciate ligament injury for male soccer players was 0.11 compared to 0.08 for male basketball players (P = .002).

• #25 Collegiate ACL Injury Rates Across 15 Sports: National Collegiate…: Ingenta Connect

  https://www.ingentaconnect.com/content/wk/jsm/2016/00000026/00000006/art00013

  Objective: To present data on the rate of anterior cruciate ligament (ACL) injury in 15 collegiate sports from 2004 to 2005 through 2012 to 2013 updating the 1988-1989 to 2003-2004 data. […] Results: Most ACL injuries to women occurred by a noncontact mechanism (60%) versus a contact mechanism for men (59%). The highest average annual rate of ACL injury for men was found in football (0.17 per 1000 athlete-exposure [A-E]). The highest average annual rate of ACL injury for women was found in lacrosse (0.23 per 1000 A-E). There were statistically significant increases in average annual injury rate for men’s (P = 0.04) and women’s soccer (P= 0.01) and a statistically significant decrease in women’s gymnastics over the 9 years (=0.009). Controlling for exposures, there were statistically significant increases in the average annual number of injuries for men’s and women’s basketball, ice hockey, field hockey, football, and volleyball and a decrease in the average annual number of injuries for baseball and women’s gymnastics. Women continue to sustain ACL injuries at higher rates than men in the comparable sports of soccer, basketball, and lacrosse.

• #26 ACL Epidemiology : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/joints/acl-epidemiology/

  The rate of anterior cruciate ligament injury for female soccer players was 0.33 and for female basketball players was 0.29 (P = .04). […] In soccer, there was a significant difference in frequency of injury for male (49.6%) and female (58.3%) athletes when comparing contact and non contact injuries ( P .05). […] Rate per 1000 athlete exposures (a practice or a game is one exposure): Womens soccer .31, Mens soccer .13, Womens basketball .26, Mens basketball .07, Womens soccer 60-70% non contact, Mens soccer 50% non contact.

• #27 ACL Epidemiology : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/joints/acl-epidemiology/

  The rate of anterior cruciate ligament injury for female soccer players was 0.33 and for female basketball players was 0.29 (P = .04). […] In soccer, there was a significant difference in frequency of injury for male (49.6%) and female (58.3%) athletes when comparing contact and non contact injuries ( P .05). […] Rate per 1000 athlete exposures (a practice or a game is one exposure): Womens soccer .31, Mens soccer .13, Womens basketball .26, Mens basketball .07, Womens soccer 60-70% non contact, Mens soccer 50% non contact.

• #28 Collegiate ACL Injury Rates Across 15 Sports: National Collegiate…: Ingenta Connect

  https://www.ingentaconnect.com/content/wk/jsm/2016/00000026/00000006/art00013?crawler=true

  Objective: To present data on the rate of anterior cruciate ligament (ACL) injury in 15 collegiate sports from 2004 to 2005 through 2012 to 2013 updating the 1988-1989 to 2003-2004 data. […] Most ACL injuries to women occurred by a noncontact mechanism (60%) versus a contact mechanism for men (59%). The highest average annual rate of ACL injury for men was found in football (0.17 per 1000 athlete-exposure [A-E]). The highest average annual rate of ACL injury for women was found in lacrosse (0.23 per 1000 A-E). There were statistically significant increases in average annual injury rate for men’s (P = 0.04) and women’s soccer (P= 0.01) and a statistically significant decrease in women’s gymnastics over the 9 years (=0.009). […] Women continue to sustain ACL injuries at higher rates than men in the comparable sports of soccer, basketball, and lacrosse.

• #29 High School ACL Injury Rates – Training & Conditioning

  https://training-conditioning.com/article/high-school-acl-injury-rates/

  When comparing sports that are played by both boys and girls, girls were eight times more likely to suffer an ACL injury. […] One important reason to focus on ACL injury prevention is because most ACL injuries typically require surgery. […] Most sports have a rate of at least two-thirds of their injured athletes requiring surgical repair. […] The mechanism leading to ACL injury varies by sport. Knowing these mechanisms can help coaches and athletic trainers develop targeted preventive interventions. […] Coaches and athletic trainers working with high school athletes should practice targeted preventive measures to reduce the risk of ACL injuries.

• #30 Why Female Athletes Injure Their ACL’s More Frequently? What can we do to mitigate their risk? | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/25467-why-female-athletes-injure-their-acl-s-more-frequently-what-can-we-do-to-mitigate-their-risk

  Anterior Cruciate Ligament (ACL) injuries are one of the most deleterious knee injuries reported in sport. They continue to confound the sports medicine community, particularly with respect to the high rates reported in girls and women. There are approximately 200,000 to 250,000 ACL injuries that occur in the United States annually, a rate that has doubled over the last 20 years. Approximately 25% of these injuries occur in youth athletics; and this rate has been increasing by a rate of 2.5% annually in the United States and has increased by 147.8% over a 10 year period in Victoria, Australia. Although the overall rate of ACL injury is higher in males, primarily due to greater opportunity(s) to participate in contact sports, the relative risk of ACL injury in women is 3 to 8 times greater than males. In the National Collegiate Athletic Association (NCAA), the rate of ACL injuries incurred by collegiate females is three times higher compared to men. In high school aged athletes (13-18 years), there is approximately 1.6-fold greater rate of ACL tears in females, and a multisport female athlete is estimated to have a nearly 10% risk of incurring an ACL injury during her high school or secondary school career.

• #31 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  The ACL is the most commonly injured ligament in the knee, almost half of all knee injuries. The annual reported incidence in the United States alone is approximately 1 in 3500 people. There are approximately 400,000 ACL reconstructions every year in the united states. However, data may not be accurate as there is no standard surveillance. […] There is no age or gender bias; however, it has been suggested that women are at an increased risk of ACL injury secondary to a multitude of factors. In athletes, the female-to-male ratio has been reported to be 4.5: 1. Female athletes tend to get ACL ruptures at a younger age and more in the supporting leg versus the kicking leg in males. […] Among the factors increasing the female risk, as suggested by some studies that females may have weaker hamstrings (more quadriceps dominant) and preferential recruitment of the quadriceps muscle group while decelerating. Engaging the quadriceps musculature while slowing down places abnormally increased stresses on the ACL, as the quadriceps muscles are less effective at preventing anterior tibial translation versus the hamstring muscles. Additionally, females have weaker core stability than males.

• #32 Epidemiology of Primary Anterior Cruciate Ligament Ruptures in Men and Women

  https://clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise-medicine-ijsem-5-114.php?jid=ijsem

  Having women, a 4 to 6 times higher risk than men to suffer an ACL injury, there is a wide range of articles that discuss the possible causes of this fact. […] The extrinsic factors are related with the type of sport, the environment and the conditions of the athlete. None of them shows the possible difference between men and women regarding this injury. […] For example, in the case of male players, during the exercise they tend to activate with more frequency the hamstrings, whose contraction protects the ACL. In contrast, in the female exercise, the activation of the quadriceps and gastrocnemius predominates. […] On the other hand, intrinsic factors seem to have more importance in justifying the possible causes of why women suffer more ACL ruptures. […] To begin with the anatomical differences, we found a crossing area of ligaments between femur and tibia that is smaller in women than in men, in addition to a lower ACL volume in women.

• #33 Epidemiology of Primary Anterior Cruciate Ligament Ruptures in Men and Women

  https://clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise-medicine-ijsem-5-114.php?jid=ijsem

  These characteristics are supposed to increase the ligament laxity that is also accentuated by the hormonal influence during the menstrual cycle of the women. […] Another of the anatomical differences between women and men, which goes hand to hand with the biomechanical causes is the Q angle, that is greater in women for having a larger pelvis. […] Therefore, those athletes who have an increased Q angle are more likely to suffer an ACL rupture. […] After this evaluation, being able to verify that women have a greater risk in this type of injury, it would be necessary to increase the prevention, especially in sports, and decrease the neuromuscular imbalances. […] In conclusion, the anatomical, biomechanical and neuromuscular control aspects that differentiate women and men are the ones that demonstrate the best, that female athletes have a greater risk of suffering an anterior cruciate ligament injury.

• #34 Epidemiology of Primary Anterior Cruciate Ligament Ruptures in Men and Women

  https://clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise-medicine-ijsem-5-114.php?jid=ijsem

  Having women, a 4 to 6 times higher risk than men to suffer an ACL injury, there is a wide range of articles that discuss the possible causes of this fact. […] The extrinsic factors are related with the type of sport, the environment and the conditions of the athlete. None of them shows the possible difference between men and women regarding this injury. […] For example, in the case of male players, during the exercise they tend to activate with more frequency the hamstrings, whose contraction protects the ACL. In contrast, in the female exercise, the activation of the quadriceps and gastrocnemius predominates. […] On the other hand, intrinsic factors seem to have more importance in justifying the possible causes of why women suffer more ACL ruptures. […] To begin with the anatomical differences, we found a crossing area of ligaments between femur and tibia that is smaller in women than in men, in addition to a lower ACL volume in women.

• #35 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  Landing biomechanics in females may increase the risk of ACL injury with increased valgus angulation and extension of the knee. One study utilizing video analysis demonstrated that female athletes are more likely to place their knees in increased valgus angulations when changing directions suddenly, which increases the stress on the ACL ligament, in addition to decreased hip and knee flexion and decreased fatigue resistance. […] Other risk factors that might increase the risk of injury include anatomical risk factors such as increased body mass index, smaller femoral notch, impingement on the notch, smaller ACL, hypermobility, joint laxity, and previous ACL injury. […] Certain risk factors related to specific sports participation were reported, such as soccer and basketball, with increased risk in females and males, respectively.

• #36 Epidemiology of Primary Anterior Cruciate Ligament Ruptures in Men and Women

  https://clinmedjournals.org/articles/ijsem/international-journal-of-sports-and-exercise-medicine-ijsem-5-114.php?jid=ijsem

  Having women, a 4 to 6 times higher risk than men to suffer an ACL injury, there is a wide range of articles that discuss the possible causes of this fact. […] The extrinsic factors are related with the type of sport, the environment and the conditions of the athlete. None of them shows the possible difference between men and women regarding this injury. […] For example, in the case of male players, during the exercise they tend to activate with more frequency the hamstrings, whose contraction protects the ACL. In contrast, in the female exercise, the activation of the quadriceps and gastrocnemius predominates. […] On the other hand, intrinsic factors seem to have more importance in justifying the possible causes of why women suffer more ACL ruptures. […] To begin with the anatomical differences, we found a crossing area of ligaments between femur and tibia that is smaller in women than in men, in addition to a lower ACL volume in women.

• #37 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  Moreover, hormones were reported to affect coordination, especially the preovulatory phase of the menstrual cycle. Females on OCP were noted to be less affected. Estrogen effects on the strength and flexibility of tissues such as ligaments may play a role and predispose females to injury; however, this remains controversial and has yet to be proven. […] Collagen production (COL5A1 gene) was noted to be associated with lower injury risk in females.

• #38 Anterior Cruciate Ligament Knee Injury – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499848/

  The ACL is the most commonly injured ligament in the knee, almost half of all knee injuries. The annual reported incidence in the United States alone is approximately 1 in 3500 people. There are approximately 400,000 ACL reconstructions every year in the united states. However, data may not be accurate as there is no standard surveillance. […] There is no age or gender bias; however, it has been suggested that women are at an increased risk of ACL injury secondary to a multitude of factors. In athletes, the female-to-male ratio has been reported to be 4.5: 1. Female athletes tend to get ACL ruptures at a younger age and more in the supporting leg versus the kicking leg in males. […] Among the factors increasing the female risk, as suggested by some studies that females may have weaker hamstrings (more quadriceps dominant) and preferential recruitment of the quadriceps muscle group while decelerating. Engaging the quadriceps musculature while slowing down places abnormally increased stresses on the ACL, as the quadriceps muscles are less effective at preventing anterior tibial translation versus the hamstring muscles. Additionally, females have weaker core stability than males.

• #39

  https://www.orthobullets.com/knee-and-sports/3008/acl-tear

  ACL tears are common athletic injuries leading to anterior and lateral rotatory instability of the knee. […] Incidence: ~400,000 ACL reconstructions / year. […] account for half of all knee injuries. […] more common among female athletes (4.5:1 ratio) […] females sustain ACL injuries at a younger age than males. […] females get more ACL injuries on the supporting leg (males get more ACL injuries on the kicking leg). […] Risk factors: female participation in soccer, male participation in basketball. […] valgus moment at knee and adduction moment at hip upon landing. […] previous concussion.

• #40 ACL Prevention | Fairfield Medical Center

  https://www.fmchealth.org/services/orthopedic-care/acl-prevention/

  We have seen a high prevalence of ACL injuries in athletes of all ages. Although this impacts all athletes, we have seen a higher rate of injury in our youth. Athletes between the ages of 15-25 who are playing a competitive sport are at the greatest risk of injury. Female high school athletes had a nine-fold increase injury risk and five-fold in collegiate sports [1], and those who competed at a higher level of play had a five times higher risk than their male counterpart [2]. […] We have developed a program that includes a variety of different exercises, which have shown a great incidence of decreasing injury risk. […] Strength Training: proven to be most effective in decreasing ACL injuries.

• #41 Why Female Athletes Injure Their ACL’s More Frequently? What can we do to mitigate their risk? | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/25467-why-female-athletes-injure-their-acl-s-more-frequently-what-can-we-do-to-mitigate-their-risk

  Anterior Cruciate Ligament (ACL) injuries are one of the most deleterious knee injuries reported in sport. They continue to confound the sports medicine community, particularly with respect to the high rates reported in girls and women. There are approximately 200,000 to 250,000 ACL injuries that occur in the United States annually, a rate that has doubled over the last 20 years. Approximately 25% of these injuries occur in youth athletics; and this rate has been increasing by a rate of 2.5% annually in the United States and has increased by 147.8% over a 10 year period in Victoria, Australia. Although the overall rate of ACL injury is higher in males, primarily due to greater opportunity(s) to participate in contact sports, the relative risk of ACL injury in women is 3 to 8 times greater than males. In the National Collegiate Athletic Association (NCAA), the rate of ACL injuries incurred by collegiate females is three times higher compared to men. In high school aged athletes (13-18 years), there is approximately 1.6-fold greater rate of ACL tears in females, and a multisport female athlete is estimated to have a nearly 10% risk of incurring an ACL injury during her high school or secondary school career.

• #42 Teen ACL injuries on the rise, UNC researchers call for wider use of injury prevention programs | UNC Orthopaedics

  https://www.med.unc.edu/ortho/2017/07/teen-acl-injuries-on-the-rise-unc-researchers-call-for-wider-use-of-injury-prevention-programs/

  New research from UNC shows that rates of anterior cruciate ligament (ACL) reconstruction are increasing sharply, with the most dramatic increase among girls aged 13-17. […] Among teenage athletes, the rate of ACL tears is rising, with the sharpest increase seen in females aged 13-17 who, over the last 13 years, have experienced a 59 percent increase in the number of required reconstruction procedures, according to a new study published in the Journal of the American Medical Association (JAMA) Pediatrics. […] Researchers from the UNC School of Medicine and UNC Gillings School of Global Public Health say that the orthopaedics community had been anecdotally aware of these trends, but this study puts concrete numbers behind the rise. […] These results, they hope, will lead to more widespread adoption of injury prevention programs which have been studied in both Europe and America, and shown to reduce injuries.

• #43 Teen ACL injuries on the rise, UNC researchers call for wider use of injury prevention programs | UNC Orthopaedics

  https://www.med.unc.edu/ortho/2017/07/teen-acl-injuries-on-the-rise-unc-researchers-call-for-wider-use-of-injury-prevention-programs/

  There are proven injury prevention resources available, but the continued high rate of injuries suggests that they are not being implemented across the board, said lead study author Mackenzie Herzog, MPH, doctoral candidate in the department of epidemiology at the UNC Gillings School of Global Public Health. […] In compiling the data for the study, researchers analyzed a database containing private insurance claims from 148 million Americans. The number of ACL injuries reconstruction operations was up in males 13-17 as well, but it was not as sharp a jump as seen in females. […] Researchers agree that athletic participation has positive physical and psychological benefits but they encourage parents to push for adoption of more injury prevention programs alongside other practice and training regimens.

• #44 ACL injuries in men’s and women’s football: So many factors equal so much uncertainty – The Athletic

  https://www.nytimes.com/athletic/5120100/2023/12/08/acl-crisis-premier-league-wsl/

  So far, this season has seen seven WSL players suffer ACL injuries, if you include Arsenal defender Teyah Goldie (whose injury occurred in pre-season) and Liverpool goalkeeper Faye Kirby (who is on loan at Aberdeen), both 19 years old. […] On the international stage, the 2023 Women’s World Cup was missing between 25 and 30 players because of ACL tears. […] Dr Kaeding points out that, prior to puberty, the incidence between males and females is the same (a caveat to that being that it is relatively uncommon prior to puberty, with the vast majority of ACL injuries occurring between the ages of 12 and 25). […] It’s often assumed that the increased risk for females comes down to hormonal and anatomical differences. […] The reality is that the higher risk [in females] would seem to be related to the mechanics says Mackay, and the thing that has been shown to have a significant impact in reducing the risks are those pre-training drills where you’re working on proprioception, landing and turning and decelerating manoeuvres that mechanically start to protect the knee.

• #45 Epidemiology of Anterior Cruciate Ligament Tears in National Collegiate Athletic Association Athletes: 2014/2015-2018/2019 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/37616175/

  Purpose: This study aimed to describe the epidemiology of ACL tears in NCAA men’s and women’s sports. […] Injury and exposure data collected within the NCAA Injury Surveillance Program from 2014/2015 to 2018/2019 were analyzed. ACL tear frequencies, injury rates (IR), and injury proportions were used to describe injury incidence by sport, event type, injury mechanism, and injury history. […] A total of 729 ACL tears were reported from 8,474,401 recorded athlete exposures (AE) during the study period (IR = 0.86 per 10,000 AE), and the competition-related ACL tear rate was higher than the practice-related rate (IRR = 5.52, 95% confidence interval [CI] = 4.75-6.39). […] Among men’s sports, the highest overall ACL tear rate was observed in men’s football (IR = 1.44 per 10,000 AE), whereas among women’s sports, the highest overall rate was observed in women’s soccer (IR = 2.60 per 10,000 AE).

• #46 New Study Published on ACL Injury Rates in High School Athletes – Sportsmetrics

  https://sportsmetrics.org/new-study-published-on-acl-injury-rates-in-high-school-athletes/

  The knee joint is the second most commonly injured body site after the ankle and the leading cause of sport-related surgeries. […] To investigate the epidemiology of ACL injuries among high school athletes by sport and sex. […] During the study period, 617 ACL injuries were reported during 9 452 180 athlete exposures (AEs), for an injury rate of 6.5 per 100 000 AEs. Nationally, in the 9 sports studied, an estimated 215 628 ACL injuries occurred during the study period. […] The injury rate was higher in competition (17.6) than practice (2.4; rate ratio [RR]7.3, 95% confidence interval [CI] 6.08,8.68). […] In sex-comparable sports, girls had a higher rate (8.9) than boys (2.6; RR 3.4, 95% CI 2.64,4.47). […] Overall, 76.6% of ACL injuries resulted in surgery. […] Anterior cruciate ligament injury rates vary by sport, sex, and type of exposure. Recognizing such differences is important when evaluating the effectiveness of evidence based, targeted prevention efforts.

• #47 Epidemiologic characteristics of anterior cruciate ligament injury in 10 consecutive seasons of Turkish Division-1 professional football league | 2022, Volume 57, Issue 3 | Turkish Journal of Sports Medicine

  https://journalofsportsmedicine.org/full-text/617/eng

  Epidemiologic characteristics of professional male football players participating in the professional first division Turkish Super League in 10 consecutive seasons were evaluated through a publicly available online soccer archive. […] A total of 100 ACL injuries were included (mean age at the time of injury: 25.23.9). […] The ACL incidence rate was 0.4060 per 1000 hours of play during Super League matches, 0.0801 per 1000 hours of training (rate ratio [RR], 5.06; 95% CI, 3.25-11.84; p0.001), and 0.0622 per 1000 hours of total play. […] Epidemiologic data is important as a resource for athletes and those responsible for their health to develop appropriate training and preparation programs to reduce the risk of ACL injury. […] Few studies investigated epidemiologic characteristics of ACL injuries through consecutive seasons in different countries using publicly available internet news and databases.

• #48

  https://link.springer.com/article/10.1007/s40279-022-01697-w

  We need to better understand the extent of non-contact ACL injuries because they impose a wide-ranging personal, societal and economic burden. […] Exercise-based injury risk reduction programs (IRRPs) are a prominent feature in ACL injury risk-reduction efforts and these programs seem to have a stronger effect on reducing the risk of non-contact ACL injuries compared with contact ones. […] While female athletes are at a greater risk of ACL injuries compared to male athletes, this is the first systematic review to confirm that a similar sex disparity also exists for non-contact ACL injury risk. […] Competition settings are often associated with additional internal and external stressors, and failure to manage these stressors may increase injury risk. […] Our findings have implications for future ACL epidemiological research in sport, and the development and implementation of effective ACL injury risk reduction efforts in team ball-sports.

• #49 Non-contact ACL injury patterns and prevention

  https://www.velofitpt.com/single-post/2017/12/09/non-contact-acl-injury-patterns-and-prevention

  ACL injury is costly. Replication of injuries is not feasible and measurement is tough. We establish interesting observations and recurring patterns of non-contact ACL injury. In-vivo studies and regressions show that some populations are at higher risk of non-contact ACL injury. […] The cost of an ACL injury is high. As many as 250000 individuals are affected and the cost to the American healthcare system exceeds $2B on annual basis, per the CDC. […] Up to 80% of ACL injury is non-contact, therefore further biomechanics and movement pattern investigation is warranted. […] The IOC’s report investigates the higher rate of female non-contact ACL injury head on. IOC states 2x higher rate of non-contact ACL injury for pre-college age (14-18 year old) females than in males. […] Literature confirms that then properly designed and implemented ACL injury prevention programs can significantly reduce the incidence of non-contact ACL injury. ACL injury prevention programs are not a one-off event. Rather, systematic integration into the practice routines pre and post-season must be implemented to achieve injury risk reduction. […] Throughout the literature review, the causality of ACL injury is still unclear. While there are signs and characteristics of ACL injury, critical review of the knowledge to date and keeping abreast of the latest literature is recommended.

• #50 The economics of a national anterior cruciate ligament injury prevention program for amateur football players: a Markov model analysis | The Medical Journal of Australia

  https://www.mja.com.au/journal/2024/221/3/economics-national-anterior-cruciate-ligament-injury-prevention-program-amateur

  Objectives: To estimate the long term cost savings, return on investment, and gain in quality-adjusted life years (QALYs) that could be achieved by a national anterior cruciate ligament (ACL) injury prevention program for amateur football (soccer) players in Australia. […] The total mean cost of an ACL injury was estimated to be $30665. The national injury prevention program was projected to save $52539751 in medical and societal costs caused by ACL ruptures in amateur footballers over 35 years; the estimated return on each dollar invested in the program was $3.51. […] Our findings support investing in a national, evidence-based program for the primary prevention of ACL injuries in amateur football players. […] A national ACL injury prevention exercise program for amateur soccer players could save $1501136 each year in medical and societal costs by averting 125 ACL ruptures, four ACL reruptures, 22 cases of knee osteoarthritis, and three total knee replacements.

• #51 The economics of a national anterior cruciate ligament injury prevention program for amateur football players: a Markov model analysis | The Medical Journal of Australia

  https://www.mja.com.au/journal/2024/221/3/economics-national-anterior-cruciate-ligament-injury-prevention-program-amateur

  Our findings provide health policymakers and football organisations information that could assist decision making regarding investing in primary ACL injury prevention. […] Anterior cruciate ligament (ACL) ruptures are among the most devastating injuries for football players at any playing level, and are associated with high costs for health systems, insurance companies, and sporting organisations. […] A systematic review of the longer term effects of ACL injuries found that some people reported prolonged work absences and modified activities of daily living two or more years after their injury. […] ACL injury is also associated with increased risk of developing knee osteoarthritis. […] It is important to consider up-to-date cost-effectiveness estimates and predict the return on investment of efficacious primary preventive exercise programs when seeking funding for a national strategy.

• #52 Teen ACL injuries on the rise, UNC researchers call for wider use of injury prevention programs | UNC Orthopaedics

  https://www.med.unc.edu/ortho/2017/07/teen-acl-injuries-on-the-rise-unc-researchers-call-for-wider-use-of-injury-prevention-programs/

  For ACL injuries, the secondary burdens are heavy and persistent. […] Females have both a higher rate of re-tear and a higher rate of injury to the other knee, Spang said. More than 10 percent of adolescent females who undergo an ACL reconstruction will require a second operation somewhere down the line. […] For both males and females, Spang said, research has suggested that half of people experiencing ACL tears will go on to develop radiographic arthritis within 10 years. […] Right now we have a lot of teenagers tearing their ACLs, and that could turn into a lot of people in their mid-30s with post-traumatic arthritis of varying degrees, which would be a major burden on our health system, Spang said. […] In the near term, though, Spang and Herzog hope this research will lead to more widespread adoption of injury prevention programs.

• #53 Why Female Athletes Injure Their ACL’s More Frequently? What can we do to mitigate their risk? | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/25467-why-female-athletes-injure-their-acl-s-more-frequently-what-can-we-do-to-mitigate-their-risk

  A concerted effort has been made over the last three decades to address the complexities of the sequence of prevention; to mitigate ACL injury risk by virtue of the implementation of validated injury prevention program (IPP) interventions. A vast majority of these IPPs were designed specifically to address ACL injury in females. The targeted risk factors included anatomic, environmental, hormonal, genetic and biomechanical. These neuromuscular IPP training programs, that addressed the biomechanical deficiencies, included in-season elements of strength, plyometrics, sport specific agility drills, proper landing technique, proprioception, proximal control and a biomechanical emphasis on addressing the most common pathokinematic movement patterns associated with ACL injury mechanisms. Additional components of successful ACL IPPs include socio-economic feasibility, sports-specificity, physiological competency, neurocognitive and psychological (improving confidence and reducing fear) and implementation strategies that may improve overall program adoption. The IPPs have been largely successful; reporting overall ACL injury reduction rates between 55-88%. The programs are designed to be introduced during preseason and continue throughout the season to mitigate biomechanical recidivism.

• #54 ACL Injury Prevention — Recognize to Recover

  http://www.recognizetorecover.org/acl-injury-prevention

  A potentially modifiable risk factor is biomechanics (i.e. movement patterns). […] Regular participation in an exercise-based injury prevention program may help improve these movement patterns and assist in mitigating overall ACL injury risk. […] Environmental risk factors including playing surface and cleat/shoe choice are additional modifiable risk factors that have been explored. […] However, research studies have not shown a clear conclusion that new generation artificial turf poses a higher risk than natural grass in soccer athletes, but may differ across age groups and sex. […] Exercise-based injury prevention programs can significantly reduce the risk of injury. […] The injury prevention programs with the strongest evidence are structured, multi-component programs. […] The most effective components include: lower-extremity strengthening, core strengthening, and plyometrics. […] Fortunately, leading medical professionals and researchers have created several open-access injury prevention programs.

• #55 Digging in to prevent ACL injuries in volleyball | Lower Extremity Review Magazine

  https://lermagazine.com/cover_story/digging-in-to-prevent-acl-injuries-in-volleyball

  The PEP (preventing injury and enhancing performance) program is freely available online from the Santa Monica Sports Medicine Foundation in California. In two large studies involving high school- and college-aged female athletes, ACL injury rates were shown to decrease markedly with the use of the PEP program, a 20-minute program designed to replace a standard warm up. […] Most prevention programs involve a combination of strength training, plyometrics, and balance and flexibility training. Little attention has been given to the individual contribution of each of these types of training to the overall prevention of ACL injury. […] As part of a comprehensive ACL injury prevention program, individualized feedback on movement patterns should be provided to athletes, as there is good evidence to suggest this will significantly improve how volleyball athletes land from a jump. […] ACL injuries are serious life-changing events that can occur in any sport that involves jumping or changes of direction. The good news is that athletes and coaches can take preventive steps to significantly decrease the chance of the injury occurring.

• #56 Digging in to prevent ACL injuries in volleyball | Lower Extremity Review Magazine

  https://lermagazine.com/cover_story/digging-in-to-prevent-acl-injuries-in-volleyball

  The PEP (preventing injury and enhancing performance) program is freely available online from the Santa Monica Sports Medicine Foundation in California. In two large studies involving high school- and college-aged female athletes, ACL injury rates were shown to decrease markedly with the use of the PEP program, a 20-minute program designed to replace a standard warm up. […] Most prevention programs involve a combination of strength training, plyometrics, and balance and flexibility training. Little attention has been given to the individual contribution of each of these types of training to the overall prevention of ACL injury. […] As part of a comprehensive ACL injury prevention program, individualized feedback on movement patterns should be provided to athletes, as there is good evidence to suggest this will significantly improve how volleyball athletes land from a jump. […] ACL injuries are serious life-changing events that can occur in any sport that involves jumping or changes of direction. The good news is that athletes and coaches can take preventive steps to significantly decrease the chance of the injury occurring.

• #57 Why Female Athletes Injure Their ACL’s More Frequently? What can we do to mitigate their risk? | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/25467-why-female-athletes-injure-their-acl-s-more-frequently-what-can-we-do-to-mitigate-their-risk

  A concerted effort has been made over the last three decades to address the complexities of the sequence of prevention; to mitigate ACL injury risk by virtue of the implementation of validated injury prevention program (IPP) interventions. A vast majority of these IPPs were designed specifically to address ACL injury in females. The targeted risk factors included anatomic, environmental, hormonal, genetic and biomechanical. These neuromuscular IPP training programs, that addressed the biomechanical deficiencies, included in-season elements of strength, plyometrics, sport specific agility drills, proper landing technique, proprioception, proximal control and a biomechanical emphasis on addressing the most common pathokinematic movement patterns associated with ACL injury mechanisms. Additional components of successful ACL IPPs include socio-economic feasibility, sports-specificity, physiological competency, neurocognitive and psychological (improving confidence and reducing fear) and implementation strategies that may improve overall program adoption. The IPPs have been largely successful; reporting overall ACL injury reduction rates between 55-88%. The programs are designed to be introduced during preseason and continue throughout the season to mitigate biomechanical recidivism.

• #58 Why Female Athletes Injure Their ACL’s More Frequently? What can we do to mitigate their risk? | Published in International Journal of Sports Physical Therapy

  https://ijspt.scholasticahq.com/article/25467-why-female-athletes-injure-their-acl-s-more-frequently-what-can-we-do-to-mitigate-their-risk

  One of the major difficulties researchers are enduring, from a public health perspective, is achieving widespread program adoption and implementation of the established and validates IPPs. Despite the earnest efforts of researchers to mitigate ACL injury rate through the development and the evolution of the aforementioned IPPs, the programs potential to reduce risk has been hindered by the overall low adoption rate of these programs. Interestingly, it has been well documented that high compliance to a scientifically vetted IPP can substantially mitigate ACL injury rates. Conversely, when overall compliance was low and the IPPs were performed less than once per week and/or with low program fidelity, the IPPs were found to be largely ineffective. […] The continued identification and understanding of the intrinsic and extrinsic sex related ACL injury risk factors will increase the clinicians ability to elucidate and improve IPPs to effectively decrease the ACL injury rate in sport.

• #59 Collegiate ACL Injury Rates Across 15 Sports: National Collegiate…: Ingenta Connect

  https://www.ingentaconnect.com/content/wk/jsm/2016/00000026/00000006/art00013

  Conclusions: Anterior cruciate ligament injury rates continue to rise in men’s and women’s soccer. Some sports have shown absolute increases in ACL rates, which persist even after exposure rates are taken into account. […] Clinical Relevance: Despite extensive research and development of prevention programs before and during the time of this study, very few sports showed a reduction in ACL injury rates in this data set.

• #60 Collegiate ACL Injury Rates Across 15 Sports: National Collegiate…: Ingenta Connect

  https://www.ingentaconnect.com/content/wk/jsm/2016/00000026/00000006/art00013

  Objective: To present data on the rate of anterior cruciate ligament (ACL) injury in 15 collegiate sports from 2004 to 2005 through 2012 to 2013 updating the 1988-1989 to 2003-2004 data. […] Results: Most ACL injuries to women occurred by a noncontact mechanism (60%) versus a contact mechanism for men (59%). The highest average annual rate of ACL injury for men was found in football (0.17 per 1000 athlete-exposure [A-E]). The highest average annual rate of ACL injury for women was found in lacrosse (0.23 per 1000 A-E). There were statistically significant increases in average annual injury rate for men’s (P = 0.04) and women’s soccer (P= 0.01) and a statistically significant decrease in women’s gymnastics over the 9 years (=0.009). Controlling for exposures, there were statistically significant increases in the average annual number of injuries for men’s and women’s basketball, ice hockey, field hockey, football, and volleyball and a decrease in the average annual number of injuries for baseball and women’s gymnastics. Women continue to sustain ACL injuries at higher rates than men in the comparable sports of soccer, basketball, and lacrosse.

• #61 The economics of a national anterior cruciate ligament injury prevention program for amateur football players: a Markov model analysis | The Medical Journal of Australia

  https://www.mja.com.au/journal/2024/221/3/economics-national-anterior-cruciate-ligament-injury-prevention-program-amateur

  Objectives: To estimate the long term cost savings, return on investment, and gain in quality-adjusted life years (QALYs) that could be achieved by a national anterior cruciate ligament (ACL) injury prevention program for amateur football (soccer) players in Australia. […] The total mean cost of an ACL injury was estimated to be $30665. The national injury prevention program was projected to save $52539751 in medical and societal costs caused by ACL ruptures in amateur footballers over 35 years; the estimated return on each dollar invested in the program was $3.51. […] Our findings support investing in a national, evidence-based program for the primary prevention of ACL injuries in amateur football players. […] A national ACL injury prevention exercise program for amateur soccer players could save $1501136 each year in medical and societal costs by averting 125 ACL ruptures, four ACL reruptures, 22 cases of knee osteoarthritis, and three total knee replacements.

• #62 Sex, Military Occupation, and Rank Are Associated with Risk of Anterior Cruciate Ligament Injury in Tactical-Athletes | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.09.30.21264383v1.full-text

  The results of this study highlight important trends of ACL injury in regards to sex, occupation, rank, branch of service, and changes over time that require further investigation into the cause of these trends. […] Surveillance of ACL injury should continue as the percentage of women in previously restricted combat roles grows.

• #63 ACL injuries in men’s and women’s football: So many factors equal so much uncertainty – The Athletic

  https://www.nytimes.com/athletic/5120100/2023/12/08/acl-crisis-premier-league-wsl/

  In August, FIFA unveiled their Women’s Health, Wellbeing and Performance project, dedicated to addressing crucial challenges in women’s health. […] The long-term aim is to publish a consensus on ACL injury prevention and management, plus an up-to-date ACL injury prevention programme by the summer of 2024.

• #64 ACL injuries in men’s and women’s football: So many factors equal so much uncertainty – The Athletic

  https://www.nytimes.com/athletic/5120100/2023/12/08/acl-crisis-premier-league-wsl/

  In August, FIFA unveiled their Women’s Health, Wellbeing and Performance project, dedicated to addressing crucial challenges in women’s health. […] The long-term aim is to publish a consensus on ACL injury prevention and management, plus an up-to-date ACL injury prevention programme by the summer of 2024.

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