Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational incidence studies
PubMed 31009238 · doi:10.4085/1062-6050-407-16
What was done
Authors conducted a systematic review and meta-analysis of studies indexed in PubMed and EBSCOhost (CINAHL, SPORTDiscus) from 1969 to January 2017. They included studies reporting anterior cruciate ligament (ACL) injuries and athlete-exposures (AEs) stratified by sex across sport categories (collision, contact, limited contact, noncontact, and a post hoc category of fixed-object high-impact rotational landing [HIRL]). Meta-analyses calculated weighted incidence rates (IRs per 10,000 AEs) and incidence rate ratios (IRRs) comparing females to males.
What was found
Sex differences varied markedly by sport classification: - Collision sports: Female IR 2.10 vs male IR 1.12 per 10,000 AEs (IRR = 1.14, P = .63). - Limited contact sports: Female IR 0.71 vs male IR 0.29 per 10,000 AEs (IRR = 1.21, P = .77). - Noncontact sports: Female IR 0.36 vs male IR 0.21 per 10,000 AEs (IRR = 1.49, P = .22). - Contact sports: Female IR 1.88 vs male IR 0.87 per 10,000 AEs (IRR = 3.00, P < .001). - Fixed-object HIRL sports (gymnastics, obstacle courses): Female IR 4.80 vs male IR 1.75 per 10,000 AEs (IRR = 5.51, P < .001). HIRL sports had the highest overall incidence rates of ACL injury among all sport types for both sexes.
Why it matters
This review shows that elevated female ACL injury risk is not universal across all sports, but is heavily concentrated in contact sports and high-impact rotational landing activities.
Limits
The abstract does not state the total number of included studies, athletes, or athlete-exposures. The fixed-object HIRL category was created post hoc to account for outlier rates in gymnastics and obstacle courses. Non-English studies were excluded, and potential confounding variables like athlete age, playing level, or neuromuscular training history are not reported.
Cited by
- supports Women are more susceptible to ACL injuries than men.