Risk of Anterior Cruciate Ligament Injury in Female Soccer Athletes: A Review

Abstract

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.

Evolution of Core Stability, Athletic Performance, and ACL Injury Risk across a Soccer Season

“…Anterior cruciate ligament (ACL) injury is one of the most debilitating injuries in soccer, as it often requires surgery [1,4] with a mean time to return to play around 250 days for professional players [4]. Non-contact ACL ruptures (i.e., without the intervention of external constraints), representing between 45% and 65% of ACL injuries in soccer [4,5], mainly occur during single-leg landing and sidestep cutting [6][7][8]. Typical lower limb mechanisms that lead to ACL rupture are hip adduction and internal rotation combined with knee abduction and internal or external rotation [9,10].…”

Return to Sport Following Anterior Cruciate Ligament Reconstruction: Women's Soccer

“…It involves speed, agility and endurance, requiring its athletes to sprint, explode to the ball, change direction and maintain high thresholds of work for prolonged periods. It has been played competitively and recreationally by ages young and old since the mid-19th century 1 . Throughout the last two hundred years, female participation has increased exponentially, most specifically within the United States where over 1.6 million female players are registered soccer players, ranking highest in participation globally 1 .…”

“…It has been played competitively and recreationally by ages young and old since the mid-19th century 1 . Throughout the last two hundred years, female participation has increased exponentially, most specifically within the United States where over 1.6 million female players are registered soccer players, ranking highest in participation globally 1 .…”

“…Injury mechanisms for ACL injuries in female soccer players have been shown to be primarily noncontact in nature 10,11,12 . ACL injuries sustained in NCAA women's soccer players have been shown to account for 15.9% of all injuries 13 , with more injuries occurring in games than practices 14 and more commonly in college female soccer players (0.391) than high schoolers (0.131) 15 . ACL injuries accounted for 4.6% of all injuries and had an incidence rate of 0.09 per 1000 player hours in the Women's United Soccer Association (WUSA) 16 .…”

“…Changing direction, jumping, landing, pivoting, sprinting and tackling place the sport of soccer at a unique disadvantage for being responsible for such a high-risk profile. It is well established in the literature that female's relative risk for suffering ACL injuries when compared to males is higher [18][19][20] . Females tend to be more at risk for ACL injury for a multitude of reasons including biomechanical, structural, hormonal, strength imbalances and neuromuscular activation patterns [21][22][23][24][25][26][27][28] .…”