Sex-Based Differences in Anterior Cruciate Ligament Injuries Among United States High School Soccer Players: An Epidemiological Study

Gupta, Andrew; Pierpoint, Lauren A.; Comstock, R. Dawn; Saper, Michael G.

doi:10.1177/2325967120919178

Cited by 26 publications

(28 citation statements)

References 18 publications

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“…After sub-grouping by age group and sex, this proportion was 60% in adult female athletes (95% CI 49–70, I 2 = 85%) and 52% in adult male athletes (95% CI 43–60, I 2 = 86%) (Appendix A5-2). There were insufficient studies to investigate injury proportions by sex in adolescents (Appendix A5-3) [ 53 , 59 , 66 ]. None of the included studies investigated children.…”

Section: Resultsmentioning

confidence: 99%

“…After sub-grouping by exposure types and sex, injury incidence in female athletes during competition was 0.67 per 1000 player-hours (95% CI 0.33–1.35, I 2 = 75%) and in training was 0.07 per 1000 player-hours (95% CI 0.05–0.10, I 2 = 2%) (Appendix A11-3). There were insufficient studies to perform meta-analysis by player-exposures in females [ 45 , 53 ]. For males, injury incidence was 0.37 per 1000 player-hours (95% CI 0.24–0.59, I 2 = 72%) and 0.34 per 1000 player-exposures, 95% CI 0.12–0.99, I 2 = 96%) during competition while for training was 0.02 per 1000 player-hours (95% CI 0.01–0.05, I 2 = 55%) and 0.03 per 1000 player-exposures (95% CI 0.01–0.06, I 2 = 83%).…”

Section: Resultsmentioning

confidence: 99%

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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

et al. 2022

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Background Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more 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. Objective To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports. Methods Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included. Results Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48–62, I2 = 82%; females: 63%, 95% CI 53–71, I2 = 84%; males: 50%, 95% CI 42–58, I2 = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05–0.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03–0.07, I2 = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10–0.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03–0.07, I2 = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32–0.72, I2 = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15–0.70, I2 = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02–0.07, I2 = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01–0.05, I2 = 86%) and these differences were significant. Heterogeneity across studies was generally high. Conclusion 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. Injuries mostly occurred in competition settings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2022

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“…To our knowledge, this is the first study to use GPS-derived external workload metrics to evaluate lower extremity injury risk in women’s soccer. Studies comparing men’s and women’s soccer have demonstrated that men are more likely to sustain groin and hamstring injuries, 10 , 54 whereas women have a higher risk of anterior cruciate ligament (ACL) tears, 28 , 33 ankle ligament injuries, 35 and concussions. 14 Furthermore, consistent with previous findings, 17 , 26 the present study found that the incidence of lower extremity injury was over 3 times higher in games than in practices, at rates of 11.25 injuries per 1000 game hours and 3.07 injuries per 1000 practice hours, respectively.…”

Section: Discussionmentioning

confidence: 99%

Increased Lower Extremity Injury Risk Associated With Player Load and Distance in Collegiate Women’s Soccer

Xiao

Nguyen

Hwang

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: There is limited research regarding the impact of workload on injury risk specific to women’s soccer. Wearable global positioning system (GPS) units can track workload metrics such as total distance traveled and player load during games and training sessions. These metrics can be useful in predicting injury risk. Purpose: To examine the relationship between injury risk and player workload as collected from wearable GPS units in National Collegiate Athletic Association (NCAA) Division I women’s soccer players. Study Design: Case-control study; Level of evidence, 3. Methods: Lower extremity injury incidence and GPS workload data (player load, total distance, and high-speed distance) for 65 NCAA Division I women’s soccer players were collected over 3 seasons. Accumulated 1-, 2-, 3-, and 4-week loads and acute-to-chronic workload ratios (ACWR) were classified into discrete ranges by z-scores. ACWR was calculated using rolling averages and exponentially weighted moving averages (EWMA) models. Binary logistic regression models were used to compare the 7:28 rolling average and EWMA ACWRs between injured and noninjured players for all GPS/accelerometer variables. The prior 1-, 2-, 3-, and 4-week accumulated loads for all GPS/accelerometer variables were compared between the injured and uninjured cohorts using 2-sample t tests. Results: There were a total of 53 lower extremity injuries that resulted in lost time recorded (5.76/1000 hours “on-legs” exposure time; 34 noncontact and 19 contact injuries). The prior 2-week (7242 vs 6613 m/s2; P = .02), 3-week (10,533 vs 9718 m/s2; P = .02), and 4-week (13,819 vs 12,892 m/s2; P = .04) accumulated player loads and 2-week (62.40 vs 57.25 km; P = .04), 3-week (90.97 vs 84.10 km; P = .03), and 4-week (119.31 vs 111.38 km; P = .05) accumulated total distances were significantly higher for injured players compared with noninjured players during the same time frames. There were no significant differences in player load, total distance, or high-speed distance ACWR between injured and noninjured players for both the rolling averages and EWMA calculations. Conclusion: Higher accumulated player load and total distance, but not ACWR, were associated with injury in women’s soccer players.

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“…We expect injuries still occurred as COVID-precautions varied regionally and a portion of athletes continued to practice and play informally. Per Gupta et al 15 , rates of ACL injury are significantly lower in practice versus competition, therefore the decrease in scheduled competitions alone may have led to fewer injuries. There are some studies suggesting that the rate of sports injuries O n l i n e F i r s t increases at the beginning of a sports season.…”

Section: Discussionmentioning

confidence: 99%

Trends in Pediatric Anterior Cruciate Ligament Reconstruction: The Effect of COVID-19

Kiani

Yellin

Houlihan

et al. 2022

Journal of Athletic Training

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Context: The number of pediatric anterior cruciate ligament reconstructions (ACLRs) occurring yearly increased almost 6-fold from 2004 to 2014. Interestingly, there are limited recent data on rates of ACL injury and reconstruction in children and adolescents, especially in the context of COVID-19. Objective: Given the impact of the COVID-19 pandemic on youth sports seasons and the postponement of many elective surgeries, we sought to examine the changes in rates of ACLR during this period. Design: Retrospective cohort study. Setting: This study used the Pediatric Health Information System (PHIS) database to identify eligible patients at PHIS-participating hospitals nationwide from January 2016 to June 2021, with March 1, 2020 considered the “start” of the COVID-19 pandemic. Patients or Other Participants: Using CPT codes, patients 18 years old and younger who underwent ACLR surgery were identified. Interventions: None. Main Outcome Measures: Patient demographics and overall rates of surgery pre- and intra-pandemic were compared. Data were analyzed using bivariate, mixed model, and time series analyses. Results: A total of 24,843 ACLRs were identified during this time period. In total, 1,853 fewer surgeries were performed after March 2020 than expected given pre-pandemic trends. Examining demographics, intra-pandemic, there was an increase in the proportion of patients who identified as White and with private insurance and a decrease in the proportion who identified as Black and with public insurance. There was also a significant shift in the proportion of ACLRs by region, with increased surgeries performed in the Midwest and decreased in the Northeast. In the model adjusted for hospital-level variability, only race and insurance status remained significant. Conclusions: Based on pre-pandemic trends, there were fewer patients than projected who underwent ACLR once the pandemic began, likely due to a combination of decreased rates of injury and delayed surgery.

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Sex-Based Differences in Anterior Cruciate Ligament Injuries Among United States High School Soccer Players: An Epidemiological Study

Cited by 26 publications

References 18 publications

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

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

Increased Lower Extremity Injury Risk Associated With Player Load and Distance in Collegiate Women’s Soccer

Trends in Pediatric Anterior Cruciate Ligament Reconstruction: The Effect of COVID-19

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