scholarly journals Sexual Dimorphisms in Anterior Cruciate Ligament Injury: A Current Concepts Review

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110253
Author(s):  
Tayt M. Ellison ◽  
Ilexa Flagstaff ◽  
Anthony E. Johnson
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Extrinsic Factors ◽  
Male Athletes ◽  
Acl Injuries ◽  
Sexual Dimorphisms ◽  
Increased Risk ◽  
Anterior Cruciate ◽  
Postsurgical Outcomes

Background: Although most anterior cruciate ligament (ACL) injuries occur in male athletes, female athletes are consistently observed to be at a higher risk for sports-specific ACL injury. Purpose: To provide a thorough review of what is known about the sexual dimorphisms in ACL injury to guide treatment and prevention strategies and future research. Study Design: Narrative review. Methods: We conducted a comprehensive literature search for ACL-related studies published between January 1982 and September 2017 to identify pertinent studies regarding ACL injury epidemiology, prevention strategies, treatment outcomes, and dimorphisms. By performing a broad ACL injury search, we initially identified 11,453 articles. After applying additional qualifiers, we retained articles if they were published in English after 1980 and focused on sex-specific differences in any of 8 different topics: sex-specific reporting, difference in sports, selective training, hormonal effects, genetics, neuromuscular and kinematic control, anatomic differences, and outcomes. Results: A total of 122 articles met the inclusion criteria. In sum, the literature review indicated that female athletes are at significantly higher risk for ACL injuries than are their male counterparts, but the exact reasons for this were not clear. Initial studies focused on intrinsic differences between the sexes, whereas recent studies have shifted to focus on extrinsic factors to explain the increased risk. It is likely both intrinsic and extrinsic factors contribute to this increased risk, but further study is needed. In addition to female patients having an increased risk for ACL injuries, they are less likely than are male patients to undergo reconstructive surgery, and they experience worse postsurgical outcomes. Despite this, reconstructive surgery remains the gold standard when knee stability, return to sports, and high functional outcome scores are the goal, but further research is needed to determine why there is disparity in surgical rates and what surgical techniques optimize postsurgical outcomes for female patients. Conclusion: Male athletes often predominated the research concerning ACL injury and treatment, and although sex-specific reporting is progressing, it has historically been deficient. ACL injuries, prevention techniques, and ACL reconstruction require further research to maximize the health potential of at-risk female athletes.

Management of the female anterior cruciate ligament: current concepts

2020 ◽  
Vol 5 (3) ◽  
pp. 123-127
Author(s):  
Nicholas Vaudreuil ◽  
Justin Roe ◽  
Lucy Salmon ◽  
Elvire Servien ◽  
Carola van Eck
Keyword(s):  
Anterior Cruciate Ligament ◽  
Sports Medicine ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Return To Sport ◽  
Acl Injury ◽  
Acl Injuries ◽  
Unique Challenge ◽  
Increased Risk ◽  
Anterior Cruciate

Female athletes represent a unique challenge for sports medicine providers. Care for skeletally mature female athletes requires an understanding of the distinct physiology, risk factors and injury patterns that have been described in this population. Anterior cruciate ligament (ACL) injuries are commonly observed in female athletes, especially in high-risk sports such as soccer, basketball, lacrosse and volleyball. Women have been shown to be at a higher risk for ACL injury compared with their male peers, even competing in the same sport. Several factors must be considered when discussing the increased risk of ACL injuries in women. Anatomic factors and altered landing mechanics alignment contribute to increased forces seen at the ACL. A variety of other factors including altered neuromuscular profiles, hormonal factors and genetic factors may all play a role in increased predisposition towards ACL injury. Prevention strategies for ACL such as proprioceptive training may be helpful, especially for at-risk activities such as landing and cutting drills. Optimal surgical management including graft choice is an area of debate. Postoperatively, return to sport protocols are not well standardised for female athletes. Women have a lower return to sport frequency, and psychological factors such as fear of reinjury are often cited as a predominant factor. Overall, the influence of female gender on ACL injury treatment has been an area of heavy research recently. However, more research is needed to elicit the reasons for physical and psychological differences between men and women in order to clarify optimal postoperative management.

scholarly journals Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification

2019 ◽  
Vol 54 (5) ◽  
pp. 472-482 ◽  
Author(s):  
Alicia M. Montalvo ◽  
Daniel K. Schneider ◽  
Kate E. Webster ◽  
Laura Yut ◽  
Marc T. Galloway ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Injury Incidence ◽  
Male Athletes ◽  
Acl Injuries ◽  
Sport Type ◽  
Anterior Cruciate

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 1.12/10 000 AEs, IRR = 1.14, P = .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21, P = .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49, P = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10 000 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 (4.80/10 000 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.

Musculoskeletal Problems in the Female Athlete

2013 ◽  
Author(s):  
Irfan M Asif ◽  
Emily Edwards ◽  
Kimberly Harmon
Keyword(s):  
Female Athlete ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Adhesive Capsulitis ◽  
Stress Fractures ◽  
Pubic Ramus ◽  
Male Athletes ◽  
Acl Injuries ◽  
Musculoskeletal Problems ◽  
Anterior Cruciate

Musculoskeletal injuries in the female athlete are, for the most part, similar to those in the male athlete. However, there are differences in the incidence of these injuries and in the sports in which they tend to occur. Stress fractures are more common in the female athlete because of the higher prevalence of disordered eating and subsequent energy imbalance that leads to detrimental effects on bone. In addition, female athletes have a higher rate of noncontact anterior cruciate ligament (ACL) injuries than male athletes. Other musculoskeletal problems are also more common in females, such as multidirectional instability of the shoulder, adhesive capsulitis, and patellofemoral pain. Finally, as a function of greater participation by females in certain sports, such as dance and gymnastics, injuries specific to those sports are more common in females. This chapter addresses injuries that are seen commonly in the female athlete and reviews unique issues related to exercise and the female reproductive system. Figures depict the management of stress fractures, a stress fracture of the inferior pubic ramus, the tension aspect of the femoral neck, stress fractures of the rib, multidirectional shoulder instability, adhesive capsulitis, spondylolysis, proper squat landing technique, and the female athlete triad. A table outlines the recommended intake of both calcium and vitamin D for bone health at various ages.This chapter contains 9 figures, 1 table, 59 references, and 5 Board-styled MCQs.

Assessing Laxity Characteristics of Hyperextension Knee in Healthy Young Females Using a Knee Ligament Arthrometer

2007 ◽  
Author(s):  
Hsiu-Chen Lin ◽  
Weng-Hang Lai ◽  
Chia-Ming Chang ◽  
Horng-Chaung Hsu
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Acl Injury ◽  
Male Athletes ◽  
Knee Ligament ◽  
Young Females ◽  
Anterior Knee Laxity ◽  
Anterior Cruciate ◽  
Anterior Knee

Female athletes are more likely to sustain an anterior cruciate ligament (ACL) injury than male athletes. Previous study has showed that female individuals had larger anterior knee laxity than their male counterparts [1]. Researchers have also reported that knee laxity and hyperextension knee were a possible factor contributing to ACL injury [2]. Loudon showed that a person with hyperextension knee, either healthy or ACL-injured, had poorer proprioceptive control. Even more, ACL-injured subjects with hyperextension knee demonstrated a declined function of proprioception feedback loop and the ability to initiate protective reflexes [3].

Lower Extremity Biomechanical Differences Between Female Dancers and Soccer Players

2020 ◽  
Vol 25 (5) ◽  
pp. 254-257
Author(s):  
Hayley M. Ericksen ◽  
Rachele E. Vogelpohl
Keyword(s):  
Lower Extremity ◽  
National Collegiate Athletic Association ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Acl Injuries ◽  
Jump Landing ◽  
Ankle Eversion ◽  
Anterior Cruciate ◽  
Modern Dancers

Anterior cruciate ligament (ACL) injury in female athletes is common. Team sport athletes experience more ACL injuries than ballet and modern dancers. Examining biomechanical differences between these two groups may help to explain the discrepancy in ACL injury rates. The purpose of this study was to examine lower extremity kinematic differences between collegiate dancers and National Collegiate Athletic Association Division I soccer athletes during a rebound jump-landing task. Peak hip, knee, and ankle kinematics were collected during a jump-landing task. Results showed more knee flexion and less ankle eversion in the dancers compared to the soccer athletes. Differences in training and strategies used during landing may explain the kinematic differences between groups.

scholarly journals Tendency of Driving to the Basket Is Associated With Increased Risk of Anterior Cruciate Ligament Tears in National Basketball Association Players: A Cohort Study

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110529
Author(s):  
Blake J. Schultz ◽  
Kevin A. Thomas ◽  
Mark Cinque ◽  
Joshua D. Harris ◽  
William J. Maloney ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Standard Deviation ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
National Basketball Association ◽  
Acl Injuries ◽  
Increased Risk ◽  
Significant Difference ◽  
Anterior Cruciate ◽  
Level Performance

Background: Driving to the basket in basketball involves acceleration, deceleration, and lateral movements, which may expose players to increased anterior cruciate ligament (ACL) injury risk. It is unknown whether players who heavily rely on driving have decreased performance on returning to play after ACL reconstruction (ACLR). Hypothesis: Players with a greater tendency to drive to the basket would be more likely to tear their ACL versus noninjured controls and would experience decreased performance when returning to play after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: Season-level performance statistics and ACL injuries were aggregated for National Basketball Association (NBA) seasons between 1980 and 2017 from publicly available sources. Players’ tendency to drive was calculated using 49 common season-level performance metrics. Each ACL-injured player was matched with 2 noninjured control players by age, league experience, and style of play metrics. Points, playing minutes, driving, and 3-point shooting tendencies were compared between players with ACL injuries and matched controls. Independent-samples t test was utilized for comparisons. Results: Of 86 players with a total of 96 ACL tears identified in the NBA, 50 players were included in the final analysis. Players who experienced an ACL tear had a higher career-average drive tendency than controls ( P = .047). Players with career-average drive tendency ≥1 standard deviation above the mean were more likely to tear their ACL than players with drive tendency <1 standard deviation (5.2% vs 2.7%; P = .026). There was no significant difference in total postinjury career points ( P = .164) or career minutes ( P = .237) between cases and controls. There was also no significant change in drive tendency ( P = .152) or 3-point shooting tendency ( P = .508) after return to sport compared with controls. Conclusion: NBA players with increased drive tendency were more likely to tear their ACL. However, players who were able to return after ACLR did not underperform compared with controls and did not alter their style of play compared with the normal changes seen with age. This information can be used to target players with certain playing styles for ACL injury prevention programs.

scholarly journals A Tomahawk Shaped Femur is a Risk Factor for Anterior Cruciate Ligament Injury

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0001
Author(s):  
Thomas Pfeiffer ◽  
Jeremy Burnham ◽  
Elmar Herbst ◽  
Sven Shafizadeh ◽  
Volker Musahl
Keyword(s):  
Acl Reconstruction ◽  
Roc Analysis ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Control Group ◽  
Acl Injuries ◽  
Injury Group ◽  
Increased Risk ◽  
The Mean ◽  
Anterior Cruciate

Bony morphologic characteristics have been demonstrated to increase the risk of anterior cruciate ligament (ACL) injury. The purpose of the study was to examine distal femoral morphology relative to ACL injury, reconstruction failure, and contralateral ACL injury. It was hypothesized that an increased posterior femoral condylar depth, quantified as the tomahawk ratio, would correlate with increased risk of primary ACL ruptures, ACL reconstruction failures, and contralateral ACL injuries. Consecutive patients undergoing arthroscopic knee surgery at an academic medical center from 2012-2016 with minimum 24-month follow-up were retrospectively reviewed. Subjects were stratified into four groups: a control group consisting of patients with no ACL injuries and three groups of patients with a primary ACL injury, failed ACL reconstruction, or previous ACL injury with subsequent contralateral ACL injury. Using lateral radiographs, the ratio of posterior condylar depth over total condylar distance was defined as the tomahawk ratio. Analysis-of-variance (ANOVA) and post-hoc testing were used to test for differences in the mean tomahawk ratio between study groups (p<0.05). Receiver Operating Characteristic (ROC) analysis was performed to determine the optimal tomahawk ratio cut-off for detecting increased risk for ACL injury 175 patients met inclusion criteria. The mean tomahawk ratios in the control group, primary ACL injury group, failed ACL reconstruction group, and contralateral ACL injury group were 61.1% (± 2.1), 64.2% (± 3.8), 64.4% (± 3.6), and 66.9% (± 4.0), respectively. Patients with a primary ACL injury, failed ACL reconstruction, or contralateral ACL injury had a significantly higher tomahawk ratio compared to the control group (p<0.008). ROC analysis demonstrated a tomahawk ratio of 63% or greater to be associated with an increased risk for ACL injury with a sensitivity of 83% and a specificity of 71%. The data from this study show that an increased posterior femoral condylar depth, or tomahawk ratio, is associated with increased risk of ACL injury, including primary ACL injury, failed ACL reconstruction, and contralateral ACL injury. Readily identifiable risk factors, such as an increased tomahawk ratio, could assist clinicians in identifying at-risk individuals who may experience greater benefit from targeted ACL injury prevention counseling and intervention. The presence of the tomahawk-shaped femur could also be used to guide treatment decisions and identify ACL reconstruction patients who may benefit from additional surgical procedures such as extra articular tenodesis.

scholarly journals The Influence of Age on the Effectiveness of Neuromuscular Training to Reduce Anterior Cruciate Ligament Injury in Female Athletes

2012 ◽  
Vol 41 (1) ◽  
pp. 203-215 ◽  
Author(s):  
Gregory D. Myer ◽  
Dai Sugimoto ◽  
Staci Thomas ◽  
Timothy E. Hewett
Keyword(s):  
Injury Risk ◽  
Knee Injury ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Acl Injury ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Injury Reduction ◽  
Anterior Cruciate

Background: In female athletes, sports-related injuries to the anterior cruciate ligament (ACL) increase during adolescence and peak in incidence during the mid- to late teens. Although biomechanical investigations indicate that a potential window of opportunity exists for optimal timing for the initiation of integrative neuromuscular training (NMT) in young female athletes, the influence of the timing of initiation of these programs on the efficacy of ACL injury reduction has yet to be evaluated. Hypothesis/Purpose: The purpose of the current report was to systematically review and synthesize the scientific literature regarding the influence of age of NMT implementation on the effectiveness for reduction of ACL injury incidence. The hypothesis tested was that NMT would show a greater effect in younger populations. Study Design: Meta-analysis; Level of evidence 1a. Methods: Data were pooled from 14 clinical trials that met the inclusion criteria of (1) number of ACL injuries reported; (2) NMT program used; (3) female participants were included; (4) investigations used prospective, controlled trials; and (5) age of participants was documented or was obtainable upon contact with the authors. A meta-analysis with odds ratio (OR) was used to compare the ratios of ACL injuries between intervention and control groups among differing age categorizations. Results: A meta-analysis of the 14 included studies demonstrated significantly greater knee injury reduction in female athletes who were categorized in the preventive NMT group compared with those who were in the control group (OR: 0.54; 95% confidence interval [CI]: 0.35, 0.83). Lower ACL injuries in mid-teens (OR 0.28; CI: 0.18, 0.42) compared with late teens (OR 0.48; CI: 0.21, 1.07) and early adults (OR 1.01; CI: 0.62, 1.64) were found in participants undergoing NMT. Conclusion: The findings of this meta-analysis revealed an age-related association between NMT implementation and reduction of ACL incidence. Both biomechanical and the current epidemiological data indicate that the potential window of opportunity for optimized ACL injury risk reduction may be before the onset of neuromuscular deficits and peak knee injury incidence in female athletes. Specifically, it may be optimal to initiate integrative NMT programs during early adolescence, before the period of altered mechanics that increase injury risk.

scholarly journals Risk Factors of ACL Injury

2021 ◽  
Author(s):  
Nuthan Jagadeesh ◽  
Sachindra Kapadi ◽  
Venkatesh Deva ◽  
Ankur Kariya
Keyword(s):  
Risk Factors ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Modifiable Risk Factors ◽  
Extrinsic Factors ◽  
Joint Injury ◽  
Acl Injuries ◽  
Intrinsic Factors ◽  
Notch Width ◽  
Anterior Cruciate

An anterior cruciate ligament(ACL) is one of the major stabilizers of the knee joint, injury to which can be quite dreadful even ending many sports careers if not properly treated. Knowledge of the risk factors contributing to ACL injury will help in identifying at-risk individuals and develop preventive strategies. The factors contributing to ACL injury are multi-factorial involving biomechanical, anatomical, hormonal, neuromuscular factors etc; and can be broadly classified as Intrinsic and Extrinsic factors. Intrinsic factors are mostly non-modifiable risk factors may be subdivided into anatomical, genetic, gender, previous ACL Injuries etc . Whereas Extrinsic factors are mostly modifiable risk factors include environmental factors, characteristic of surface and shoe, BMI and others. Anatomical risk factors can divided into tibial parameters like posterior tibial slope, medial tibial plateau depth etc ; femoral parameters like notch width, notch index etc.

scholarly journals Risk Estimation of Anterior Cruciate Ligament (ACL) Injury in East Java Puslatda Pencak Silat Athletes

2021 ◽  
Vol 3 (1) ◽  
pp. 29
Author(s):  
Farhan Nur Ahmad Dzakiya ◽  
Damayanti Tinduh ◽  
Dwikora Novembri Utomo
Keyword(s):  
Anterior Cruciate Ligament ◽  
Odds Ratio ◽  
Risk Estimation ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Extrinsic Factors ◽  
Flat Foot ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Intrinsic And Extrinsic Factors

Background: Dr. Soetomo General Hospital Sports Clinic Surabaya reported that the incidence of knee injuries was rather high, particularly in martial art athletes. Injuries in pencak silat athletes are dominated by Anterior Cruciate Ligament (ACL) injuries (16.7%) Several risk factors are thought to influence ones’ propensity for these injuries.Aim: To analyze risk estimation between intrinsic and extrinsic factors in the occurrence of ACL injury in East Java Puslatda Pencak Silat Athletes.Material and Methods: This study was an analytic observational study with a case control design involving 18 pencak silat athletes from East Java Regional Training Centre. Age, gender, body mass index, previous ACL injury, range of motion, laxity, and flat foot were included as intrinsic factors; while duration of each training, training frequency, and sparring frequency were included as extrinsic factors. Data analysis was done using the Chi-Square Test. Odds Ratio was calculated through cross-tabulation.Results: It was found that 3 of 18 athletes (16.7%) had ACL injuries. None of the intrinsic and extrinsic factors significantly affected the incidence of ACL injury (p> 0.05). However, the odds ratio calculation showed that adult athletes older than 25 years-old (OR = 1.4), male (OR = 1.667), obese (OR = 1.4), with laxity (OR = 2.5), and flat foot (OR = 1) had higher risk in having ACL injury.Conclusion: Adult athletes, male, obese, with laxity, and flat foot had a higher risk of ACL injury.

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