Comparison of Anterior Cruciate Ligament Injury Rates In High School and Middle School Sports Over a 30-year Period

Background: Anterior cruciate ligament (ACL) injuries are a major concern in interscholastic sports. Comparison of ACL injuries between high school (HS) and middle school (MS) athletes over multiple years is limited. Purpose: To examine the incidence of ACL injury in HS female [HS-F] and male [HS-M], and MS female [MS-F] and male [MS-M] sports over a 30-year period. Methods: We studied 55,147 athletes who competed in interscholastic sports at a secondary school from 1988 to 2018. Data included ACL injuries incurred during interscholastic sports, and clinically confirmed by a physician. Injury rates per 100,000 AEs (practice and games where the athlete was at risk of ACL injury) were calculated for gender, sport, and contact status. Incidence rate ratios [RR] and 95% confidence intervals (CIs) were used to compare injury rates. Results: The incidence rate of ACL injury for HS athletes (4.15/100,000 AEs) was almost three times greater (RR=2.63, 95%CI: 1.7-4.2; p<0.0001) than the incidence rate for MS athletes (1.58/100,000 AEs). The risk of sustaining an ACL injury among HS-F athletes (4.26/100,000 AEs) was similar to HS-M athletes (4.06/100,000 AEs) (RR=1.05, 95%CI: 0.7-1.6; p=0.81). The risk of sustaining an ACL injury among MS-F athletes (1.06/100,000 AEs) was less than MS-M athletes (1.96/100,000 AEs) (RR=0.54, 95%CI: 0.2-1.4; p=0.21). While the risk of incurring an ACL injury occurrence was four times greater (RR=4.01, 95%CI: 1.7-9.4; p=0.0002) among HS-F athletes than MS-F athletes, the risk of ACL injury was twice as high (RR=2.08, 95%CI: 1.2-3.7; p=0.009) among HS-M athletes than MS-M athletes. ACL injuries were incurred in 15 HS sports and was greatest for HS-F basketball (25.5/100,000 AEs; p<0.001), HS-M football (20.6/100,000 AEs), and HS-F soccer (20.4/100,000 AEs). ACL injuries were sustained in 7 MS sports and was highest for MS-F softball (9.1/100,000 AEs), MS-M basketball (6.3/100,000 AEs) and MS-M football (5.0/100,000 AEs). The risk of contact-related ACL injury (1.73/100,000 AEs) was almost two times greater than non-contact-related ACL (0.96/100,000 AEs) (RR=1.80, 95%CI: 1.2-2.7; p<0.001). The rate of contact ACL injury was highest among HS-M (3.38/100,000 AEs) while the rate for noncontact ACL injury greatest among HS-F (2.44/100,000 AEs). Conclusions: The risk for ACL injury is higher in HS than in MS for both sexes. Non-contact ACL injuries were more likely to occur among HS-F athletes while contact injuries were highest for HS-M athletes, suggesting the effects of maturation and competition may play a role with increasing competition level.

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

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120919178 ◽

2020 ◽

Vol 8 (5) ◽

pp. 232596712091917

Author(s):

Andrew S. Gupta ◽

Lauren A. Pierpoint ◽

R. Dawn Comstock ◽

Michael G. Saper

Keyword(s):

United States ◽

High School ◽

Anterior Cruciate Ligament ◽

Epidemiological Study ◽

Cruciate Ligament ◽

Acl Injury ◽

Soccer Players ◽

Acl Injuries ◽

Injury Rates ◽

Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are common among high school athletes, with sex-based differences accounting for higher injury rates in girls. Previous epidemiological studies on ACL injuries focusing on adolescent athletes have looked at injuries across multiple sports, but few have analyzed ACL tears in solely high school soccer athletes. Purpose: To examine sex-based differences in the epidemiology of ACL injuries among high school soccer players in the United States (US). Study Design: Descriptive epidemiological study. Methods: ACL injury data for US high school soccer players were obtained from the internet-based National High School Sports-Related Injury Surveillance Study’s High School RIO (Reporting Information Online) system. Athletic trainers from a random sample of 100 high schools from 8 strata based on US Census geographic region reported data for athlete-exposures (AEs) (practice or competition) and ACL injuries from 2007 through 2017. Injury rates were calculated as the number of ACL injuries per 100,000 AEs. Subgroup differences were evaluated with rate ratios (RRs) or injury proportion ratios (IPRs) and 95% CIs. Statistical differences in demographics between groups were examined using independent t tests. Comparisons of categorical data (ie, level of play) were performed using the Wald chi-square test. Results: The reported number of ACL injuries corresponded to weighted national estimates of 41,025 (95% CI, 33,321-48,730) ACL injuries in boys’ soccer and 110,028 (95% CI, 95,349-124,709) in girls’ soccer during the study period. The rate of injuries was higher in girls’ soccer (13.23/100,000 AEs) than boys’ soccer (4.35/100,000 AEs) (RR, 3.04 [95% CI, 2.35-3.98]). The rate of ACL injuries was higher in competition compared with practice for girls (RR, 14.77 [95% CI, 9.85-22.15]) and boys (RR, 8.69 [95% CI, 5.01-15.08]). Overall, a smaller proportion of ACL injuries were caused by player-player contact for girls (30.1%) compared with boys (48.6%) (IPR, 0.62 [95% CI, 0.41-0.93]). Conclusion: ACL injury rates and patterns in high school soccer players differed between sex, type of exposure (practice vs competition), and mechanism of injury.

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SEX DIFFERENCES IN ANTERIOR CRUCIATE LIGAMENT INJURIES AMONG US HIGH SCHOOL SOCCER PLAYERS: AN EPIDEMIOLOGIC STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00157 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0015

Author(s):

Andrew Gupta ◽

Lauren Pierpoint ◽

Dawn Comstock ◽

Michael Saper

Keyword(s):

High School ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Acl Injury ◽

Soccer Players ◽

Mechanism Of Injury ◽

Acl Injuries ◽

Injury Rates ◽

Subgroup Differences ◽

Anterior Cruciate

BACKGROUND Anterior cruciate ligament (ACL) injuries are common among adolescent athletes, with soccer being the sport most frequently implicated in girls’ ACL injuries. The current literature on ACL injuries, while extensive, lacks a comprehensive study of ACL injuries in United States (US) high school soccer players. The objective of this study was to describe the epidemiology of ACL injuries among US high school soccer players. METHODS ACL injury and athlete exposure (AE) data for US high school soccer players were obtained from the internet-based National High School Sports-Related Injury Surveillance System, High School RIO (Reporting Information Online) dataset collected from school years 2007-2008 through 2016-2017. Injury rates were calculated as the number of ACL injuries per 100,000 AEs. Subgroup differences were evaluated with rate ratios (RRs) or injury proportion ratios (IPRs) and 95% Confidence Intervals (CIs). Subgroup differences were examined with independent t-tests. Comparisons of categorical data (i.e., mechanism of injury) were performed using Pearson’s?2 tests. RESULTS The number of ACL injuries reported to High School RIO corresponded to weighted national estimates of 41,205 (95% CI = 33,321 – 48,730) ACL injuries in boys’ soccer and 110,029 (95% CI = 95,349 – 124,709) in girls’ soccer during the study period. ACL injury rates were significantly higher in girls’ soccer (13.23 per 100,000 AEs) than boys’ soccer (4.35 per 100,000 AEs) (RR = 3.04, 95% CI = 2.35 – 3.98) and were significantly higher in competition compared to practice for both girls (RR = 14.77, 95% CI = 9.85 – 22.15) and boys (RR = 8.69, 95% CI = 5.01 – 15.08). A greater proportion of ACL injuries were due to player-player contact in boys (48.6%) compared to girls (30.1%) (IPR = 1.62, 95% CI = 1.08 – 2.42). There was no statistical difference in the proportion of ACL injuries managed surgically in boys and girls (84% vs. 78%, respectively). CONCLUSIONS There are sex-based differences in mechanism of injury and ACL injury rate in high school soccer players. In addition, boys and girls showed higher rates of injury during competition. This study suggests several areas for targeted evidence-based ACL injury prevention strategies in US high school soccer players.

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Epidemiology of Anterior Cruciate Ligament Injury in Italian First Division Soccer Players

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738119885642 ◽

2019 ◽

Vol 12 (3) ◽

pp. 279-288 ◽

Cited By ~ 1

Author(s):

Alberto Grassi ◽

Luca Macchiarola ◽

Matteo Filippini ◽

Gian Andrea Lucidi ◽

Francesco Della Villa ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Incidence Rate ◽

Cruciate Ligament ◽

Acl Injury ◽

Soccer Players ◽

Injury Incidence ◽

Acl Injuries ◽

Professional Soccer ◽

Incidence Proportion ◽

Anterior Cruciate

Background: The burden of anterior cruciate ligament (ACL) injury in professional soccer players is particularly relevant as it represents a potentially career-threatening injury. Hypothesis: Our hypotheses were that (1) injury incidence rate would be similar to that reported in the literature, (2) we would identify a uniform distribution of the injuries along the season, and (3) injury incidence rate would be similar in high-ranked and lower ranked teams, based on final placement in the league. Study Design: Descriptive epidemiological study. Level of Evidence: Level 4. Methods: Professional male soccer players participating in the Serie A championship league in 7 consecutive seasons (2011-2012 to 2017-2018) were screened to identify ACL injuries through the online football archive transfermarkt.com . Exposure in matches and training were calculated. Results: There were 84 ACL injuries found (mean player age, 25.3 ± 4.2 years). Overall, 25% of ACL injuries were reruptures (15%) or contralateral injuries (10%). ACL incidence rate was 0.4215 per 1000 hours of play during Serie A matches, 0.0305 per 1000 hours of training (rate ratio [RR], 13.8; 95% CI, 8.4-22.7; P < 0.0001), and 0.0618 per 1000 hours of total play. Injury distribution had a bimodal peak, with the highest number of events in October and March. Alternatively, training injuries peaked in June and July. A significantly higher incidence rate was found for the teams ranked from 1st to 4th place compared with those ranked 5th to 20th (0.1256 vs 0.0559 per 1000 hours of play; RR, 2.2; 95% CI, 1.4-3.6; P = 0.0003). A similar finding was found for injury incidence proportion (3.76% vs 1.64%; P = 0.0003). Conclusion: The overall incidence rate of ACL injuries in Italian Serie A was 0.062 per 1000 hours, with a 14-fold risk in matches compared with training. Relevantly, 25% were second injuries. Most injuries occurred in October and March, and an almost 2-fold incidence rate and incidence proportion were noted in those teams ranked in the first 4 positions of the championship league. Clinical Relevance: Knowing the precise epidemiology of ACL injury in one of the most competitive professional football championship leagues could help delineate fields of research aimed to investigate its risk factors.

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Trends in Recurrent Anterior Cruciate Ligament Injuries Differ From New Anterior Cruciate Ligament Injuries in College and High School Sports: 2009-2010 Through 2016-2017

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119883867 ◽

2019 ◽

Vol 7 (11) ◽

pp. 232596711988386 ◽

Cited By ~ 1

Author(s):

Lindsay V. Slater ◽

Erin B. Wasserman ◽

Joseph M. Hart

Keyword(s):

High School ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Sports Participation ◽

Acl Injury ◽

Acl Injuries ◽

Anterior Cruciate Ligament Injuries ◽

Anterior Cruciate ◽

Recurrent Injuries ◽

First Time

Background: Knee injuries are common and result in extended time missed from sports participation. Little is known regarding the comparative characteristics of recurrent versus first-time anterior cruciate ligament (ACL) injuries sustained during athletic events and how they are influenced by sex, sports participation level, and game-time features. Purpose: To evaluate the characteristics (sex, sports level, and game timing [ie, early vs late in the game]) of recurrent ACL injury in National Collegiate Athletic Association (NCAA) and high school athletes compared with first-time ACL injury. Study Design: Descriptive epidemiology study. Methods: Athletic trainers reported ACL injury occurrences and characteristics for collegiate athletes during the 2009-2010 through 2016-2017 academic years and for high school athletes during the 2011-2012 through 2013-2014 academic years. Logistic regression was used to estimate odds ratios (ORs) and 95% CIs for recurrent versus first-time ACL injury. The number of ACL injuries, proportions, and ORs were calculated by sex, competition level, and time in game played. Results were also classified according to injury mechanism: noncontact, overuse, or surface contact. Results: A total of 705 ACL injuries were reported, including 644 first-time injures and 61 recurrent injuries. When restricting to noncontact ACL injuries, 416 were reported (373 first-time injuries and 43 recurrent injuries). The odds of a recurrent versus new ACL injury in NCAA student-athletes were 4.6 times that of high school student-athletes (95% CI, 1.41-15.24; P = .01). When restricting to noncontact ACL injuries, the odds of a recurrent versus new ACL injury during postseason and preseason were 4.5 and 2.8 times that during the regular season, respectively. Athletes in limited-contact and noncontact sports had greater odds of a recurrent versus new ACL injury compared with athletes playing football and other contact and collision sports. There was no significant difference in the odds of a recurrent ACL injury by sex or time in game. Conclusion: Based on the current study, the odds of recurrent ACL injuries are associated with the level of competition but not associated with sex or timing of game play. Determinants of reinjury after primary ACL reconstruction will help advance care for young injured athletes who continue to participate in competitive sports.

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No Association Between Risk of Anterior Cruciate Ligament Rupture and Selected Candidate Collagen Gene Variants in Female Elite Athletes From High-Risk Team Sports

The American Journal of Sports Medicine ◽

10.1177/0363546518808467 ◽

2018 ◽

Vol 47 (1) ◽

pp. 52-58 ◽

Cited By ~ 2

Author(s):

Einar Andreas Sivertsen ◽

Kari Bente Foss Haug ◽

Eirik Klami Kristianslund ◽

Anne-Marie Siebke Trøseid ◽

Jari Parkkari ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

High Risk ◽

Elite Athletes ◽

Cruciate Ligament ◽

Team Sports ◽

Acl Injury ◽

Acl Rupture ◽

Acl Injuries ◽

Genes Encoding ◽

Anterior Cruciate

Background: Several single-nucleotide variants (SNVs) in collagen genes have been reported as predisposing factors for anterior cruciate ligament (ACL) tears. However, the evidence is conflicting and does not support a clear association between genetic variants and risk of ACL ruptures. Purpose: To assess the association of previously identified candidate SNVs in genes encoding for collagen and the risk of ACL injury in a population of elite female athletes from high-risk team sports. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 851 female Norwegian and Finnish elite athletes from team sports were included from 2007 to 2011. ACL injuries acquired before inclusion in the cohort were registered by interview. The participants were followed prospectively through 2015 to record new complete ACL injuries. Six selected SNVs were genotyped ( COL1A1: rs1800012, rs1107946; COL3A1: rs1800255; COL5A1: rs12722, rs13946; COL12A1: rs970547). Results: No associations were found between ACL rupture and the SNVs tested. Conclusion: The study does not support a role of the 6 selected SNVs in genes encoding for collagen proteins as risk factors for ACL injury. Clinical Relevance: Genetic profiling to identify athletes at high risk for ACL rupture is not yet feasible.

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Anterior Cruciate ligament injuries of the knee:

South African Journal of Sports Medicine ◽

10.17159/2078-516x/2018/v30i1a5265 ◽

2018 ◽

Vol 30 (1) ◽

pp. 1-6

Author(s):

G Linde Strauss ◽

D Janse van Rensburg ◽

C Grant ◽

A Jansen van Rensburg ◽

M Velleman ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Acl Injury ◽

Mechanism Of Injury ◽

Mri Scan ◽

Chi Square ◽

Valgus Stress ◽

Acl Injuries ◽

Anterior Cruciate Ligament Injuries ◽

Anterior Cruciate

Abstract Background and problem statement Anterior cruciate ligament injuries are common among athletes and the general public. These injuries may lead to significant absence from activity with an associated financial and social burden. No definitive association has been described between mechanism of injury and pathology to enable us to put preventative measures in place in order to limit these injuries. Aim To determine whether there is an association between the mechanism of injury and the pathology seen on a magnetic resonance imaging (MRI) scan in anterior cruciate ligament (ACL) injuries. Methods This was a cross-sectional analytical study. Eighty seven male patients with an ACL injury, who had an MRI scan of the knee within the last two years participated in this study. Participants were contacted to give consent that their information be used in this study. The mechanism of injury and the pathology seen on the MRI scan was noted and categorised into different mechanism of injury groups and associated pathology groups. Statistical analyses included summaries of the data and a test for association between mechanism of injury and pathology. Since there were multiple pathology responses to each mechanism, a modified version of the chi-square test for independence was used. A 5% level of significance was specified. Results MRI scans of ACL injuries indicated that the mechanism of a solid foot plant with rotation of the knee has a greater tendency to be associated with medial meniscal injuries (77%), and also a 54% possibility to be associated with lateral meniscal injuries. A solid foot plant with a valgus stress on the knee showed a higher incidence of associated medial collateral ligaments (MCL) injuries (41%) and femoral bone bruising (62 %). These two mechanisms of injury are the most common in ACL injuries and contribute to the clinical significance found in this study. The p-value was however not statistically significant (p=0.44, chi-square value=20.27, df=45) for any association between pathology and mechanism of injury. Conclusion Some injury mechanisms causing ACL injury were more common than others and also had more associated pathology. The most common mechanism of injury noted is a solid foot plant with either rotation of the knee or valgus stress on the knee. Strengthening tissue structures involved in those movement patterns that cause these mechanisms can possibly limit ACL injuries in athletes and the general public. Key words Anterior cruciate ligament injury, mechanism, association, pathology, MRI scan, prevention.

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Anterior cruciate ligament injuries in Australian football: should women and girls be playing? You’re asking the wrong question

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000778 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000778 ◽

Cited By ~ 1

Author(s):

Aaron Fox ◽

Jason Bonacci ◽

Samantha Hoffmann ◽

Sophia Nimphius ◽

Natalie Saunders

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Acl Injury ◽

Early Years ◽

High Rate ◽

Acl Injuries ◽

Sports Science ◽

Australian Football ◽

Women And Girls ◽

Anterior Cruciate

Anterior cruciate ligament (ACL) injuries have been a rising concern in the early years of the women’s Australian Football League (AFLW), eliciting headlines of a ‘knee crisis’ surrounding the league. There has been a focus on female biology as the primary factor driving the high rate of ACL injuries in the AFLW. Emphasising Australian football (AF) as being dangerous predominantly due to female biology may be misrepresenting a root cause of the ACL injury problem, perpetuating gender stereotypes that can restrict physical development and participation of women and girls in the sport. We propose that an approach addressing environmental and sociocultural factors, along with biological determinants, is required to truly challenge the ACL injury problem in the AFLW. Sports science and medicine must therefore strive to understand the whole system of women in AF, and question how to address inequities for the benefit of the athletes.

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DO TIBIAL EMINENCE FRACTURES AND ANTERIOR CRUCIATE LIGAMENT TEARS HAVE SIMILAR OUTCOMES?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00119 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0011

Author(s):

Heath P. Melugin ◽

Vishal S. Desai ◽

Christopher Camp ◽

Timothy E. Hewett ◽

Todd A. Milbrandt ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Acl Injury ◽

Activity Levels ◽

Injury Rates ◽

Tibial Eminence ◽

Anterior Laxity ◽

Surgical Fixation ◽

Anterior Cruciate

Background: Avulsion fractures involving the tibial eminence are considered equivalent in etiology to anterior cruciate ligament tears, however there is limited data comparing outcomes of adolescent patients undergoing surgical fixation of tibial eminence fractures to those undergoing anterior cruciate ligament (ACL) reconstruction. Purpose: The purpose of this study was to compare clinical outcomes, subsequent ACL injury rates, and activity levels between adolescent patients who underwent tibial eminence fracture fixation to patients with mid-substance ACL tears who required acute ligament reconstruction. Methods: This study included a group of patients with tibial eminence fractures treated with surgical fixation matched to a group of similar patients with ACL tears treated with reconstruction between the years of 2001 and 2015. Data regarding initial injury, surgical intervention, ACL/ACL graft injury rates, and physical examination findings were recorded. Clinical and functional outcomes were obtained using physical examination, IKDC subjective scores, Lysholm scores, and Tegner Activity levels. Results: Sixty patients with a mean follow-up of 57.7 (24-206) months were included. 20 patients (11 M:9 F) who underwent surgical fixation for tibial eminence fractures (TEF) with a mean age of 11.9 (7-15) years were matched to a group of 40 patients (23 M:17 F) who underwent ACL reconstruction for ACL tears with a mean age of 12.5 (8-15) years. The TEF group demonstrated significantly lower postoperative IKDC (TEF group: 94.0, ACL group: 97.2 (p=0.04)) and Lysholm scores (TEF group: 92.4, ACL group: 96.9 (p=0.02)). The TEF group returned to sport 121 days sooner (p<0.01), but there was no difference in postoperative Tegner scores (TEF group: 7.3, ACL group: 7.6 (p=0.16)). The TEF group demonstrated increased postoperative anterior laxity (p=0.02) and a higher rate of postoperative arthrofibrosis (p=0.04). There was no difference in subsequent ACL injury (p=0.41). Conclusion: Patients with tibial eminence fractures demonstrated lower mean clinical outcome scores compared to patients with ACL tears at minimum 2-year follow up. Additionally, they experienced more postoperative anterior laxity and had a higher rate of postoperative arthrofibrosis. There was no difference in subsequent ACL injury rate. The TEF group returned to sport sooner than the ACL group, but the postoperative activity level was similar.

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The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury–Prevention Program in Elite-Youth Soccer Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-50.1.10 ◽

2015 ◽

Vol 50 (6) ◽

pp. 589-595 ◽

Cited By ~ 133

Author(s):

Darin A. Padua ◽

Lindsay J. DiStefano ◽

Anthony I. Beutler ◽

Sarah J. de la Motte ◽

Michael J. DiStefano ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Screening Tool ◽

Cruciate Ligament ◽

Acl Injury ◽

Receiver Operator Characteristic ◽

Acl Injuries ◽

Youth Soccer ◽

Jump Landing ◽

Anterior Cruciate

Context Identifying neuromuscular screening factors for anterior cruciate ligament (ACL) injury is a critical step toward large-scale deployment of effective ACL injury-prevention programs. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment of jump-landing biomechanics. Objective To investigate the ability of the LESS to identify individuals at risk for ACL injury in an elite-youth soccer population. Design Cohort study. Setting Field-based functional movement screening performed at soccer practice facilities. Patients or Other Participants A total of 829 elite-youth soccer athletes (348 boys, 481 girls; age = 13.9 ± 1.8 years, age range = 11 to 18 years), of whom 25% (n = 207) were less than 13 years of age. Intervention(s) Baseline preseason testing for all participants consisted of a jump-landing task (3 trials). Participants were followed prospectively throughout their soccer seasons for diagnosis of ACL injuries (1217 athlete-seasons of follow-up). Main Outcome Measure(s) Landings were scored for “errors” in technique using the LESS. We used receiver operator characteristic curves to determine a cutpoint on the LESS. Sensitivity and specificity of the LESS in predicting ACL injury were assessed. Results Seven participants sustained ACL injuries during the follow-up period; the mechanism of injury was noncontact or indirect contact for all injuries. Uninjured participants had lower LESS scores (4.43 ± 1.71) than injured participants (6.24 ± 1.75; t1215 = −2.784, P = .005). The receiver operator characteristic curve analyses suggested that 5 was the optimal cutpoint for the LESS, generating a sensitivity of 86% and a specificity of 64%. Conclusions Despite sample-size limitations, the LESS showed potential as a screening tool to determine ACL injury risk in elite-youth soccer athletes.

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The Effect Of Playing Surface On Anterior Cruciate Ligament Injury In NCAA Soccer

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00125 ◽

2020 ◽

Vol 8 (3_suppl2) ◽

pp. 2325967120S0012

Author(s):

Mark Howard ◽

Hyunwoo Paco Kang ◽

Samantha Solaru ◽

Alexander E. Weber ◽

Mark F. Rick C

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Acl Injury ◽

Soccer Players ◽

Injury Incidence ◽

Artificial Turf ◽

Acl Injuries ◽

Natural Grass ◽

Significant Difference ◽

Anterior Cruciate

Objectives: Previous orthopaedic literature has examined the effect of synthetic playing surfaces on the risk of anterior cruciate ligament (ACL) injury in athletes and produced varying and inconclusive results. The objective of this study was to examine the role of playing surface on the incidence and risk of ACL injury in collegiate soccer athletes. Methods: The NCAA Injury Surveillance Program (ISP) database was queried for ACL injuries for male and female soccer players from the 2004-05 through the 2013-14 seasons at all levels of competition. The number of athlete exposures (AEs), defined as 1 athlete participating in 1 practice or competition in which they were exposed to the possibility of athletic injury, were recorded for grass and synthetic playing surfaces. Both the reported injuries and exposures provided were weighted in order to represent the entire NCAA collegiate soccer population. Normalized ACL incidence rates were calculated as well as 95% confidence intervals (95%CI). Rate ratios comparing competition type amongst both competition and practice were calculated. Results: ACL injuries were more common on grass surfaces (1.16 per 10,000 AEs, 95%CI 1.12-1.20) than artificial turf (0.92 per 10,000 AEs, 95%CI 0.84-1.04). This difference was statistically significant (IRR 1.26, p<0.0001), and driven primarily by the difference in injury incidence during practice. The injury incidence during practice on natural grass (1.18 per 10,000 AEs, 95% CI 1.11-1.26) was significantly greater than the injury incidence rate during practice on artificial turf (0.067 per 10,000 AEs, 95%CI 0.043-0.096). Players were 17.7 times more likely (95%CI 10.6678-27.2187, p<0.0001) to sustain an ACL injury during practice on natural grass when compared to practice on artificial turf. However, there was no significant difference in injury incidence during matches (IRR 0.96, p=0.44), with matches on natural grass (3.35 per 10,000 AEs, 95% CI 3.21-3.51) equivalent to matches on artificial surfaces (3.49 per 10,000 AEs, 95%CI 3.18-3.81). When comparing exposure type, the injury rate was significantly greater during matches (3.38 per 10,000 AEs, 95% CI 3.25-3.52) compared to practices (0.82 per 10,000 AEs, 95%CI 0.77-0.88), with a 4.10-fold increase in ACL injury incidence during matches compared to practice (p<0.0001). Conclusion: Between 2004 and 2014, NCAA soccer players experienced a greater number of ACL injuries on natural grass playing surfaces compared with artificial turf playing surfaces. This difference is driven by injuries during practice, where athletes were nearly 18 times more likely to suffer an ACL injury on grass versus artificial turf. While ACL injuries were more likely during matches compared to practices, no difference in incidence was noted between playing surfaces. Additional study is warranted investigating potential causes for this observed increased risk with soccer practice on grass fields.

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