Barriers to Predicting the Mechanisms and Risk Factors of Non-Contact Anterior Cruciate Ligament Injury

High incidences of non-contact anterior cruciate ligament (ACL) injury, frequent requirements for ACL reconstruction, and limited understanding of ACL mechanics have engendered considerable interest in quantifying the ACL loading mechanisms. Although some progress has been made to better understand non-contact ACL injuries, information on how and why non-contact ACL injuries occur is still largely unavailable. In other words, research is yet to yield consensus on injury mechanisms and risk factors. Biomechanics, video analysis, and related study approaches have elucidated to some extent how ACL injuries occur. However, these approaches are limited because they provide estimates, rather than precise measurements of knee - and more specifically ACL - kinematics at the time of injury. These study approaches are also limited in their inability to simultaneously capture many of the contributing factors to injury. This paper aims at elucidating and summarizing the key challenges that confound our understanding in predicting the mechanisms and subsequently identifying risk factors of non-contact ACL injury. This work also appraise the methodological rigor of existing study approaches, review testing protocols employed in published studies, as well as presents a possible coupled approach to better understand injury mechanisms and risk factors of non-contact ACL injury. Three comprehensive electronic databases and hand search of journal papers, covering numerous full text published English articles were utilized to find studies on the association between ACL and injury mechanisms, ACL and risk factors, as well as, ACL and investigative approaches. This review unveils that new research modalities and/or coupled research methods are required to better understand how and why the ACL gets injured. Only by achieving a better understanding of ACL loading mechanisms and the associated contributing factors, one will be able to develop robust prevention strategies and exercise regimens to mitigate non-contact ACL injuries.

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Higher risk of ACL rupture in amateur football compared to professional football: 5-year results of the ‘Anterior cruciate ligament-registry in German football’

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06737-y ◽

2021 ◽

Author(s):

Dominik Szymski ◽

Leonard Achenbach ◽

Johannes Zellner ◽

Johannes Weber ◽

Matthias Koch ◽

...

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Acl Injury ◽

Media Analysis ◽

Skill Level ◽

Targeted Prevention ◽

Professional Football ◽

Acl Injuries ◽

Anterior Cruciate

Abstract Purpose Anterior cruciate ligament (ACL) injuries are a common severe type of football injury at all levels of play. A football-specific ACL registry providing both prospective ACL injury data according to the skill level and risk factors for ACL injury is lacking in the literature. Methods This study is based on the prospective ‘ACL registry in German Football’ implemented in the 2014–15 season. Professional (1st–3rd league), semi-professional (4th–6th league) and amateur leagues (7th league) were analysed regarding the incidence and risk factors for ACL injuries. Injuries were registered according to the direct reports of the injured players to the study office and double-checked via media analysis. After injury registration, the players received a standardised questionnaire. Data were analysed from the 2014–15 to the 2018–19 football season. Results Overall, 958 ACL injuries were registered during the 5-year study period. The incidence of ACL injuries was highest in amateur football (0.074/1000 h football exposure) compared to professional (0.058/1000 h; p < 0.0001) and semi-professional football (0.043/1000 h; p < 0.0001). At all skill levels, match incidence (professional: 0.343; semi-professional: 0.249; amateur: 0.319) was significantly higher than training incidence (professional: 0.015; semi-professional: 0.004; amateur: 0.005). Major risk factors were previous ACL injury (mean: 23.3%), other knee injuries (mean: 19.3%) and move to a higher league (mean: 24.2%). Conclusion This sports-specific ACL registry provides detailed information on the incidence and risk factors for ACL injuries in football over five years. Risk factors are skill level, match exposure, move to a higher league and previous knee injury. These factors offer potential starting points for screening at-risk players and applying targeted prevention. Level of evidence II.

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Risk Factors for Anterior Cruciate Ligament Injury in Competitive Adolescent Alpine Skiers

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118766830 ◽

2018 ◽

Vol 6 (4) ◽

pp. 232596711876683 ◽

Cited By ~ 6

Author(s):

Maria Westin ◽

Marita L. Harringe ◽

Björn Engström ◽

Marie Alricsson ◽

Suzanne Werner

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Acl Injury ◽

Left Knee ◽

Alpine Skiing ◽

Acl Injuries ◽

Alpine Skiers ◽

Anterior Cruciate ◽

Reduced Risk

Background: There is a high risk for anterior cruciate ligament (ACL) injuries in alpine skiers. To reduce or try to prevent these injuries, intrinsic and extrinsic risk factors need to be identified. Purpose: To identify possible intrinsic and extrinsic ACL injury risk factors among competitive adolescent alpine skiers. Study Design: Case-control study; Level of evidence, 3. Methods: Between 2006 and 2009, a cohort of 339 alpine ski students (176 male, 163 female) from Swedish ski high schools were prospectively observed in terms of ACL injuries. First-time ACL injuries were recorded. In September, prior to each ski season, the skiers were clinically examined according to a specific knee protocol. Results: Overall, 11 male and 14 female skiers sustained a total of 25 first-episode ACL injuries. The majority of injuries occurred in the left knee ( P < .05). Skiers who had participated in alpine skiing for >13 years (hazard ratio, 0.83; 95% CI, 0.68-1.00; P < .05) had a reduced risk of sustaining an ACL injury. Eighteen ACL injuries occurred during training, 12 in the technical discipline of giant slalom, and 8 in slalom. Fourteen skiers reported not to be fatigued at all at the time of injury, and 8 skiers reported that they were somewhat fatigued. Conclusion: ACL injuries occurred more often in the left knee than the right. This should be taken into consideration in the design of ACL injury prevention programs. Those who reported a higher number of active years in alpine skiing showed a reduced risk of sustaining an ACL injury. No other factor among those studied could be identified as an independent risk factor for ACL injury.

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Treatment after anterior cruciate ligament injury: Panther Symposium ACL Treatment Consensus Group

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2020-000493 ◽

2021 ◽

pp. jisakos-2020-000493

Author(s):

Theresa Diermeier ◽

Benjamin B Rothrauff ◽

Lars Engebretsen ◽

Andrew D Lynch ◽

Eleonor Svantesson ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Operative Treatment ◽

Online Survey ◽

Cruciate Ligament ◽

Acl Injury ◽

Ligament Injury ◽

Acl Injuries ◽

Consensus Group ◽

Consensus Statements ◽

Anterior Cruciate

Treatment strategies for anterior cruciate ligament (ACL) injuries continue to evolve. Evidence supporting best practice guidelines for the management of ACL injury is to a large extent based on studies with low-level evidence. An international consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence on operative versus non-operative treatment for ACL injury.The purpose of this study was to report the consensus statements on operative versus non-operative treatment of ACL injuries developed at the ACL Consensus Meeting Panther Symposium 2019. Sixty-six international experts on the management of ACL injuries, representing 18 countries, convened and participated in a process based on the Delphi method of achieving consensus. Proposed consensus statements were drafted by the Scientific Organising Committee and Session Chairs for the three working groups. Panel participants reviewed preliminary statements prior to the meeting and provided initial agreement and comments on the statement via online survey. During the meeting, discussion and debate occurred for each statement, after which a final vote was then held. Eighty per cent agreement was defined a priori as consensus. A total of 11 of 13 statements on operative veresus non-operative treatment of ACL injury reached consensus during the symposium. Nine statements achieved unanimous support; two reached strong consensus; one did not achieve consensus; and one was removed due to redundancy in the information provided.In highly active patients engaged in jumping, cutting and pivoting sports, early anatomical anterior cruciate ligament reconstruction (ACLR) is recommended due to the high risk of secondary meniscus and cartilage injuries with delayed surgery, although a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended. For patients who seek to return to straight plane activities, non-operative treatment with structured, progressive rehabilitation is an acceptable treatment option. However, with persistent functional instability or when episodes of giving way occur, anatomical ACLR is indicated. The consensus statements derived from international leaders in the field will assist clinicians in deciding between operative and non-operative treatment with patients after an ACL injury.Level of evidence: V

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Risk Factors for Anterior Cruciate Ligament Injury: literature Review: مخاطر الإصابة بالرباط الصليبي الأمامي: مراجعة أدبية

Journal of medical and pharmaceutical sciences - مجلة العلوم الطبية و الصيدلانية ◽

10.26389/ajsrp.z181218 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Suleiman Ali Mansi

Keyword(s):

Risk Factors ◽

Anterior Cruciate Ligament ◽

Knee Joint ◽

Cruciate Ligament ◽

Acl Injury ◽

Ligament Injury ◽

Joint Stability ◽

Increased Risk ◽

Potential Risk Factors ◽

Anterior Cruciate

The Anterior cruciate ligament (ACL) plays an important role in maintaining knee-joint stability. Most ACL injures (approximately 65%) are due to a non-contact mechanism during physical activities, particularly in sports involving a landing from a jump, pivoting on the leg, rapid deceleration and cutting maneuvers. The average injury of ACL rates is still high for both professional and recreational athletes in particular between the group ages of 15 to 25 year old. The purpose of this article was to review and analysis the causes and potential risk factors for the ACL injury. Several anatomic and neuromuscular risk factors are associated with increased risk of suffering ACL injury, such as shoe-surface interaction, quadriceps angle, knee-joint laxity, genu varum of knee, and body composition. These risk factors most likely act in combination to influence the risk of ACL injury. Therefore, these factors should be considered when designing training programs, competitions, and implementing ACL injury prevention programs.

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APPROACHES TO NON-CONTACT ANTERIOR CRUCIATE LIGAMENT INJURY STUDIES: UTILITY OF OPERATIONS RESEARCH AND ARTIFICIAL INTELLIGENCE

Transactions of the Canadian Society for Mechanical Engineering ◽

10.1139/tcsme-2011-0009 ◽

2011 ◽

Vol 35 (2) ◽

pp. 145-159

Author(s):

Nicholas Ali ◽

Gholamreza Rouhi ◽

Gordon Robertson

Keyword(s):

Anterior Cruciate Ligament ◽

Operations Research ◽

Multidisciplinary Design Optimization ◽

Cruciate Ligament ◽

Acl Injury ◽

Multidisciplinary Design ◽

Ligament Injury ◽

Injury Mechanisms ◽

Anterior Cruciate ◽

Acl Injury Prevention

A multidisciplinary design optimization (MDO) approach is proposed to aid in the prediction of non-contact anterior cruciate ligament (ACL) injury mechanisms and risk factors. In this investigation the need for such an approach is argued based on an exhaustive evaluation of diverse factors that cause non-contact ACL injury, and the similarly numerous and different existing study approaches that have been carried out to investigate injury. The proposed MDO approach fuses patient data and existing study approaches via an artificial intelligent (AI) technique—absent in previous biomechanics investigations—so as to offer new insights into ACL injury prevention.

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Risk Factors Associated With a Noncontact Anterior Cruciate Ligament Injury to the Contralateral Knee After Unilateral Anterior Cruciate Ligament Injury in High School and College Female Athletes: A Prospective Study

The American Journal of Sports Medicine ◽

10.1177/0363546519886260 ◽

2019 ◽

Vol 47 (14) ◽

pp. 3347-3355

Author(s):

Annabelle P. Davey ◽

Pamela M. Vacek ◽

Ryan A. Caldwell ◽

James R. Slauterbeck ◽

Mack G. Gardner-Morse ◽

...

Keyword(s):

Risk Factors ◽

High School ◽

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Acl Injury ◽

Ligament Injury ◽

Factors Associated ◽

Younger Age ◽

Anterior Cruciate ◽

First Time

Background: The incidence of contralateral anterior cruciate ligament (CACL) injuries after recovery from a first-time anterior cruciate ligament (ACL) disruption is high in women; however, little is known about the risk factors associated with this trauma. Hypothesis: Patient characteristics, strength, anatomic alignment, and neuromuscular characteristics of the contralateral uninjured leg at the time of the first ACL trauma are associated with risk of subsequent CACL injury, and these risk factors are distinct from those for a first-time ACL injury. Study Design: Case-control study; Level of evidence, 3. Methods: Sixty-one women who suffered a first-time noncontact ACL injury while participating in high school or college sports and underwent measurement of potential risk factors on their contralateral limb soon after the initial ACL injury and before reconstruction were followed until either a CACL injury or an ACL graft injury occurred, or until the last date of contact. Results: Follow-up information was available for 55 (90.0%) of the 61 athletes and 11 (20.0%) suffered a CACL injury. Younger age, decreased participation in sport before the first ACL disruption, decreased anterior stiffness of the contralateral knee, and increased hip anteversion were associated with increases in the risk of suffering a CACL injury. Conclusion: A portion of CACL injury risk factors were modifiable (time spent participating in sport and increasing anterior knee stiffness with bracing), while others were nonmodifiable (younger age and increased hip anteversion). The relationship between younger age at the time of an initial ACL injury and increased risk of subsequent CACL trauma may be explained by younger athletes having more years available to be exposed to at-risk activities compared with older athletes. A decrease of anterior stiffness of the knee is linked to decreased material properties and width of the ACL, and this may explain why some women are predisposed to bilateral ACL trauma while others only suffer the index injury. The risk factors for CACL injury are unique to women who suffer bilateral ACL trauma compared with those who suffer unilateral ACL trauma. This information is important for the identification of athletes who may benefit from risk reduction interventions.

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Mechanisms of Noncontact Anterior Cruciate Ligament Injury

Journal of Athletic Training ◽

10.4085/1062-6050-43.4.396 ◽

2008 ◽

Vol 43 (4) ◽

pp. 396-408 ◽

Cited By ~ 223

Author(s):

Yohei Shimokochi ◽

Sandra J. Shultz

Keyword(s):

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Injury ◽

Observational Studies ◽

External Rotation ◽

Cruciate Ligament ◽

Acl Injury ◽

Ligament Injury ◽

Injury Mechanisms ◽

Loading Patterns ◽

Anterior Cruciate

Abstract Objective: To examine and summarize previous retrospective and observational studies assessing noncontact anterior cruciate ligament (ACL) injury mechanisms and to examine such reported ACL injury mechanisms based on ACL loading patterns due to knee loadings reported in in vivo, in vitro, and computer simulation studies. Data Sources: We searched MEDLINE from 1950 through 2007 using the key words anterior cruciate ligament + injury + mechanisms; anterior cruciate ligament + injury + mechanisms + retrospective; and anterior cruciate ligament + injury + mechanisms + video analysis. Study Selection: We selected retrospective studies and observational studies that specifically examined the noncontact ACL injury mechanisms (n = 7) and assessed ACL loading patterns in vivo, in vitro, and using computer simulations (n = 33). Data Extraction: The motion patterns reported as noncontact ACL injury mechanisms in retrospective and observational studies were assessed and critically compared with ACL loading patterns measured during applied external or internal (or both) forces or moments to the knee. Data Synthesis: Noncontact ACL injuries are likely to happen during deceleration and acceleration motions with excessive quadriceps contraction and reduced hamstrings co-contraction at or near full knee extension. Higher ACL loading during the application of a quadriceps force when combined with a knee internal rotation moment compared with an external rotation moment was noted. The ACL loading was also higher when a valgus load was combined with internal rotation as compared with external rotation. However, because the combination of knee valgus and external rotation motions may lead to ACL impingement, these combined motions cannot be excluded from the noncontact ACL injury mechanisms. Further, excessive valgus knee loads applied during weight-bearing, decelerating activities also increased ACL loading. Conclusions: The findings from this review lend support to ACL injury prevention programs designed to prevent unopposed excessive quadriceps force and frontal-plane or transverse-plane (or both) moments to the knee and to encourage increased knee flexion angle during sudden deceleration and acceleration tasks.

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Ball heading and subclinical concussion in soccer as a risk factor for anterior cruciate ligament injury

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02711-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

George Kakavas ◽

Nikolaos Malliaropoulos ◽

Wieslaw Blach ◽

Georgios Bikos ◽

Filippo Migliorini ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Cruciate Ligament ◽

Neuromuscular Control ◽

Acl Injury ◽

Soccer Players ◽

Ligament Injury ◽

Neurocognitive Performance ◽

Acl Injuries ◽

Anterior Cruciate ◽

The Impact

AbstractSoccer players have a high risk of anterior cruciate ligament (ACL) injury, a potentially career-ending event. ACL rupture has been linked with abnormal neuromuscular control in the lower limb. Additionally, heading the ball with the unprotected head during game play is increasingly recognized as a major source of exposure to concussive and sub-concussive repetitive head impacts. This article provides a hypothesis of potential connection of ACL injury with ball heading in soccer players. The study reviews literature sources regarding the impact of neurocognitive alterations after ball headings in ACL injuries. Poor baseline neurocognitive performance or impairments in neurocognitive performance via sleep deprivation, psychological stress, or concussion can increase the risk for subsequent musculoskeletal injury.

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Awareness of Anterior Cruciate Ligament Injury-Preventive Training Programs Among Female Collegiate Athletes

Journal of Athletic Training ◽

10.4085/1062-6050-150-19 ◽

2020 ◽

Vol 55 (4) ◽

pp. 359-364

Author(s):

Miho J. Tanaka ◽

Lynne C. Jones ◽

Jared M. Forman

Keyword(s):

Anterior Cruciate Ligament ◽

Female Athletes ◽

Training Programs ◽

Cruciate Ligament ◽

Collegiate Athletes ◽

Acl Injury ◽

Ligament Injury ◽

Acl Injuries ◽

Female Collegiate Athletes ◽

Anterior Cruciate

Context Neuromuscular training programs can reduce the rate of noncontact anterior cruciate ligament (ACL) injuries, particularly in female athletes. Objective To assess the awareness of, experience with, and factors associated with participation in preventive training programs (PTPs) among female collegiate athletes and their knowledge of ACL injuries. Design Cross-sectional study. Setting National Collegiate Athletic Association (NCAA) sports programs. Patients or Other Participants A total of 440 female NCAA athletes (age = 20 ± 1 years) representing 20 sports during the 2017–2018 academic year. Main Outcome Measure(s) We used a 12-item survey to collect data on each participant's age, sport, position, college, NCAA division, and awareness of and experience with PTPs. We performed descriptive statistics and used odds ratios (ORs) to assess relationships between demographic data and awareness of or interest in PTPs. Results Of the 440 respondents, 85% (n = 373) knew that female athletes were at higher risk for sustaining ACL injuries than male athletes, and 89% (n = 391) knew that ACL injuries were preventable. Thirty-three percent (n = 143) were familiar with the concept of ACL PTPs. Only 15% (n = 64) had ever performed PTPs, but 89% (n = 391) reported they would perform a daily PTP if it could prevent ACL injuries. Fifty-two of the 64 respondents (81%) who had performed PTPs said athletic trainers or coaches oversaw the PTPs. Participants were more likely to be familiar with ACL PTPs if they (OR = 3.5; 95% confidence interval [CI] = 2.0, 5.8) or a teammate (OR = 4.6; 95% CI = 2.1, 9.8) had sustained an ACL injury. Respondents were more willing to perform PTPs if they (OR = 2.3; 95% CI = 0.80, 6.6) or a teammate (OR = 3.4; 95% CI = 1.8, 6.6) had sustained an ACL injury. Conclusions Although 89% of respondents expressed interest in performing daily ACL PTPs, only 15% had performed such programs, and only 33% were familiar with the concept of ACL PTPs.

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