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.

Femoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy Individuals

2021 ◽  
pp. 036354652110504
Author(s):  
Grégoire Micicoi ◽  
Chistophe Jacquet ◽  
Raghbir Khakha ◽  
Sally LiArno ◽  
Ahmad Faizan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Reference Population ◽  
Acl Injuries ◽  
Notch Width ◽  
Injury Risk Factor ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are multifactorial events that may be influenced by morphometric parameters. Associations between primary ACL injuries or graft ruptures and both femoral and tibial bony risk factors have been well described in the literature. Purpose: To determine values of femoral and tibial bony morphology that have been associated with ACL injuries in a reference population. Further, to define interindividual variations according to participant demographics and to identify the proportion of participants presenting at least 1 morphological ACL injury risk factor. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography scans of 382 healthy participants were examined. The following bony ACL risk factors were analyzed: notch width index (NWI), lateral femoral condylar index (LFCI), medial posterior plateau tibial angle (MPPTA), and lateral posterior plateau tibial angle (LPPTA). The proportion of this healthy population presenting with at least 1 pathological ACL injury risk factor was determined. A multivariable logistic regression model was constructed to determine the influence of demographic characteristics. Results: According to published thresholds for ACL bony risk factors, 12% of the examined knees exhibited an intercondylar notch width <18.9 mm, 25% had NWI <0.292, 62% exhibited LFCI <0.67, 54% had MPPTA <83.6°, and 15% had LPPTA <81.6°. Only 14.4% of participants exhibited no ACL bony risk factors, whereas 84.5% had between 2 and 4 bony risk factors and 1.1% had all bony risk factors. The multivariate analysis demonstrated that only the intercondylar notch width ( P < .0001) was an independent predictor according to both sex and ethnicity; the LFCI ( P = .012) and MMPTA ( P = .02) were independent predictors according to ethnicity. Conclusion: The precise definition of bony anatomic risk factors for ACL injury remains unclear. Based on published thresholds, 15% to 62% of this reference population would have been considered as being at risk. Large cohort analyses are required to confirm the validity of previously described morphological risk factors and to define which participants may be at risk of primary ACL injury and reinjury after surgical reconstruction.

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

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.

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

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876683 ◽  
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.

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.

scholarly journals First-time anterior cruciate ligament injury in adolescent female elite athletes: a prospective cohort study to identify modifiable risk factors

2021 ◽  
Author(s):  
M. K. Zebis ◽  
P. Aagaard ◽  
L. L. Andersen ◽  
P. Hölmich ◽  
M. B. Clausen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Adolescent Female ◽  
Acl Injuries ◽  
Team Handball ◽  
Acl Injury Risk ◽  
Anterior Cruciate ◽  
First Time

Abstract Purpose To identify modifiable biomechanical and neuromuscular anterior cruciate ligament (ACL) injury risk factors for first-time ACL injury in adolescent female elite football and team handball players. Methods Adolescent female elite football and handball players with no previous ACL injury participated in the present study. At baseline, players were tested during side-cutting manoeuvres performed in a 3-dimensional motion analysis laboratory with concomitant electromyography (EMG) measurements. Maximal isometric lower limb muscle strength was assessed by handheld dynamometry. Players were prospectively followed for 2 years after baseline testing, and all magnetic resonance imaging (MRI) verified ACL injuries were registered. The effect of 16 risk factor candidates on the relative risk (RR) of ACL injury was estimated using Poisson regression analysis. Results Ninety players (age 16.9 ± 1.2 years) were included in the analyses. Nine first-time ACL injuries (injury incidence 10.0% (95% confidence interval (CI) 5.4–18.6%)) were registered during the 2-year follow-up period. Four risk factor candidates were significantly associated with the risk of ACL injury: (1) hip flexion angle at initial contact (IC) [RR 0.56, 95% confidence interval (CI) 0.34–0.92], (2) internal knee rotation angle at IC [RR 1.13, 95% CI 1.08–1.19], (3) semitendinosus EMG activity 50 ms prior to IC [RR: 0.62, 95% CI 0.43–0.89], and (4) external hip rotator strength [RR: 0.77, 95% CI 0.66–0.89]. Conclusion Four distinct ACL injury risk factors related to the side-cutting manoeuvre were identified in a population of adolescent female elite football and team handball players with no previous ACL injury. As ACL injury typically occur during side-cutting, intervention programmes to modify these risk factors pose a promising strategy for ACL injury prevention in adolescent female elite football and team handball. Level of evidence II.

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.

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

2010 ◽  
Vol 4 (1) ◽  
pp. 178-189 ◽  
Author(s):  
Nicholas Ali ◽  
Gholamreza Rouhi
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Ligament Injury ◽  
Contributing Factors ◽  
Acl Injuries ◽  
Hand Search ◽  
Injury Mechanisms ◽  
Anterior Cruciate

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.

Examining the Dynamic Nature of Anterior Cruciate Ligament Injury Risk Factors in Women’s Collegiate Soccer

2021 ◽  
pp. 1-8
Author(s):  
Elena M. D’Argenio ◽  
Timothy G. Eckard ◽  
Barnett S. Frank ◽  
William E. Prentice ◽  
Darin A. Padua
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Range Of Motion ◽  
Injury Risk ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Dynamic Risk Factors ◽  
Dynamic Risk ◽  
Anterior Cruciate

Context: Anterior cruciate ligament (ACL) injuries are a common and devastating injury in women’s soccer. Several risk factors for ACL injury have been identified, but have not yet been examined as potentially dynamic risk factors, which may change throughout a collegiate soccer season. Design: Prospective cohort study. Methods: Nine common clinical screening assessments for ACL injury risk, consisting of range of motion, movement quality, and power, were assessed in 29 Division I collegiate women’s soccer players. Preseason and midseason values were compared for significant differences. Change scores for each risk factor were also correlated with cumulative training loads during the first 10 weeks of a competitive soccer season. Results: Hip external rotation range of motion and power had statistically significant and meaningful differences at midseason compared with preseason, indicating they are dynamic risk factors. There were no significant associations between the observed risk factor changes and cumulative training load. Conclusions: Hip external rotation range of motion and power are dynamic risk factors for ACL injury in women’s collegiate soccer athletes. Serial screening of these risk factors may elucidate stronger associations with injury risk and improve prognostic accuracy of screening tools.

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

2018 ◽  
Vol 47 (1) ◽  
pp. 52-58 ◽  
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.

scholarly journals Longitudinal Assessment of Noncontact Anterior Cruciate Ligament Injury Risk Factors During Maturation in a Female Athlete: A Case Report

2009 ◽  
Vol 44 (1) ◽  
pp. 101-109 ◽  
Author(s):  
Gregory D. Myer ◽  
Kevin R. Ford ◽  
Jon G. Divine ◽  
Eric J. Wall ◽  
Leamor Kahanov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Anterior Cruciate Ligament ◽  
Body Mass ◽  
Female Athlete ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Knee Abduction ◽  
Injury Risk Factors ◽  
Anterior Cruciate

Abstract Objective: To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury. Background: In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured. Differential Diagnosis: Partial or complete tear of the ACL. Measurements: The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort. Findings: The injury occurred in the year after the third assessment during the athlete's club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth. Conclusions: During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury.

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