ACL Injury Patterns Among Collegiate Men and Women
Abstract & commentary
Synopsis: Female collegiate athletes participating in basketball or soccer tear their ACLs at significantly higher rates than males involved in the same sports. No distinct intrinsic and extrinsic factors can be attributed to this difference in injury rates.
Source: Arendt EG, et al. Anterior cruciate injury patterns among college collegiate men and women. J Athletic Training 1999;34:86-92.
Arendt and colleagues present an outstanding review and thoughtful study evaluating the increased anterior cruciate ligament (ACL) injury rate in female collegiate athletes as compared to male athletes in the sports of soccer and basketball. In an earlier paper,1 they used the NCAA Injury Surveillance System (ISS) to evaluate knee injury patterns and occurrences from 1989 to 1993. In that original study, Arendt et al noted the ACL injury rate in women’s soccer (0.3%) was more than double that of the men (0.13%). Interestingly, in the women’s injuries, no apparent contact was the primary mechanism (63%) as compared to player contact (37%). In men’s soccer games, the reverse was noted, in which 52% of ACL tears involved player contact and 48% of the tears involved no contact. In NCAA basketball, Arendt et al found a similar difference such that the women’s ACL injury rate was more than four times that of men.
The current paper is a follow-up study from 1994 to 1998 using similar NCAA ISS data in an attempt to evaluate whether training or exposure to the sport possibly was involved in the increased incidence of ACL injury in the female athlete. Arendt et al found continued similar injury rates that were increased both in women’s basketball and women’s soccer as compared to men’s basketball and soccer. In this second five-year period, they also investigated women’s volleyball, which had a significantly lower ACL injury rate than women’s basketball. Arendt et al also report on a pilot study that looked at the participants’ athletic profiles to try to evaluate extrinsic or intrinsic causes for the increased ACL tear in basketball and soccer.2 Interestingly, females were more likely to be injured just before or after their menses and not in midcycle.3 No other factors were identified concerning mechanism injury, health, sports participation, treatment, or physical attributes.
Comment by Robert C. Schenck, Jr., MD
Increased ACL injury rates in the female athletic population in collegiate sports such as basketball have been documented by several authors. Many hypotheses have been proposed in an attempt to explain this difference from men. Most commonly the authors describe mechanical differences between the female knee and lower extremity alignment: increased knee valgus, increased tibial external rotation, and differences in femoral notch width and ACL diameter. Nonetheless, no author has been able to elucidate the exact cause of this increased rate and, in all likelihood, as Arendt et al note, it is multifactorial.
This descriptive report allows us an in-depth view of injury rates in NCAA female and male same-sport athletes. It should be used to understand the differences in collegiate athletic injuries. Education of our athletes, coaches, and parents continues to be lacking with regard to the patterns of ligament injury and this education should be improved. Recently other authors have attempted to prospectively identify factors related to this increased injury rate, such as menstrual cycle and jump training. Our next step in orthopedic sports medicine is to identify causes and make attempts to decrease these injuries using preventive measures.
References
1. Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 1995; 23:694-701.
2. Ireland ML, Wall C. Epidemiology comparison of injuries of collegiate male and female US basketball athletes (abstract). Med Sci Sports Exerc 1990;22:S82.
3. Wojtys EM, et al. Association between the menstrual cycle and anterior cruciate ligament injuries in female athletes. Am J Sports Med 1998;26:614-619.
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