Increased risk of ACL reconstruction found among adolescents in level I sports

Injury prevention training should be prioritized to reduce the risk of ACL injury, reconstruction.

Adolescents who participate in both level I sports and in sport competitions had a significantly increased risk of undergoing primary ACL reconstruction, according to study results.

“Even though we are well-aware of the health benefits of engaging in physical activity for children and adolescents, we should be aware of the high risk of musculoskeletal injuries, especially in level I sports (soccer, handball),” Marianne Brakke Johnsen, MSc, of the Communication and Research Unit for Musculoskeletal Disorders at Oslo University Hospital and faculty of medicine at the University of Oslo, in Norway, told Orthopedics Today.

Johnsen and colleagues prospectively followed 7,644 adolescents (3,808 boys and 3,836 girls) who were included in the Young-Nord-Trøndelag Health Study from 2006 to 2008. Level of sport participation and sport competitions were included as main risk factors of interest and the endpoint was primary ACL reconstruction recorded in the Norwegian National Knee Ligament Registry between January 2006 and December 2013.

ACL reconstructions identified

Results showed an overall incidence of 38.9 per 100,000 person-years, with 69 ACL reconstructions identified with a median follow-up of 7.3 years. Researchers noted level I sports had an ACL reconstruction incidence rate over 3 times higher than level II or level III sports, which was also seen in sex-stratified and age-adjusted analyses. However, the increased risk of ACL reconstruction associated with level I sports was only statistically significant for girls.

Compared with adolescents who did not compete in sports, the patients who participated in sport competitions had a 4-times higher incidence of ACL reconstruction. Adjusted analyses showed there was a statistically significant increase in risk of ACL reconstruction in girls and boys.

“The findings were not surprising, as high risk of ACL injury and ACL reconstruction have been associated with level I sports in previous studies and the difference in incidence of ACL reconstruction between boys and girls,” Johnsen said. “However, we were a little surprised the findings were also clear in a population-based cohort of adolescents, as previous studies predominantly have been performed on athlete populations.”

Injury prevention training

According to Johnsen, it is important that injury prevention programs be prioritized among adolescents to reduce the risk of ACL injury and ACL reconstruction. Beyond that, coaches, parents and team leaders should be informed about the risk factors for injury so they are aware of what to look for in adolescent athletes.

“The injury prevention training can be part of the warm-up routine and can, in addition to preventing injury, be beneficial for performance in general,” Johnsen said. – by Casey Tingle

Reference:

Johnsen MB, et al. Am J Sports Med. 2016;doi:10.1177/0363546516643807.

For more information:

Marianne Bakke Johnsen, MSc, can be reached at Communication and Research Unit for Musculoskeletal Disorders, Oslo University Hospital, Building 37, PO Box 4956, Nydalen, Oslo 0424, Norway; email: m.b.johnsen@medisin.uio.no.

Disclosure: Johnsen reports the study was supported by a grant from the Norwegian Fund for Postgraduate Training in Physiotherapy.