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ACL reconstruction may yield higher rate of ACL injuries in female soccer players
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Results published in The American Journal of Sports Medicine showed a higher rate of new ACL injuries and other new knee injuries among female soccer players who underwent ACL reconstruction compared with knee-healthy controls.
Researchers matched 117 active female soccer players who had undergone ACL reconstruction with 119 knee-healthy female soccer players from the same teams. Researchers had players answer a web-based questionnaire that addressed players’ participation in soccer, new acute-onset or nontraumatic injuries to either knee or injury to other body locations six times during the 2-year follow-up. Researchers graded current activity level according to the Tegner Activity Scale at baseline and 2-year follow-up.
Results showed an almost fivefold higher incidence of new ACL injuries and a seven-times higher incidence of knee injury treated with surgery among players who underwent ACL reconstruction compared with controls. During the 2-year follow-up, researchers found 62% of players who underwent ACL reconstruction quit soccer vs. 36% of patients in the control group. Greater satisfaction with knee function was found among the control group at baseline and follow-up, according to results. Researchers noted no differences in the rate of other injuries between the two groups.
“Our results point to an unacceptably high rate of new traumatic and nontraumatic knee injuries among female soccer players with [ACL reconstruction] ACLR,” the authors wrote. “High-quality research is required to identify which factors increase or decrease the risk for sustaining additional knee injuries. This information may subsequently help to inform the development and implementation of injury prevention strategies.” – by Casey Tingle
Disclosure: The study was supported financially by Futurum – the Academy for Healthcare, Region Jönköping County, the Medical Research Council of Southeast Sweden, the Faculty of Health Sciences at Linköping University, The Swedish Research Council for Sport Science and the Swedish Football Association.
Perspective
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Nathan D. Schilaty, PhD
This study from the Swedish National Knee Ligament Register is a powerful epidemiological study that confirms the high risk of female athletes for ACL injury. A demonstration of a five-fold higher risk for second ACL injury is reported among female soccer players compared to non-injured controls, consistent with previous reports. In addition, this study reports 25% second ACL injury incidence. This is consistent with previous reports with a high incidence of second injury among athletes from various worldwide populations, with estimates of second injury (up to 35%) higher in young athletes within 2 years of return to sport. Further, this study reports the risk of other knee injuries is high for females who have sustained an ACL injury.
Recent meta-analyses have determined 1) injury prevention training programs can reduce the incidence of ACL injury in females by 67%; and 2) current return to sport criteria do not decrease the risk of subsequent ACL injury. Consequently, these meta-analyses, coupled with the results reported in this article, highlight the importance of research of individualized rehabilitation, improved neuromuscular control, biomechanical screening and adequate healing time (minimum of 9 months) prior to return to sport.
References:
Webster KE, et al. J Orthop Res. 2018;doi:10.1002/jor.24043.
Webster KE, et al. Sports Med. 2019;doi:10.1007/s40279-019-01093-x.
Assistant professor of physiology
Rochester, Minnesota
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