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

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 parti...

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Bibliographic Details
Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2022-04, Vol.30 (4), p.1341-1351
Main Authors: Zebis, M. K., Aagaard, P., Andersen, L. L., Hölmich, P., Clausen, M. B., Brandt, M., Husted, R. S., Lauridsen, H. B., Curtis, D. J., Bencke, J.
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Anterior cruciate ligament
Anterior Cruciate Ligament Injuries - epidemiology
Athletes
Athletic Injuries - epidemiology
Biomechanics
Cohort analysis
Confidence intervals
Contact angle
Cutting
Dimensional analysis
Electromyography
Female
Females
Football
Football - injuries
Health risks
Hip
Humans
Injuries
Injury analysis
Injury prevention
Joint and ligament injuries
Knee
Ligaments
Magnetic resonance imaging
Medicine
Medicine & Public Health
Muscle contraction
Muscle strength
Orthopedics
Players
Prospective Studies
Regression analysis
Risk analysis
Risk Factors
Sports injuries
Sports Medicine
Statistical analysis
Team handball
Three dimensional motion
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Summary: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.
ISSN:0942-2056
1433-7347
DOI:10.1007/s00167-021-06595-8