1: Scand J Med Sci Sports. 2006 Oct;16(5):364-75.
Links
"Voices of the broken body." The resumption of non-professional
female players' sports careers after anterior cruciate ligament injury.
The female player's dilemma: is she willing to run the risk?
 Thing LF.
The University Hospitals Centre for Nursing and Care Research, Rigshospitalet,
Copenhagen O, Denmark.
The article takes as its starting point the lived experiences of female sports patients
in rehabilitation. The research data are semi-structured qualitative interviews (N=17)
with non-professional female players as patients, having anterior cruciate ligament
injuries (ACL-injuries). Injury narratives have been conducted, with a focus upon
how female handball players managed the injured situation. Ethnographic research
was taken in a private physiotherapy clinic over a period of more than 1 (1/2) years.
The narratives show the impact of risk management - the individual coping strategy
of the players. The handball her-player has choices to make regarding the
resumption of the career. The options and possibilities of playing or not playing after
an ACL-injury are connected to the trust in the capacity of the body. The concept of
bodily risk reflexive coping strategy is constructed to understand the question of the
resumption of the career. The individualistic self-care management indicates a
manageable body with a desire to act as worthy of being a full part of the sporting
society. This strategy is adding to the sense of accomplishment and to the continuing
development of self-identity. The study shows that there is a need for guidance in the
injury process. Playing is connected with pleasurable feelings and excitements, but
the her-player does care for the bodily self and her risk assessment is so far not a
"misuse" or a consumption of sports medicine in the name of sporting achievements.
1: Scand J Med Sci Sports. 2002 Apr;12(2):65-8.
Links
Anterior cruciate ligament injuries in young females playing soccer at
senior levels.
 Soderman K,
 Pietila T,
 Alfredson H,
 Werner S.
Department of Surgical and Perioperative Sciences, Sports Medicine Unit, Umea
University, Stockholm, Sweden.
The aim of this investigation was to study the consequences of anterior cruciate
ligament injuries in female soccer players. Special interest was focused on young
female soccer players (< 16 years) sustaining anterior cruciate ligament injuries
when playing at a senior level, which means playing together with players 19 years or
older. In Sweden, all players belonging to an organized soccer club are insured by the
same insurance company, the Folksam Insurance Company. Data of all
soccer-related knee injuries in females reported to the Folksam Insurance Company
between 1994 and 1998 were collected. A questionnaire was sent to 978 females who
were registered to have sustained a knee injury before the age of 20 years. The
response rate was 79%. Three hundred and ninety-eight female soccer players who
had sustained an anterior cruciate ligament injury before the age of 19 years were
analysed. Most of their anterior cruciate ligament injuries had been diagnosed using
arthroscopy or magnetic resonance imaging (84%). Thirty-eight percent of the
players had been injured before the age of 16 years. Of these, 39% were injured
when playing in senior teams. When playing in senior teams 59% of the players
below the age of 16 years and 44% of the players 16 years or older sustained their
ACL injuries during contact situations. At the time of this investigation (2-7 years
after the anterior cruciate ligament injury), altogether 78% (n = 311) reported that
they had stopped playing soccer. The most common reason (80%) was symptoms
from their anterior cruciate ligament-injured knee. It appears that many young
female soccer players injure their anterior cruciate ligament when playing at a senior
level. Therefore, we suggest that female soccer players under the age of 16 years
should be allowed to participate only in practice sessions but not games at a senior
level.
1: Am J Sports Med. 2005 Apr;33(4):524-30. Epub 2005 Feb
8.
Links
Anterior cruciate ligament injury in national collegiate athletic
association basketball and soccer: a 13-year review.
 Agel J,
 Arendt EA,
 Bershadsky B.
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue,
Suite R200, Minneapolis, MN 55454, USA. agelx001@umn.edu
BACKGROUND: Female collegiate athletes have been reported to have a higher rate
of anterior cruciate ligament injury compared to male collegiate athletes. This finding
has spawned a branch of research focused on understanding and preventing this
injury pattern. PURPOSE: To determine if the trends reported in 1994 have continued.
STUDY TYPE: Descriptive epidemiology study. METHODS: The National Collegiate
Athletic Association Injury Surveillance System database was reviewed for all data
relating to men's and women's basketball and soccer anterior cruciate ligament
injuries for 1990 to 2002. RESULTS: No significant difference was seen in basketball
comparing frequency of contact versus noncontact injuries between men (70.1%)
and women (75.7%). Male basketball players sustained 37 contact injuries and 78
noncontact injuries. Female basketball players sustained 100 contact injuries and
305 noncontact injuries. In soccer, there was a significant difference in frequency of
injury for male (49.6%) and female (58.3%) athletes when comparing contact and
noncontact injuries (chi2=4.1, P<.05). Male soccer players sustained 72 contact
injuries and 66 noncontact injuries. Female soccer players sustained 115 contact
injuries and 161 noncontact injuries. The magnitude of the difference in injury rates
between male and female basketball players (0.32-0.21, P=.93) remained constant,
whereas the magnitude of the difference in the rate of injuries between male and
female soccer players (0.16-0.21, P=.08) widened. Comparing injury within gender
by sport, soccer players consistently sustained more anterior cruciate ligament
injuries than did basketball players. The rate of anterior cruciate ligament injury for
male soccer players was 0.11 compared to 0.08 for male basketball players (P=.002).
The rate of anterior cruciate ligament injury for female soccer players was 0.33 and
for female basketball players was 0.29 (P=.04). The rates for all anterior cruciate
ligament injuries for women were statistically significantly higher (P<.01) than the
rates for all anterior cruciate ligament injuries for men, regardless of the sport. In
soccer, the rate of all anterior cruciate ligament injuries across the 13 years for male
soccer players significantly decreased (P=.02), whereas it remained constant for
female players. CONCLUSIONS: In this sample, the rate of anterior cruciate ligament
injury, regardless of mechanism of injury, continues to be significantly higher for
female collegiate athletes than for male collegiate athletes in both soccer and
basketball. CLINICAL RELEVANCE: Despite vast attention to the discrepancy between
anterior cruciate ligament injury rates between men and women, these differences
continue to exist in collegiate basketball and soccer players. Also demonstrated is
that although the rate of injury for women is higher than for men, the actual rate of
injury remains low and should not be a deterrent to participation in sports.
1: Arthritis Rheum. 2004 Oct;50(10):3145-52.
Links
High prevalence of knee osteoarthritis, pain, and functional
limitations in female soccer players twelve years after anterior
cruciate ligament injury.
 Lohmander LS,
 Ostenberg A,
 Englund M,
 Roos H.
Lund University, Lund, Sweden.
OBJECTIVE: To determine the prevalence of radiographic knee osteoarthritis (OA) as
well as knee-related symptoms and functional limitations in female soccer players 12
years after an anterior cruciate ligament (ACL) injury. METHODS: Female soccer
players who sustained an ACL injury 12 years earlier were examined with
standardized weight-bearing knee radiography and 2 self-administered patient
questionnaires, the Knee Injury and Osteoarthritis Outcome Score questionnaire and
the Short Form 36-item health survey. Joint space narrowing and osteophytes were
graded according to the radiographic atlas of the Osteoarthritis Research Society
International. The cutoff value to define radiographic knee OA approximated a
Kellgren/Lawrence grade of 2. RESULTS: Of the available cohort of 103 female soccer
players, 84 (82%) answered the questionnaires and 67 (65%) consented to undergo
knee radiography. The mean age at assessment was 31 years (range 26-40 years)
and mean body mass index was 23 kg/m2 (range 18-40 kg/m2). Fifty-five women
(82%) had radiographic changes in their index knee, and 34 (51%) fulfilled the
criterion for radiographic knee OA. Of the subjects answering the questionnaires, 63
(75%) reported having symptoms affecting their knee-related quality of life, and 28
(42%) were considered to have symptomatic radiographic knee OA. Slightly more
than 60% of the players had undergone reconstructive surgery of the ACL. Using
multivariate analyses, surgical reconstruction was found to have no significant
influence on knee symptoms. CONCLUSION: A very high prevalence of radiographic
knee OA, pain, and functional limitations was observed in young women who
sustained an ACL tear during soccer play 12 years earlier. These findings constitute a
strong rationale to direct increased efforts toward prevention and better treatment of
knee injury. Copyright 2004 American College of Rheumatology
1: Am J Sports Med. 1997 May-Jun;25(3):341-5.
Links
Epidemiology of anterior cruciate ligament injuries in soccer.
 Bjordal JM,
 Arnly F,
 Hannestad B,
 Strand T.
Bjordals Physical Therapy Clinic, Bergen, Norway.
We did a retrospective study of all anterior cruciate ligament injuries (972) verified
by arthroscopic evaluation at hospitals in the Hordaland region of Norway from 1982
to 1991. Our final study group comprised 176 patients who had participated in
organized soccer and answered a questionnaire. The overall incidence rate was 0.063
injuries per 1000 game hours. Men incurred 75.6% (133) of the injuries. Women had
an incidence rate of 0.10 injuries per 1000 game hours, significantly higher than that
for men (0.057). The incidence rate was higher (0.41) for men in the top three
divisions. Most of the injuries (124) occurred during games. Contact injuries from
tackling was the injury mechanism in 46.0% of the cases. Players on the offensive
team incurred 122 (69.3%) of the injuries. Reconstructive surgery was performed on
131 (74.4%) of the injured players and was found necessary for return to a high level
of play. Half of the players (87) returned to soccer; men at high levels of play had the
highest return rate (88.9%), and men over age 34 had the poorest return rate
(22.9%). Nearly one-third of the injured athletes gave up soccer because of poor
knee function or fear of new injury.
1: J Pediatr Orthop. 2004 Nov-Dec;24(6):623-8.
Links
Anterior cruciate ligament injury in pediatric and adolescent soccer
players: an analysis of insurance data.
 Shea KG,
 Pfeiffer R,
 Wang JH,
 Curtin M,
 Apel PJ.
Intermountain Orthopaedics, Boise, Idaho 83702, USA.
Injury claims from an insurance company specializing in soccer coverage were
reviewed for a 5-year period. A total of 8215 injury claims (3340 females, 4875 males)
were divided into three categories: (1) all injury, (2) knee injury, and (3) ACL injury.
Knee injuries accounted for 22% of all injuries (30% female, 16% male). ACL injury
claims represented 31% of total knee injury claims (37% female, 24% males). The
youngest ACL injury was age 5. The ratio of knee injury/all injury increased with age.
Compared with males, females demonstrated a higher ratio of knee injury/all injury
and a higher ratio of ACL injury/all injury. This study demonstrates that ACL injury
occurs in skeletally immature soccer players and that females appear to have an
increased risk of ACL injury and knee injury compared with males, even in the
skeletally immature. Future research related to ACL injury in females will need to
consider skeletally immature patients.
1: Int J Sports Med. 2006 Jan;27(1):75-9.
Links
Mechanism of anterior cruciate ligament injuries in soccer.
 Fauno P,
 Wulff Jakobsen B.
Sports Clinic, Department of Orthopedic Surgery, Arhus University Hospital,
Denmark. faunoe@stofanet.dk
One hundred and thirteen patients, consecutively admitted to our clinic with an
anterior cruciate ligament (ACL) rupture sustained while playing soccer, were
surveyed and the mechanism behind their injury analyzed. The diagnosis was made
arthroscopically or by instrumented laxity testing. The findings showed that the vast
majority of the injuries were of the non-contact type and that very few were
associated with foul play. No player positions were over- or underrepresented and
goal keepers are apparently just as prone to ACL injury as their teammates. The
findings of this study have helped our understanding of the mechanism behind ACL
injuries in soccer and could be an aid to establishing future prophylactic measures.
The findings also emphasize that certain injury mechanisms on the soccer field
should alert the physician and draw his attention to a possible ACL injury.
1: Am J Sports Med. 2005 Apr;33(4):492-501. Epub 2005 Feb
8.
Links
Comment in:
Am J Sports Med. 2005 Dec;33(12):1930; author reply 1930-1.
Biomechanical measures of neuromuscular control and valgus
loading of the knee predict anterior cruciate ligament injury risk in
female athletes: a prospective study.
 Hewett TE,
 Myer GD,
 Ford KR,
 Heidt RS Jr,
 Colosimo AJ,
 McLean SG,
 van den Bogert AJ,
 Paterno MV,
 Succop P.
Cincinnati Children's Hospital Research Foundation, Sports Medicine Biodynamics
Center, Division of Molecular Cardiovascular Biology, Cincinatti Children's Hospital
Medical Center, Cincinnati, OH 45229, USA. tim.hewett@chmcc.org
BACKGROUND: Female athletes participating in high-risk sports suffer anterior
cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes.
HYPOTHESIS: Prescreened female athletes with subsequent anterior cruciate
ligament injury will demonstrate decreased neuromuscular control and increased
valgus joint loading, predicting anterior cruciate ligament injury risk. STUDY DESIGN:
Cohort study; Level of evidence, 2. METHODS: There were 205 female athletes in the
high-risk sports of soccer, basketball, and volleyball prospectively measured for
neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads
using kinetics (joint moments) during a jump-landing task. Analysis of variance as
well as linear and logistic regression were used to isolate predictors of risk in athletes
who subsequently ruptured the anterior cruciate ligament. RESULTS: Nine athletes
had a confirmed anterior cruciate ligament rupture; these 9 had significantly different
knee posture and loading compared to the 196 who did not have anterior cruciate
ligament rupture. Knee abduction angle (P<.05) at landing was 8 degrees greater in
anterior cruciate ligament-injured than in uninjured athletes. Anterior cruciate
ligament-injured athletes had a 2.5 times greater knee abduction moment (P<.001)
and 20% higher ground reaction force (P<.05), whereas stance time was 16%
shorter; hence, increased motion, force, and moments occurred more quickly. Knee
abduction moment predicted anterior cruciate ligament injury status with 73%
specificity and 78% sensitivity; dynamic valgus measures showed a predictive r2 of
0.88. CONCLUSION: Knee motion and knee loading during a landing task are
predictors of anterior cruciate ligament injury risk in female athletes. CLINICAL
RELEVANCE: Female athletes with increased dynamic valgus and high abduction
loads are at increased risk of anterior cruciate ligament injury. The methods
developed may be used to monitor neuromuscular control of the knee joint and may
help develop simpler measures of neuromuscular control that can be used to direct
female athletes to more effective, targeted interventions.
1: Knee Surg Sports Traumatol Arthrosc. 1996;4(1):19-21.
Links
Prevention of anterior cruciate ligament injuries in soccer. A
prospective controlled study of proprioceptive training.
 Caraffa A,
 Cerulli G,
 Projetti M,
 Aisa G,
 Rizzo A.
Orthopedic Clinic R. S. Maria Hospital, University of Perugia, Terni, Italy.
Proprioceptive training has been shown to reduce the incidence of ankle sprains in
different sports. It can also improve rehabilitation after anterior cruciate ligament
(ACL) injuries whether treated operatively or nonoperatively. Since ACL injuries lead
to long absence from sports and are one of the main causes of permanent sports
disability, it is essential to try to prevent them. In a prospective controlled study of
600 soccer players in 40 semiprofessional or amateur teams, we studied the possible
preventive effect of a gradually increasing proprioceptive training on four different
types of wobble-boards during three soccer seasons. Three hundred players were
instructed to train 20 min per day with 5 different phases of increasing difficulty. The
first phase consisted of balance training without any balance board; phase 2 of
training on a rectangular balance board; phase 3 of training on a round board; phase
4 of training on a combined round and rectangular board; phase 5 of training on a
so-called BABS board. A control group of 300 players from other, comparable teams
trained "normally" and received no special balance training. Both groups were
observed for three whole soccer seasons, and possible ACL lesions were diagnosed by
clinical examination, KT-1000 measurements, magnetic resonance imaging or
computed tomography, and arthroscopy. We found an incidence of 1.15 ACL injuries
per team per year in the proprioceptively trained group (P < 0.001). Proprioceptive
training can thus significantly reduce the incidence of ACL injuries in soccer players.
1: Clin Sports Med. 1998 Oct;17(4):779-85, vii.
Mechanisms of injury of the anterior cruciate ligament in soccer
players.
Links
 Delfico AJ,
 Garrett WE Jr.
Division of Orthopaedic Surgery, Duke University Medical Center, Durham, North
Carolina, USA.
Despite the great amount of research that has been focused on the anterior cruciate
ligament in recent years, relatively little is known about the exact mechanisms that
cause these injuries. By defining the factors that contribute to these injury
mechanisms in soccer players, the authors hope to facilitate appropriate training
methods and work at preventing these serious injuries.
1: Br J Sports Med. 2006 Feb;40(2):158-62; discussion
158-62.
Links
High risk of new knee injury in elite footballers with previous anterior
cruciate ligament injury.
 Walden M,
 Hagglund M,
 Ekstrand J.
Department of Health and Society, Linkoping University, S-581 83 Linkoping,
Sweden. markus.walden@telia.com
BACKGROUND: Anterior cruciate ligament (ACL) injury is a severe event for a
footballer, but it is unclear if the knee injury rate is higher on returning to football
after ACL injury. OBJECTIVE: To study the risk of knee injury in elite footballers with
a history of ACL injury compared with those without. METHOD: The Swedish male
professional league (310 players) was studied during 2001. Players with a history of
ACL injury at the study start were identified. Exposure to football and all time loss
injuries during the season were recorded prospectively. RESULTS: Twenty four
players (8%) had a history of 28 ACL injuries in 27 knees (one rerupture). These
players had a higher incidence of new knee injury of any type than the players
without ACL injury (mean (SD) 4.2 (3.7) v 1.0 (0.7) injuries per 1000 hours, p =
0.02). The risk of suffering a knee overuse injury was significantly higher regardless
of whether the player (relative risk 4.8, 95% confidence interval 2.0 to 11.2) or the
knee (relative risk 7.9, 95% confidence interval 3.4 to 18.5) was used as the unit of
analysis. No interactive effects of age or any other anthropometric data were seen.
CONCLUSION: The risk of new knee injury, especially overuse injury, was
significantly increased on return to elite football after ACL injury regardless of
whether the player or the knee was used as the unit of analysis.
1: Am J Sports Med. 1994 Mar-Apr;22(2):219-22.
Links
The prevalence of gonarthrosis and its relation to meniscectomy in
former soccer players.
 Roos H,
 Lindberg H,
 Gardsell P,
 Lohmander LS,
 Wingstrand H.
Department of Orthopaedics, University Hospital, Lund, Sweden.
The prevalence of radiographic signs of gonarthrosis and its relation to knee injuries
were studied in 286 former soccer players--215 nonelite and 71 elite players--and
were compared with 572 age-matched controls with a mean age of 55 years. The
prevalence of gonarthrosis among the nonelite players was 4.2%, among the elite
players 15.5%, and among the controls 1.6%. Seven of the soccer players had
known anterior cruciate ligament injuries, and 40 had had meniscectomies. Of the 32
nonelite players with knee injuries, 4 (13%) had gonarthrosis, and of the 183 without
known knee injuries 5 (3%) had gonarthrosis. Among the elite players, the
prevalence of gonarthrosis in knees without diagnosed injuries was 11%. We
conclude that soccer, especially at an advanced level, is associated with an increased
risk for gonarthrosis. After excluding subjects with known knee injuries, there was no
difference between nonelite players and controls, but we found a higher rate of
gonarthrosis among the elite players.
1: Am J Sports Med. 2005 Jan;33(1):29-34.
Links
Intercondylar notch stenosis is not a risk factor for anterior cruciate
ligament tears in professional male basketball players: an 11-year
prospective study.
 Lombardo S,
 Sethi PM,
 Starkey C.
Kerlan Jobe Orthopedic Clinic, Los Angeles, California, USA.
BACKGROUND: The value of femoral notch size and the notch width index in
predicting anterior cruciate ligament injury has been debated. This study examined
the relationship between the notch width index and anterior cruciate ligament injury
in professional basketball players. HYPOTHESIS: No significant difference exists
between the notch width index of anterior cruciate ligament-injured and noninjured
professional basketball players. STUDY DESIGN: Case-control study; Level of
evidence, 3. METHODS: Using a notch view radiograph, the authors prospectively
measured the femoral notch and the condylar widths and then calculated the notch
width index of 615 male athletes who participated in the National Basketball
Association's combine workouts between 1992 and 1999. Players who participated in
at least 1 professional game were included. After an 11-year follow-up period, the
National Basketball Association's leaguewide injury database was reviewed to
identify injured players. The players were then categorized into anterior cruciate
ligament-injured or noninjured groups. Notch width, condylar width, and notch width
index were compared between the 2 groups. RESULTS: A total of 305 players were
followed for a period of up to 11 years. Anterior cruciate ligament trauma was
suffered by 14 (4.6%) of the subjects. The average notch width index was 0.235 +/0.031 for anterior cruciate ligament-injured players and 0.242 +/- 0.041 for
noninjured players (t305=-0.623, P=.534). This difference was not significantly
different. Two (3.9%) of the subjects with critical notch stenosis (notch width index
0.20) had noncontact anterior cruciate ligament injuries. CONCLUSIONS: The notch
width index did not predict the rate of anterior cruciate ligament injury. A level of
critical notch stenosis was not detected. Anterior cruciate ligament injury could not
be predicted by the absolute measurement of the femoral inter-condylar notch. Use
of a preparticipation notch view radiograph in male professional basketball players as
a predictor of anterior cruciate ligament injury is not recommended.
1: J Orthop Sports Phys Ther. 2005 Feb;35(2):52-61; discussion 61-6.
Links
Comment in:
J Orthop Sports Phys Ther. 2005 Feb;35(2):50-1.
Return to official Italian First Division soccer games within 90 days
after anterior cruciate ligament reconstruction: a case report.
 Roi GS,
 Creta D,
 Nanni G,
 Marcacci M,
 Zaffagnini S,
 Snyder-Mackler L.
Isokinetic Education and Research Department, Bologna, Italy.
gs.roi@isokinetic.com
STUDY DESIGN: Case report. BACKGROUND: To present the rehabilitative course,
decision-making, and clinical milestones that allowed a top-level professional soccer
player to return to full competitive activity 90 days after surgery. CASE
DESCRIPTION: The patient was a 35-year-old forward player who sustained an
isolated complete tear of the left anterior cruciate ligament (ACL) in the midst of the
competitive 2001-2002 season. He was in contention for a position on the Italian
World Cup Team that was to be played 135 days after his injury, only if he
demonstrated that he could return to play at the highest level before the team was
selected. The patient underwent an arthroscopically assisted ACL reconstruction with
a double-loop semitendinosus-gracilis autograft 4 days after the injury. Eight days
after surgery he began rehabilitation at a rate of 2 sessions a day, 5 days a week, plus
1 session every Saturday morning. These sessions were performed in a pool for
aquatic exercises, in a gymnasium for flexibility, coordination, and strength exercises,
and on a soccer field for recovery of technical and tactical skills, with continuous
monitoring of training intensity. OUTCOMES: The surgical technique and the
progressive rehabilitation program allowed the patient to play for 20 minutes in an
official First Division soccer game 77 days after surgery and to play a full game 90
days after surgery. Eighteen months postsurgery, the player had participated in 62
First Division matches, scoring 26 times, and had received no further treatment for
his knee. DISCUSSION: This case report suggests that early return to high-level
competition after ACL reconstruction is possible in some instances. Some factors that
may have favored the early return include optimal physical fitness before surgery, a
strong psychological determination, an isolated ACL lesion, a properly placed and
tensioned graft, a personalized progression of volume and intensity of exercise loads,
and an appropriate density of rehabilitative training consisting of a mix of gymnasium,
pool, and field exercises.
1: Am J Sports Med. 2005 Sep;33(9):1356-64. Epub 2005 Jul
7.
Links
Age and gender effects on lower extremity kinematics of youth
soccer players in a stop-jump task.
 Yu B,
 McClure SB,
 Onate JA,
 Guskiewicz KM,
 Kirkendall DT,
 Garrett WE.
Center for Human Movement Science, Division of Physical Therapy, CB# 7135
Medical School Wing E, University of North Carolina at Chapel Hill, Chapel Hill, NC
27599-7135, USA. byu@med.unc.edu
BACKGROUND: Gender differences in lower extremity motion patterns were
previously identified as a possible risk factor for non-contact anterior cruciate
ligament injuries in sports. HYPOTHESIS: Gender differences in lower extremity
kinematics in the stop-jump task are functions of age for youth soccer players
between 11 and 16 years of age. STUDY DESIGN: Descriptive laboratory study.
METHODS: Three-dimensional videographic data were collected for 30 male and 30
female adolescent soccer players between 11 and 16 years of age performing a
stop-jump task. The age effects on hip and knee joint angular motions were
compared between genders using multiple regression analyses with dummy
variables. RESULTS: Gender and age have significant interaction effects on standing
height (P = .00), body mass (P = .00), knee flexion angle at initial foot contact with
the ground (P = .00), maximum knee flexion angle (P = .00), knee valgus-varus
angle (P = .00), knee valgus-varus motion (P = .00), and hip flexion angle at initial
foot contact with the ground (P = .00). CONCLUSION: Youth female recreational
soccer players have decreased knee and hip flexion angles at initial ground contact
and decreased knee and hip flexion motions during the landing of the stop-jump task
compared to those of their male counterparts. These gender differences in knee and
hip flexion motion patterns of youth recreational soccer players occur after 12 years
of age and increase with age before 16 years. CLINICAL RELEVANCE: The results of
this study provide significant information for research on the prevention of
noncontact anterior cruciate ligament injuries.
1: Am J Sports Med. 2004 Jun;32(4):1002-12.
Links
Injury mechanisms for anterior cruciate ligament injuries in team
handball: a systematic video analysis.
 Olsen OE,
 Myklebust G,
 Engebretsen L,
 Bahr R.
Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical
Education, PO Box 4014 US, 0806 Oslo, Norway. odd-egil.olsen@nih.no
OBJECTIVE: To describe the mechanisms for anterior cruciate ligament injuries in
female team handball. STUDY DESIGN: Descriptive video analysis. METHODS:
Twenty videotapes of anterior cruciate ligament injuries from Norwegian or
international competition were collected from 12 seasons (1988-2000). Three
medical doctors and 3 national team coaches systematically analyzed these videos to
describe the injury mechanisms and playing situations. In addition, 32 anterior
cruciate ligament-injured players in the 3 upper divisions in Norwegian team
handball were interviewed during the 1998-1999 season to compare the injury
characteristics between player recall and the video analysis. RESULTS: Two main
injury mechanisms for anterior cruciate ligament injuries in team handball were
identified. The most common (12 of 20 injuries), a plant-and-cut movement,
occurred in every case with a forceful valgus and external or internal rotation with the
knee close to full extension. The other main injury mechanism (4 of 20 injuries), a
1-legged jump shot landing, occurred with a forceful valgus and external rotation
with the knee close to full extension. The results from the video analysis and
questionnaire data were similar. CONCLUSIONS: The injury mechanism for anterior
cruciate ligament injuries in female team handball appeared to be a forceful valgus
collapse with the knee close to full extension combined with external or internal
rotation of the tibia.
1: Am J Sports Med. 1989 Nov-Dec;17(6):803-7.
Links
Epidemiology and traumatology of injuries in soccer.
 Nielsen AB,
 Yde J.
Accident Analysis Center, Arhus County Hospital, Denmark.
A prospective investigation of soccer injuries among 123 players participating at
various competition levels was undertaken in a Danish soccer club. The injury
incidence during games was highest at division level (18.5/1000 hours) and lowest at
series level (11.9/1000 hours), whereas the distribution of the incidences during
practice was reversed. The youth section (16 to 18 years) had incidences that could
be compared to the highest senior level. The lower extremity was involved in 84% of
the injuries, including 34% of overuse injuries. Ankle sprains were most common
(36%) and equally found at all levels, whereas half of all overuse injuries were seen
among division players. Contact injuries during tackling occurred most often in lower
series and youths (45%). Players participating at high levels had only 30% of the
injuries during tackling and 54% during running. More than half of 20 knee injuries
were caused by tackling. Thirty-five percent of injured players were absent from
soccer for more than 1 month; 28% had complaints 12 months after the end of the
season with knee injuries the most serious. The study shows that the injury incidence,
the pattern of injury, and the traumatology varied between players participating at
different levels of soccer competition.
1: Ann Acad Med Singapore. 2004 May;33(3):298-301.
Links
Rising trend of anterior cruciate ligament injuries in females in a
regional hospital.
 Chong RW,
 Tan JL.
Medical Officer, Department of Orthopaedic Surgery, Changi General Hospital,
Singapore.
INTRODUCTION: We see a rising trend in the number of anterior cruciate ligament
(ACL) injuries in females over the past 4 years (1999 to 2002). This article seeks to
identify and examine the rising trend in the number of ACL injuries in females in our
institution over this period. MATERIALS AND METHODS: Two hundred and fifty-nine
patients with ACL reconstructions were identified and their casenotes were retrieved
from the medical records office. Of these, 13 were females. RESULTS: The number of
ACL reconstructions has increased from 9 cases to 144 cases a year from 1999 to
2002. Over this period, 13 female cases (3 in 2001 and 10 in 2002) with an age range
of 13 to 38 years were performed in our institution. Their injuries were mainly
sustained from a bad landing or during pivoting on 1 leg. There were 8 patients
(61.5 %) with prior conditioning and experience and 5 without (38.5 %). The mean
number of years of prior training was 4.4 years. Of these 8, 4 were netball players. All
were competitive players either at the school or club level and they were all playing
as goal attackers. CONCLUSION: Linear regression analysis shows a significant
increase in the number of ACL reconstructions performed for females in our
institution over this time period. Netball was a common sport in our series. This
suggests a likely relationship between netball and ACL injuries. All the patients were
playing as goal attackers. The area of court covered and frequency of jump-stop and
sudden deceleration activities could be a cause.
1: Am J Sports Med. 2004 Dec;32(8):1906-14.
Links
The effect of anterior cruciate ligament reconstruction on the risk of
knee reinjury.
 Dunn WR,
 Lyman S,
 Lincoln AE,
 Amoroso PJ,
 Wickiewicz T,
 Marx RG.
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New
York, USA.
BACKGROUND: Although there is evidence that very active, young patients are
better served with anterior cruciate ligament reconstruction, there is a lack of
objective data demonstrating that future knee injury is prevented by these
procedures. HYPOTHESIS: Anterior cruciate ligament reconstruction protects against
reinjury of the knee that would require reoperation. STUDY DESIGN: Retrospective
cohort study. METHODS: A cohort of 6576 active-duty army personnel who had been
hospitalized for anterior cruciate ligament injury from 1990 to 1996 were identified.
Using the Total Army Injury and Health Outcomes Database, the authors followed
these individuals for up to 9 years and collected clinical, demographic, and
occupational data. These data were evaluated with bivariate and multivariable
analyses to determine the effect of anterior cruciate ligament reconstruction on the
rate of knee reinjury that required operation. RESULTS: Of the 6576 study subjects,
3795 subjects (58%) underwent anterior cruciate ligament reconstruction and 2781
(42%) did not. The rate of reoperation was significantly lower among the anterior
cruciate ligament reconstruction group (4.90/100 person-years) compared with
those treated conservatively (13.86/100 person-years; P < .0001). Proportional
hazard regression analyses adjusted for age, race, sex, marital status, education,
and physical activity level confirmed that anterior cruciate ligament reconstruction
was protective against meniscal and cartilage reinjury (P < .0001). Secondary medial
meniscal injury was more common than secondary lateral meniscal injury (P < .003).
Younger age was the strongest predictor of failure of conservative management
leading to late anterior cruciate ligament reconstruction (P < .0001). CONCLUSIONS:
Anterior cruciate ligament reconstruction protected against reoperation in this young,
active population; younger subjects were more likely to require late anterior cruciate
ligament reconstruction. CLINICAL RELEVANCE: Strong consideration should be
given to anterior cruciate ligament reconstruction after anterior cruciate ligament
injury in young, active individuals.
1: Am J Sports Med. 2006 Jun;34(6):899-904. Epub 2006 Mar
27.
Links
Comparing the incidence of anterior cruciate ligament injury in
collegiate lacrosse, soccer, and basketball players: implications for
anterior cruciate ligament mechanism and prevention.
 Mihata LC,
 Beutler AI,
 Boden BP.
Department of Family Medicine, Malcolm Grow Medical Center, 1075 West Perimeter
Road, Andrews AFB, MD 20762, USA. thesportsmd@yahoo.com
BACKGROUND: Female college basketball and soccer athletes have higher rates of
anterior cruciate ligament injury than do their male counterparts. Rates of anterior
cruciate ligament injuries for women and men in collegiate lacrosse have not been
examined. Understanding anterior cruciate ligament injury patterns in lacrosse, a
full-contact sport for men and noncontact sport for women, could further injury
prevention efforts. HYPOTHESES: Female anterior cruciate ligament injury rates will
decrease over time owing to longer participation in sports. Lacrosse anterior cruciate
ligament injury rates will be lower than rates in basketball and soccer possibly owing
to beneficial biomechanics of carrying a lacrosse stick. STUDY DESIGN: Cohort study
(Prevalence); Level of evidence, 2. METHODS: Data from the National Collegiate
Athletic Association Injury Surveillance System were analyzed to compare men's and
women's anterior cruciate ligament injuries in basketball, lacrosse, and soccer over
15 years. RESULTS: Anterior cruciate ligament injury rates in women's basketball
and soccer were 0.28 and 0.32 injuries per 1000 athlete exposures, respectively, and
did not decline over the study period. In men's basketball, injury rate fluctuated
between 0.03 and 0.13 athlete exposures. Rates of anterior cruciate ligament injury
did not significantly change in men's soccer over the study period. The rate of
anterior cruciate ligament injury in men's lacrosse (0.17 athlete exposures, P < .05)
was significantly higher than in men's basketball (0.08 athlete exposures) and soccer
(0.12 athlete exposures). Injury rate in women's lacrosse (0.18 athlete exposures, P
< .05) was significantly lower than in women's basketball and soccer. CONCLUSION:
There was no discernable change in rate of anterior cruciate ligament injury in men or
women during the study period. Men's lacrosse is a high-risk sport for anterior
cruciate ligament injury. Unlike basketball and soccer, the rates of anterior cruciate
ligament injury are essentially the same in men's and women's lacrosse. The level of
allowed contact in pivoting sports may be a factor in determining sport-specific
anterior cruciate ligament risk.
1: Arthroscopy. 2004 Jul;20(6):564-71.
Links
Right and left knee laxity measurements: a prospective study of
patients with anterior cruciate ligament injuries and normal control
subjects.
 Sernert N,
 Kartus JT Jr,
 Ejerhed L,
 Karlsson J.
Department of Orthopaedics, Norra Alvsborg/Uddevalla Hospital, the Fyrbodal
Research Institute, Uddevalla, Sweden. ninni.sernert@vgregion.se
PURPOSE: The purpose of this study was to analyze and compare knee laxity in a
group of patients with a unilateral right anterior cruciate ligament (ACL) rupture and
a group of patients with a unilateral left ACL rupture. Another goal was to analyze and
compare the knee laxity of the right and left knees in a group of persons without any
known knee problems. TYPE OF STUDY: Prospective examination of the same
patients preoperatively and 2 years after the reconstruction with examination of the
healthy controls at 2 different occasions. METHODS: Group A was composed of 41
patients with a right-sided chronic ACL rupture, and group B was composed of 44
patients with a left-sided chronic ACL rupture. All patients underwent an arthroscopic
ACL reconstruction using patellar tendon autograft. Group C was composed of 35
persons without any known knee problems. One experienced physiotherapist
performed all the KT-1000 measurements and the clinical examinations. RESULTS:
Group A displayed an increased difference in side-to-side laxity between the injured
and non-injured side compared with group B in terms of both anterior and total knee
laxity. This difference was found to be statistically significant preoperatively (P =.01,
anterior; P =.001, total) and at follow-up evaluation 2 years after the index surgery
(P =.008, anterior; P =.006, total). In group C, a significant increase was seen in
absolute anterior and total laxity in the right knee compared with the left knee when
2 repeated measurements were performed (P <.0001 and P =.003, anterior; P
<.0001 and P =.001, total). CONCLUSIONS: The KT-1000 arthrometer revealed a
significant increase in laxity measurements in right knees compared with left knees.
This difference was found both preoperatively and postoperatively in patients
undergoing ACL reconstruction. The same thing was found in a group of persons
without any known knee problems. LEVEL OF EVIDENCE: Level II.
1: BMC Musculoskelet Disord. 2004 Jul
8;5:21.
Links
Magnetic resonance imaging of anterior cruciate ligament rupture.
 Tsai KJ,
 Chiang H,
 Jiang CC.
Department of Orthopaedic Surgery, Cathay General Hospital, Taipei, Taiwan.
tsaikj@ms2.hinet.net
BACKGROUND: Magnetic resonance (MR) imaging is a useful diagnostic tool for the
assessment of knee joint injury. Anterior cruciate ligament repair is a commonly
performed orthopaedic procedure. This paper examines the concordance between
MR imaging and arthroscopic findings. METHODS: Between February, 1996 and
February, 1998, 48 patients who underwent magnetic resonance (MR) imaging of the
knee were reported to have complete tears of the anterior cruciate ligament (ACL).
Of the 48 patients, 36 were male, and 12 female. The average age was 27 years
(range: 15 to 45). Operative reconstruction using a patellar bone-tendon-bone
autograft was arranged for each patient, and an arthroscopic examination was
performed to confirm the diagnosis immediately prior to reconstructive surgery.
RESULTS: In 16 of the 48 patients, reconstructive surgery was cancelled when
incomplete lesions were noted during arthroscopy, making reconstructive surgery
unnecessary. The remaining 32 patients were found to have complete tears of the
ACL, and therefore underwent reconstructive surgery. Using arthroscopy as an
independent, reliable reference standard for ACL tear diagnosis, the reliability of MR
imaging was evaluated. The true positive rate for complete ACL tear diagnosis with
MR imaging was 67%, making the possibility of a false-positive report of "complete
ACL tear" inevitable with MR imaging. CONCLUSIONS: Since conservative treatment
is sufficient for incomplete ACL tears, the decision to undertake ACL reconstruction
should not be based on MR findings alone.
1: BMC Musculoskelet Disord. 2004 Jul
8;5:21.
Magnetic resonance imaging of anterior cruciate ligament rupture.
 Tsai KJ,
 Chiang H,
 Jiang CC.
Department of Orthopaedic Surgery, Cathay General Hospital, Taipei, Taiwan.
tsaikj@ms2.hinet.net
Links
BACKGROUND: Magnetic resonance (MR) imaging is a useful diagnostic tool for the
assessment of knee joint injury. Anterior cruciate ligament repair is a commonly
performed orthopaedic procedure. This paper examines the concordance between
MR imaging and arthroscopic findings. METHODS: Between February, 1996 and
February, 1998, 48 patients who underwent magnetic resonance (MR) imaging of the
knee were reported to have complete tears of the anterior cruciate ligament (ACL).
Of the 48 patients, 36 were male, and 12 female. The average age was 27 years
(range: 15 to 45). Operative reconstruction using a patellar bone-tendon-bone
autograft was arranged for each patient, and an arthroscopic examination was
performed to confirm the diagnosis immediately prior to reconstructive surgery.
RESULTS: In 16 of the 48 patients, reconstructive surgery was cancelled when
incomplete lesions were noted during arthroscopy, making reconstructive surgery
unnecessary. The remaining 32 patients were found to have complete tears of the
ACL, and therefore underwent reconstructive surgery. Using arthroscopy as an
independent, reliable reference standard for ACL tear diagnosis, the reliability of MR
imaging was evaluated. The true positive rate for complete ACL tear diagnosis with
MR imaging was 67%, making the possibility of a false-positive report of "complete
ACL tear" inevitable with MR imaging. CONCLUSIONS: Since conservative treatment
is sufficient for incomplete ACL tears, the decision to undertake ACL reconstruction
should not be based on MR findings alone.
1: Br J Sports Med. 2006 May;40(5):451-3.
Links
Tennis specific limitations in players with an ACL deficient knee.
 Maquirriain J,
 Megey PJ.
National High Performance Training Centre (CeNARD), Argentine Tennis Association,
Pilar, Buenos Aires, Argentina. jmaquirriain@yahoo.com
BACKGROUND: Complete rupture of the anterior cruciate ligament (ACL) causes
significant alteration of knee joint kinematics. Untreated patients often develop joint
instability, chronic articular degeneration, and knee dysfunction. Demands on the
ACL produced by playing tennis have not been investigated. OBJECTIVE: To identify
subjective sport-specific limitations in tennis players with isolated unilateral ACL
deficiency. STUDY DESIGN: Prospective case-control study. METHODS: 16 players
(mean (SD) age, 39.9 (2.3) years; 14 men) with a chronic unilateral ACL deficient
knee and 16 healthy controls (38.25 (8.47) years; 14 men) were recruited. ACL
deficiency was confirmed by clinical and magnetic resonance imaging. A Lysholm
score was obtained in all patients, together with subjective evaluation of their current
tennis performance compared with pre-injury levels, applying a 0-100% visual scale.
Both groups completed a questionnaire on tennis specific abilities. RESULTS:
Lysholm scores were: 85.6 (10.3) points in the study group and 100 (0) points in the
control group (p<0.001, t test for independent samples). Injured players evaluated
their current tennis performance as 66.8 (15.2)% compared with 100% pre-injury
level (p<0.005, t test for dependent samples). Abilities affected in the ACL deficient
group were landing after a smash stroke (p<0.001); stopping abruptly and changing
(p<0.001); playing a three set singles match (p<0.05); and playing on a hard court
surface (p<0.001, Kolmogorov-Smirnov test). CONCLUSIONS: There are specific
limitations associated with complete isolated ACL rupture, including subjective tennis
performance impairment, limitations landing after a smash, stopping and changing
step direction, difficulties playing a three set singles match, and playing on hard court
surfaces.