A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics

J Athl Train. Nov-Dec 2013;48(6):810-7. doi: 10.4085/1062-6050-48.6.03. Epub 2013 Oct 23.

Abstract

Background: The knee joint is the second most commonly injured body site after the ankle and the leading cause of sport-related surgeries. Knee injuries, especially of the anterior cruciate ligament (ACL), are among the most economically costly sport injuries, frequently requiring expensive surgery and rehabilitation.

Objective: To investigate the epidemiology of ACL injuries among high school athletes by sport and sex.

Design: Descriptive epidemiology study.

Main outcome measure(s): Using an Internet-based data-collection tool, Reporting Information Online (RIO), certified athletic trainers from 100 nationally representative US high schools reported athlete-exposure and injury data for athletes from 9 sports during the 2007/08-2011/12 academic years. The outcome of interest in this study was ACL injuries.

Results: During the study period, 617 ACL injuries were reported during 9 452 180 athlete exposures (AEs), for an injury rate of 6.5 per 100 000 AEs. Nationally, in the 9 sports studied, an estimated 215 628 ACL injuries occurred during the study period. The injury rate was higher in competition (17.6) than practice (2.4; rate ratio [RR] = 7.3, 95% confidence interval [CI] = 6.08, 8.68). Girls' soccer had the highest injury rate (12.2) followed by boys' football (11.1), with boys' basketball (2.3) and boys' baseball (0.7) having the lowest rates. In sex-comparable sports, girls had a higher rate (8.9) than boys (2.6; RR = 3.4, 95% CI = 2.64, 4.47). Overall, 76.6% of ACL injuries resulted in surgery. The most common mechanisms of injury were player-to-player contact (42.8%) and no contact (37.9%).

Conclusions: Anterior cruciate ligament injury rates vary by sport, sex, and type of exposure. Recognizing such differences is important when evaluating the effectiveness of evidence-based, targeted prevention efforts.

MeSH terms

  • Adolescent
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries*
  • Athletes
  • Athletic Injuries / epidemiology*
  • Female
  • Humans
  • Knee / surgery
  • Knee Injuries / epidemiology*
  • Knee Injuries / physiopathology
  • Knee Injuries / surgery
  • Knee Joint / surgery
  • Male
  • Schools
  • Sex Factors
  • Sports
  • Students