Original Article
A Meta-analysis of the Incidence of Anterior Cruciate Ligament Tears as a Function of Gender, Sport, and a Knee Injury–Reduction Regimen

https://doi.org/10.1016/j.arthro.2007.07.003Get rights and content

Purpose: The literature has shown that anterior cruciate ligament (ACL) tear rates vary by gender, by sport, and in response to injury-reduction training programs. However, there is no consensus as to the magnitudes of these tear rates or their variations as a function of these variables. For example, the female-male ACL tear ratio has been reported to be as high as 9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate accurate estimates of the true incidences of ACL tear as a function of gender, sport, and injury-reduction training. Methods: A PubMed literature search was done to identify all studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to identify additional articles. Meta-analytic principles were applied to generate ACL incidences as a function of gender, sport, and prior injury-reduction training. Results: Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67; lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08, respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03, with no gender variance. The two volleyball studies had no ACL tears. Training reduced the ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball. Conclusions: Female subjects had a roughly 3 times greater incidence of ACL tears in soccer and basketball versus male subjects. Injury-reduction programs were effective for soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear, whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender difference for ACL tear rate. Year-round female athletes who play soccer and basketball have an ACL tear rate of approximately 5%. Level of Evidence: Level IV, therapeutic case series.

Section snippets

Methods

A PubMed computerized literature search was performed to identify all English-language peer-reviewed research articles dealing with the incidence of ACL tears. A number of indexing terms were used to achieve this goal. The exact phrase “anterior cruciate ligament” with either the keyword “incidence” or “rate” was used initially. Each individual sport with the phrase “anterior cruciate ligament” was also indexed. We found 793 articles. Abstracts were then reviewed of each of these to identify

Results

In this section the sports are listed in descending order based on the number of exposures for each sport from the studies available.

Discussion

This is the only study to our knowledge that evaluates the overall relative risks of ACL tears as a function of sport, gender, and injury-reduction training. It is also the only study to use meta-analytic methods to arrive at these conclusions for all three parameters. The data analysis provides a number of interesting observations.

Before these observations are discussed, it should be pointed out that there is great variation in the number of exposures among the available studies. The largest

Conclusions

Female subjects had a roughly 3 times higher incidence of ACL tears in soccer and basketball than male subjects. Injury-reduction programs were effective for soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear, whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender difference for ACL tear rate. Year-round female soccer and

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    The authors report no conflict of interest.

    Note: To access the supplementary tables accompanying this report, visit the December issue of Arthroscopy at www.arthroscopyjournal.org.

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