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      The incidence of paediatric ACL injury is increasing in Finland

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          Abstract

          Purpose

          Anterior cruciate ligament (ACL) injury is a common knee injury in paediatric and adolescent patients. The population-based incidence of paediatric ACL injury is, however, unknown. Recent studies suggest increased ACL injury rates among adolescents, especially in active, sports-participating population. The purpose of this study was to investigate the population-based incidence rates of ACL injuries and trends in paediatric ACL reconstruction surgery.

          Method

          All ACL injuries were identified (ICD-10 diagnosis code S83.5) leading to hospitalisation or surgery using validated Finnish National Hospital Discharge Register (NHDR) data from 1997 to 2014. The sample comprised 19,961,205 Finnish residents aged less than 18 years at the time of injury. Hospital admissions with the diagnosis code S83.5 were analysed more thoroughly including, sex, age and the need for surgical interventions.

          Results

          During the 18-year study period, 4725 subjects of the study population had sustained an ACL injury. The total ACL injury incidence in study population was 23.3 per 100,000 person-years. The median age of the patients at the time of injury was 16 years (range 4–17). The incidence of ACL injury increased with age, and the highest incidence was observed among 17-year old (113.5 per 100,000 person-years). Incidence rate did not differ between genders. From the total ACL injury population of 4725 hospitalisations, 3168 (67.0%) underwent ACL reconstruction, of which 2988 (94.3%) were treated with arthroscopic reconstruction and 180 (5.6%) with open surgery. In addition, 1557 (33.0%) were treated non-operatively without ACL reconstruction. The annual incidence of ACL injuries in the Finnish paediatric population has increased during the past 15 years. The lowest incidence rate was seen in 1999 (incidence of 17.7 per 100,000 person-years, 195 ACL injuries) and the highest in 2011 (incidence of 31.5 per 100,000 person-years, 346 ACL injuries). The highest increase in ACL injuries was seen in girls aged 13–15 years, with an increase of 143%.

          Conclusion

          ACL injury is not a negligible knee injury in the paediatric population. The incidence of paediatric ACL injury has increased during the past 15 years. Moreover, a twofold increase in incidence of paediatric ACL injury was noted during the last 10 years of the study period. Incidence rates among male and female paediatric patients were comparable.

          Level of evidence

          III.

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          Most cited references20

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          A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen.

          Chadwick C. Prodromos, Yung Han, Julie Rogowski … (2007)
          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. 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. 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. 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 IV, therapeutic case series.
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            Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature.

            E Arendt, R. Dick (1995)
            Women's participation in intercollegiate athletics has increased dramatically in recent years. Greater participation has increased awareness of health and medical issues specific to the female athlete. Some reports have noted a higher susceptibility to knee injury, specifically injuries to the anterior cruciate ligament, in female athletes as compared with their male counterparts. We performed a 5-year evaluation of anterior cruciate ligament injuries in collegiate men's and women's soccer and basketball programs using the National College Athletic Association Injury Surveillance System. Results showed significantly higher anterior cruciate ligament injury rates in both female sports compared with the male sports. Noncontact mechanisms were the primary cause of anterior cruciate ligament injury in both female sports. Possible causative factors for this increase in anterior cruciate ligament injuries among women may be extrinsic (body movement, muscular strength, shoe-surface interface, and skill level) or intrinsic (joint laxity, limb alignment, notch dimensions, and ligament size).
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              Mechanisms of non-contact ACL injuries.

              Pamela W Garrett, Bing Yu (2007)
              In soccer one of the most common knee injuries is the anterior cruciate ligament (ACL) tear, which usually occurs through non-contact mechanisms. Female soccer players are at higher risk of sustaining non-contact ACL injuries than male soccer players. A good understanding of ACL loading mechanisms is the basis for a good understanding of the mechanisms of non-contact ACL injuries, which in turn is essential for identifying risk factors and developing prevention strategies. Current literature demonstrates that sagittal plane biomechanical factors, such as small knee flexion angle, great posterior ground reaction force and great quadriceps muscle force, are the major ACL loading mechanisms. A great posterior ground reaction force may be associated with a great quadriceps muscle force, which would cause great anterior draw force at the knee. A small knee flexion is associated with a large patella tendon-tibia shaft angle and ACL elevation angle, which would result in great ACL loading. Current literature also demonstrates that the ACL is not the major structure of bearing knee valgus-varus moment and internal-external rotation loadings. Knee valgus-varus moment and internal-external rotation moment alone are not likely to result in isolated ACL injuries without injuring other knee structures.
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                Author and article information

                Contributors
                Frederick K. Weitz:
                ORCID: http://orcid.org/0000-0003-0024-0947
                frederick.weitz@fimnet.fi
                Journal
                Journal ID (nlm-ta): Knee Surg Sports Traumatol Arthrosc
                Journal ID (iso-abbrev): Knee Surg Sports Traumatol Arthrosc
                Title: Knee Surgery, Sports Traumatology, Arthroscopy
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0942-2056
                ISSN (Electronic): 1433-7347
                Publication date (Electronic): 20 June 2019
                Publication date PMC-release: 20 June 2019
                Publication date (Print): 2020
                Volume: 28
                Issue: 2
                Pages: 363-368
                Affiliations
                [1 ]GRID grid.502801.e, ISNI 0000 0001 2314 6254, Department of Paediatric Surgery, , University of Tampere, ; Teiskontie 35, 33521 Tampere, Finland
                [2 ]Pihlajalinna Koskisairaala Hospital, Hatanpään Valtatie 1, 33100 Tampere, Finland
                [3 ]GRID grid.502801.e, ISNI 0000 0001 2314 6254, Department of Orthopaedic Surgery, , University of Tampere, ; Teiskontie 35, 33521 Tampere, Finland
                Author information
                http://orcid.org/0000-0003-0024-0947
                Article
                Publisher ID: 5553
                DOI: 10.1007/s00167-019-05553-9
                PMC ID: 6994437
                PubMed ID: 31222395
                SO-VID: 3d668ff4-6b6f-4241-956b-f40342c4a1b1
                Copyright © © The Author(s) 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 15 August 2018
                Date accepted : 5 June 2019
                Categories
                Subject: Knee
                Custom metadata
                issue-copyright-statement © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020

                ScienceOpen disciplines: Surgery
                Keywords: paediatric acl rupture,adolescent acl rupture
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: paediatric acl rupture, adolescent acl rupture

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