Assessment of neuromuscular risk factors for anterior cruciate ligament injury through tensiomyography in male soccer players

The mechanism underlying gender disparity in anterior cruciate ligament injury risk is likely multifactorial in nature. Several theories have been proposed to explain the mechanisms underlying the gender difference in anterior cruciate ligament injury rates. These theories include the intrinsic variables of anatomical, hormonal, neuromuscular, and biomechanical differences between genders and extrinsic variables. Identification of both extrinsic and intrinsic risk factors associated with the anterior cruciate ligament injury mechanism may provide direction for targeted prophylactic treatment to high-risk individuals.

The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.

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. To determine if the trends reported in 1994 have continued. Descriptive epidemiology study. 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. 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. 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. 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.