Anterior Cruciate Ligament Injury Incidence Across Sex, Sport, and Competition Level: A Systematic Review and Meta-Analysis
Despite the efficacy of injury prevention programs, ACL injury rates have remained steady, which may be due to limited knowledge of which groups/athletes are greatest at risk of sustaining an ACL injury. The purpose of our study was to characterize ACL injury rate (IR) across sports, sex, and levels of play to identify high-risk groups per season. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched electronic databases of PubMed and EBSCohost. Inclusion criteria required that studies noted level of play, number of ACL injuries, and total number of athletes. We excluded studies if the injury was a secondary one, the total population was unclear or noted only cases of reconstruction. We extracted data on sport, sex, level of play, number of ACL injuries, and total number of athletes. The electronic literature search yielded 9469 studies for initial review, and at the end of the search, a total of 89 studies were included in our meta-analysis. The highest risk sports were female semi-pro handball (IR=0.045/athlete-year), female professional basketball (IR=0.027/athlete-year), and female professional alpine skiing (IR=0.025/athlete-year). Across all the sports, sex and levels there were large gaps in the data and variability in the injury rates. There was variability in injury risk rates across competition level, sex and sport, with the highest risk of ACL injury in semi-professional and professional sports. While female athletes demonstrated greater risk of ACL injury than male athletes, it’s unknown if this was true in every sport or level due to gaps in the data. Practitioners should understand the impact of sex and sport differences in ACL injury risk to guide the best evidenced-based risk reduction strategies.ABSTRACT
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