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Document Title: Mihata-AJSM-Jun06.shtml
Article Title: Comparing the Incidence of Anterior Cruciate Ligament Injury in Collegiate Lacrosse, Soccer, and Basketball Players -- Implications for Anterior Cruciate Ligament Mechanism and Prevention
Authors: Leanne C.S. Mihata, MD, Anthony I. Beutler, MD, and Barry P. Boden, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: June 2006
Volume 34, pages 899-904
Keywords: female athlete ACL, contact versus noncontact sport, ACL injury, twisting-type injury, injurious involving sideways forcing and injurious hyperextension, epidemiology, implications for prevention.
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Comments: Mihata et al. looked at the injury rates in intercollegiate (varsity) soccer, basketball, and lacrosse, for both males and females. They found a very high rate of ACL injuries in men's lacrosse, and noted that this sport is high-risk for ACL injuries, just like soccer and basketball. They note that lacrosse is contact for males, but noncontact for females. They note that there is a strong correlation between the level of contact in sports and the ACL-injury risk. So, for example, a high-contact sport can bring a high likelihood of ACL injuries via both contact means and non-contact means. The level of contact of the sport is merely indicative of its aggressiveness. Contact knee injuries (e.g. knee forced sideways or injuriously hyperextended) routinely occur via unintentional contact in noncontact sports. And, non-contact (i.e. twisting-type, thus pivoting-type) knee injuries often occur in contact sports. The authors originally thought that the carrying of a stick in lacrosse reduces the risk of knee injury, but this does not seem to be the case. (In ice hockey, the risk of twisting-type knee injuries is reduced not because of the stick, but rather because it is inherently very difficult to plant a skate on ice in a torque-resisting fashion.) The authors note that "the key to injury prevention is an accurate understanding of biomechanical risk factors, followed by prospective identification and demonstrable changing of those factors presumed to be modifiable, culminating in proven decreases in long-term ACL injury rates." In practice, the best knee-injury-prevention methodologies seem to be good training (including for both strength and endurance), along with learning to pivot only on the front portion of the foot (instead of planting the entire shoe sole prior to twisting) and, for athletes with previous knee-injury histories, the use of functional knee bracing.
ABSTRACT
Background: Female college basketball and soccer athletes have higher rates of anterior cruciate ligament injury than do their male counterparts. Rates of anterior cruciate ligament injuries for women and men in collegiate lacrosse have not been examined. Understanding anterior cruciate ligament injury patterns in lacrosse, a full-contact sport for men and noncontact sport for women, could further injury prevention efforts.
Hypotheses: Female anterior cruciate ligament injury rates will decrease over time owing to longer participation in sports. Lacrosse anterior cruciate ligament injury rates will be lower than rates in basketball and soccer possibly owing to beneficial biomechanics of carrying a lacrosse stick.
Study Design: Cohort study (Prevalence); Level of evidence, 2.
Methods: Data from the National Collegiate Athletic Association Injury Surveillance System were analyzed to compare men’s and women’s anterior cruciate ligament injuries in basketball, lacrosse, and soccer over 15 years.
Results: Anterior cruciate ligament injury rates in women’s basketball and soccer were 0.28 and 0.32 injuries per 1000 athlete exposures, respectively, and did not decline over the study period. In men’s basketball, injury rate fluctuated between 0.03 and 0.13 athlete exposures. Rates of anterior cruciate ligament injury did not significantly change in men’s soccer over the study period. The rate of anterior cruciate ligament injury in men’s lacrosse (0.17 athlete exposures, P < .05) was significantly higher than in men’s basketball (0.08 athlete exposures) and soccer (0.12 athlete exposures). Injury rate in women’s lacrosse (0.18 athlete exposures, P < .05) was significantly lower than in women’s basketball and soccer.
Conclusion: There was no discernable change in rate of anterior cruciate ligament injury in men or women during the study period. Men’s lacrosse is a high-risk sport for anterior cruciate ligament injury. Unlike basketball and soccer, the rates of anterior cruciate ligament injury are essentially the same in men’s and women’s lacrosse. The level of allowed contact in pivoting sports may be a factor in determining sport-specific anterior cruciate ligament risk.
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