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Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type

Journal Article


Abstract


  • Background: Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts. Objective: To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports. Methods: Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included. Results: Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48���62, I2 = 82%; females: 63%, 95% CI 53���71, I2 = 84%; males: 50%, 95% CI 42���58, I2 = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05���0.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03���0.07, I2 = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10���0.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03���0.07, I2 = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32���0.72, I2 = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15���0.70, I2 = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02���0.07, I2 = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01���0.05, I2 = 86%) and these differences were significant. Heterogeneity across studies was generally high. Conclusion: This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.

Publication Date


  • 2022

Citation


  • Chia, L., De Oliveira Silva, D., Whalan, M., McKay, M. J., Sullivan, J., Fuller, C. W., & Pappas, E. (2022). Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type. Sports Medicine, 52(10), 2447-2467. doi:10.1007/s40279-022-01697-w

Scopus Eid


  • 2-s2.0-85130806700

Web Of Science Accession Number


Start Page


  • 2447

End Page


  • 2467

Volume


  • 52

Issue


  • 10

Place Of Publication


Abstract


  • Background: Not all anterior cruciate ligament (ACL) injuries are preventable. While some ACL injuries are unavoidable such as those resulting from a tackle, others that occur in non-contact situations like twisting and turning in the absence of external contact might be more preventable. Because ACL injuries commonly occur in team ball-sports that involve jumping, landing and cutting manoeuvres, accurate information about the epidemiology of non-contact ACL injuries in these sports is needed to quantify their extent and burden to guide resource allocation for risk-reduction efforts. Objective: To synthesize the evidence on the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level and exposure type in team ball-sports. Methods: Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus and SPORTDiscus) were searched from inception to July 2021. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included. Results: Forty-five studies covering 13 team ball-sports were included. The overall proportion of non-contact to total ACL injuries was 55% (95% CI 48���62, I2 = 82%; females: 63%, 95% CI 53���71, I2 = 84%; males: 50%, 95% CI 42���58, I2 = 86%). The overall incidence of non-contact ACL injuries was 0.07 per 1000 player-hours (95% CI 0.05���0.10, I2 = 77%), and 0.05 per 1000 player-exposures (95% CI 0.03���0.07, I2 = 97%). Injury incidence was higher in female athletes (0.14 per 1000 player-hours, 95% CI 0.10���0.19, I2 = 40%) than male athletes (0.05 per 1000 player-hours, 95% CI 0.03���0.07, I2 = 48%), and this difference was significant. Injury incidence during competition was higher (0.48 per 1000 player-hours, 95% CI 0.32���0.72, I2 = 77%; 0.32 per 1000 player-exposures, 95% CI 0.15���0.70, I2 = 96%) than during training (0.04 per 1000 player-hours, 95% CI 0.02���0.07, I2 = 63%; 0.02 per 1000 player-exposures, 95% CI 0.01���0.05, I2 = 86%) and these differences were significant. Heterogeneity across studies was generally high. Conclusion: This study quantifies several key epidemiological findings for ACL injuries in team ball-sports. Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in female than in male athletes. Injuries mostly occurred in competition settings.

Publication Date


  • 2022

Citation


  • Chia, L., De Oliveira Silva, D., Whalan, M., McKay, M. J., Sullivan, J., Fuller, C. W., & Pappas, E. (2022). Non-contact Anterior Cruciate Ligament Injury Epidemiology in Team-Ball Sports: A Systematic Review with Meta-analysis by Sex, Age, Sport, Participation Level, and Exposure Type. Sports Medicine, 52(10), 2447-2467. doi:10.1007/s40279-022-01697-w

Scopus Eid


  • 2-s2.0-85130806700

Web Of Science Accession Number


Start Page


  • 2447

End Page


  • 2467

Volume


  • 52

Issue


  • 10

Place Of Publication