Sports Medicine Research: In the Lab & In the Field: Incidence and Risk Factors for ACL Injuries in College Football (Sports Med Res)
Monday, May 14, 2012

Incidence and Risk Factors for ACL Injuries in College Football

Incidence and Risk Factors for Injuries to the Anterior Cruciate Ligament in National Collegiate Athletic Association Football: Data from the 2004 – 2005 Through 2008 – 2009 National Collegiate Athletic Association Injury Surveillance System

Dragoo JL, Braun HJ, Durham JL, Chen MR, & Harris AHS. The American Journal of Sports Medicine. 2012; 40: 990-995.

Football athletes experience a high rate of sport-related injuries including injuries to the anterior cruciate ligament (ACL).  Epidemiology data may help us understand when these injuries are most likely to occur.  The purpose of this study was to determine the incidence and epidemiology of football ACL injuries utilizing the NCAA Injury Surveillance System (ISS) for a five year period (seasons 2004-05 through 2008-09).  The NCAA ISS contains athletic exposures and injury data reported by athletic trainers from participating NCAA institutions (any of the 3 NCAA divisions).  During the 5 year period, 318 ACL injuries occurred in NCAA football athletes.  The overall ACL incidence rate was 1.42 per 10,000 exposures.  Rate of ACL injury was highest during postseason (1.55 per 10,000), when compared to pre-/in- season.  Furthermore, an athlete was 10 times more likely to injure their ACL during a game (8.06 per 10,000) when compared to practice (.8 per 10,000).  ACL injury rate on an artificial turf was 1.3 times higher than natural grass.  Reported mechanisms of injury were player contact (53%), non-contact (40%), and ground contact (4%). 

Clinically, it appears that ACL injuries are far more likely to occur during a football game when compared to practice.  Is it the speed or intensity that games are played in comparison to practice?  Or could it be related to the fatigue of high level game activity compared to practices?  The mechanisms of injury consisted of player contact as well as non-contact mechanisms.  The most common ACL mechanism in a general population is non-contact, but the contact nature of football seems to add to the increased risk of ACL injury when compared to athletes participating in other sports.  It would be interesting to analyze the contact mechanisms in more detail.  Another interesting thing to consider is that football athletes vary in size and sport demands, largely influenced by position.  There was not enough data collected to compare incidence rates by position (since this was only collected in the game data). Observationally, ACL injuries were most commonly reported in linebackers, running backs, and special teams players.  Could it be a sport task specific to these positions such as turning and cutting that is associated with the increased risk of ACL injuries?  Further research may be able to provide insight to what predisposed these positions to ACL injuries.  Injury rates may be confounded when playing a game on artificial turf.  There was mention of a significantly greater rate of injury on the newest generation turfs in comparison to earlier turf fields.  Many institutions seem to be installing turf fields due to their all-weather use and long-term upkeep.  If these newest generation turfs are more “like grass” what is it about them that is seemingly causing more injury?  Given the contact nature of football, is there anything that clinicians can do to target prevention of ACL injury efforts in football players?

Written by: Nicole Cattano

Dragoo JL, Braun HJ, Durham JL, Chen MR, & Harris AH (2012). Incidence and risk factors for injuries to the anterior cruciate ligament in national collegiate athletic association football: data from the 2004-2005 through 2008-2009 national collegiate athletic association injury surveillance system. The American Journal of Sports Medicine, 40 (5), 990-5 PMID: 22491794

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