Collegiate ACL injury rates across 15 sports: National Collegiate Athletic Association injury surveillance system data update (2004-2005 through 2012-2013)
Agel J, Rockwood T, and Klossner D. Clin J Sport Med. 2016. [Epub Ahead of Print].
Take Home Message: Anterior cruciate ligament (ACL) injury affect a small number of athletes. While overall ACL injury rates are decreasing, ACL injuries still affect a disproportionally higher number of women than men.
Anterior cruciate ligament (ACL) injury research has led to the implementation of preventative programs to decrease the risk of injury. Updated injury surveillance data can be useful in both evaluating the effectiveness of current clinical practice as well as directing future research. Therefore, Agel, Rockwood, and Klossner used NCAA ACL injury surveillance data to determine the rate of ACL injury among collegiate athletes from 2004 to 2013. This is an update of the data previously reported for the 15 academic years between 1988 to 2004. The data were extracted from the NCAA web-based injury surveillance system. Sports included in this data were men’s football, baseball, ice hockey, soccer, basketball, wrestling, and lacrosse; and women’s softball, ice hockey, soccer, basketball, lacrosse, field hockey, gymnastics, and volleyball. Overall, 1,118 ACL injuries were recorded. 60% of injuries in women were noncontact ACL injuries compared to 41% among male athletes. Men’s football and women’s basketball recorded the most ACL injuries, but both significantly decreased in overall injury rates between studies (6% and 4%, respectively). However, women’s gymnastics, lacrosse, and basketball had the highest rate of ACL injuries. Among women’s sports, gymnastics had the greatest decrease (88%) in ACL injuries in injury rate from the previous data period (1988 to 2004) while field hockey had the greatest increase (57%). Comparatively, men’s soccer had the greatest decrease in injury rates between the previous data period and the current one. Unfortunately, men’s soccer also had a steady increase in ACL injury rates from 2008 to 2012. Nine of the 15 analyzed sports recorded an overall decrease in ACL injuries as compared to the previous study period. Women continue to experience ACL injuries at higher rates than men in similar sports (soccer, basketball, lacrosse).
The data presented reminds clinicians that ACL injuries are relatively infrequent, yet the short- and long-term impacts of the injury can be detrimental to a young athlete and thus should always be considered by the clinician. Furthermore, this data suggests that while ACL injury prevention programs are available, some sports such as women’s field hockey and men’s basketball are still reporting a steady increase in the rate of ACL injuries. The authors also show that the rate of noncontact ACL injuries continue to disproportionally affect women compared with men. There are some explanations for these findings. For example, with injury prevention programs, there may be a lack of implementation, incorrect implementation, and/or poor adherence. Clinicians need to continue to communicate the benefits of injury prevention programs and how to optimally deploy them. Another explanation may be that ACL injuries are so infrequent in some sports it will be challenging to have a large enough study population to show the benefits of injury prevention programs on reducing the injury risk. Clinicians can use these results to help reassure athletes that despite the media attention about ACL injuries they are rare. However, it is also important to highlight the short- and long-term consequences of an ACL injury. So while it may be a rare injury it could have profound effects on a person later in life. Hence, clinicians need to continue to encourage the use of injury prevention programs because they can reduce the risk of injuries and improve performance.
Questions for Discussion: Do you implement ACL injury prevention programs in your current clinical practice? What barriers/ difficulties have you encounters with this implementation?
Written by: Kyle Harris & Jeffrey Driban
Reviewed by: Jane McDevitt