Retrospective Analysis of Non-Contact ACL Injury Risk: A Case Series Review of Elite Female Athletes
Lee Herrington* and Ros Cooke
Published: 06 February, 2017 | Volume 2 - Issue 1 | Pages: 001-008
Background: Literature on ACL injury is limited when assessing for the presence and interaction of multiple risk factors simultaneously. Identifying risk factor interaction may increase the impact of prevention programmes to target ACL injury reduction. The aim of this study was to retrospectively assess ACL injured female athletes to identify which modifiable and non-modifiable risk factors were present at the time of injury.
Method: Seventeen female athletes who had sustained a non-contact ACL injury were interviewed retrospectively to assess for the presence of reported risk factors for ACL injury.
Result: This retrospective analysis ACL injury cases highlighted a number of factors which were present with high frequency across this group of cases. All had non-contact ACL injury occurring during cutting or landing, which suggests a predisposing deficit in neuromuscular control. This poor neuromuscular control could be exacerbated by the presence of fatigue identified within the cohort. This poor control could be further influenced by the fact a majority of athletes had another significant injury in the 12 weeks prior to ACL injury. The restriction to training could have either decreased fatigue resistance, or potentially changed their movement pattern because of the method of injury management undertaken.
Conclusion: This case series provides insight into the interaction of risk factors for ACL injury in sportswomen, with the presence of another injury disrupting training, decreasing the athletes work capacity and fatigue resistance, being compounded perceived or actually elevated levels of fatigue, leading to the potential for abhorrent movement patterns and increased injury risk.
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ACL; Risk factors; Female
- Hewett T, Di Stasi S, Myer G. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med. 2013; 41: 216-224. Ref.: https://goo.gl/sIhO5s
- Culvenor AG, Collins NJ, Guermazi A, Cook JL, Vicenzino B, et al. Early osteoarthritis is evident one year following anterior cruciate ligament reconstruction. Arth Rheumatol. 2015; 67: 946-955. Ref.: https://goo.gl/Xny1w5
- Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE. Incidence of second ACL injuries 2 years after primary ACL reconstruction and return to sport. Am J Sports Med. 2014; 42: 1567-1573. Ref.: https://goo.gl/ppRAkP
- Postma WF, West RV. Anterior cruciate ligament injury prevention programs. J Bone Jt Surg. 2013; 95: 661-665. Ref.: https://goo.gl/cNSdpl
- Smith H, Vacek P, Johnson R, Slauterbeck J, Hashemi J, et al. Risk factors for anterior cruciate ligament injury: a review of the literature – part 1:neuromuscular and anatomic risk. Sports Health. 2012; 4: 69-78. Ref.: https://goo.gl/lu6zeV
- Smith H, Vacek P, Johnson R, Slauterbeck J, Hashemi J, et al. Risk factors for anterior cruciate ligament injury: a review of the literature – part 2: hormonal, genetic, cognitive function, previous injury and extrinsic risk factors. Sports Health. 2012; 4: 155-161. Ref.: https://goo.gl/ZD2lPC
- Opar D, Serpell B. Is there a potential relationship between prior hamstring strain injury and increased risk for future anterior cruciate ligament injury. Arch Phys Med Rehab. 2014; 95: 401-405. Ref.: https://goo.gl/kFyLxE
- Myer G, Ford K, Di Stasi S, Foss K, Micheli L, et al. High knee abduction moment are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury? Brit J Sports Med. 2015; 49: 118-122. Ref.: https://goo.gl/xcy6nO
- Wesley C, Aronson P, Docherty C. Lower extremity landing biomechanics in both sexes after a functional exercise protocol. J Athl Train. 2015; 50: 914-920. Ref.: https://goo.gl/px1xgu
- Joseph A, Collins C, Henke N, Yard E, Fields S, et al. A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. J Athl Train. 2013; 48: 810-817. Ref.: https://goo.gl/T3PBfH
- Gouttebarge V, Aoki H, Ekstrand J, Verhagen E, Kerkhoffs G. Are severe musculoskeletal injuries associated with symptoms of common mental disorders among European professional footballers? Kn Surg Sports Traum Arthros. 2015; 24: 3934-3942. Ref.: https://goo.gl/sA3rPi
- Sousa P, Krych A, Cates R, Levy B, Stuart M, et al. Return to sport: Does excellent 6 month strength and function following ACL reconstruction predict midterm outcomes. Kn Surg Sports Traum Arthros. 2015; [Epub ahead of print]. Ref.: https://goo.gl/0eDV8Y
- Saw A, Main L, Gastin P. Monitoring the athlete training response: subjective self-reported measures trump objective measures: a systematic review. Brit J Sports Med. 2015; 50: 281-291. Ref.: https://goo.gl/xA0WIs
- Hulin B, Gabbett T, Lawson D, Caputi P, Sampson J. The acute:chronic workload ratio predicts injury: high chronic workload may decrease injury risk in elite rugby league players. Brit J Sports Med. 2016; 50: 231-236. Ref.: https://goo.gl/vMNonS
- Herrington L. Effect of hip abductor muscle fatigue on knee valgus angle during a unilateral step landing task. Int J Athl Ther Train. 2013; 19: 38-43.
- Pethick J, Winter S, Burnley M. Fatigue reduces the complexity of knee extensor torque fluctuations during maximal and submaximal intermittent isometric contractions. J Physiol. 2015; in press DOI: 10.1113/jphysiol.2014.284380. Ref.: https://goo.gl/yNlVN4
- Gescheit D, Cormack S, Reid M, Duffield R. Consecutive Days of Prolonged Tennis Matchplay: Performance, Physical, and Perceptual Responses in Trained Players Int J Sports Physiol Perform. 2015; 10: 913-920. Ref.: https://goo.gl/0g7pNa
- Smith M, Samuelle M, Coutts A. Mental fatigue impairs intermittent running performance. Med Sci Sport Exs. 2015; 47: 1682-1690. Ref.: https://goo.gl/2LaO4G
- Sandberg J, Grzywacz J, Talton J, Quandt S, Chen H, et al. A cross sectional exploration of excessive daytime sleepiness, depression and musculoskeletal pain among migrate farmworkers. J Agromed. 2012; 1: 70-80. Ref.: https://goo.gl/Pvv5Ze
- Uelhi K, Miedinger D, Bingisser R, Durr S, Holsboer-Tachsler E, et al. Sleep problems and work injury types: a study of 180 patients in a Swiss emergency department. Swiss Med Week. 2013; 143: w13902. Ref.: https://goo.gl/4UHLS7
- Garrison M, Westrick R, Johnson M, Benenson J. Association between the functional movement screen and injury development in college athletes. Int J Sports Phys Ther. 2015; 10: 21-28. Ref.: https://goo.gl/PYbKIo
- Bullock-Saxton J. Local sensation changes and altered hip muscle function following severe ankle sprain. Phys Ther. 1994; 74: 17-28. Ref.: https://goo.gl/yiQAgu
- Homan K, Norcross M, Goerger B, Prentice W, Blackburn T. The influence of hip strength on gluteal activity and lower extremity kinematics. J Electromyo Kinesio. 2013; 23: 411-415. Ref.: https://goo.gl/1U3O6u
- McKeon P, Hertel J. Systematic review of postural control and lateral ankle instability, part 1: can deficits be detected with instrumented testing. J Athl Train. 2008; 43: 293-304. Ref.: https://goo.gl/qy56fH
- Van den Bekerom M, van Kimmenade R, Sierevelt I, Eqqink K, Kerkhoffs G, et al. Randomised comparison of tape versus semi-rigid and versus lace-up ankle support in the treatment of acute lateral ankle ligament injury. Kn Surg Sports Trauma Arthros. 2015; 24: 978-984. Ref.: https://goo.gl/63xwEF
- Rabin A, Kozol Z. Measures of range of motion and strength among healthy women with differing quality of lower extremity movement during the lateral step down tests. J Orthop Sports Phys Ther. 2010; 40: 792-800. Ref.: https://goo.gl/HmEouZ
- Smits-Engelsman B, Klerks M, Kirby A. Beighton score: a valid measure for generalisied hypermobility in children. Journal of Pediatrics. 2010; 158: 119-123. Ref.: https://goo.gl/YP2snh
- Saito K, Hatayama K, Terauchi M, Haqiwara K, Hiquchi H, et al. Clinical outcomes after anatomic double-bundle anterior cruciate ligament reconstruction: comparison of extreme knee hyperextension and normal to mild knee hyperextension. Arthros. 2015; 31: 1310-1317. Ref.: https://goo.gl/X8rz5D
- Brimitt J, Heiderscheit B, Manske R, Niemuth P, Rauh M. Lower extremity functional tests and risk of injury in division III collegiate athletes. Int J Sports Phys Ther. 2013; 8: 216-227. Ref.: https://goo.gl/xZ5M0P
Fullagar H, Skorski S, Duffield R, Hammes D, Coutts A, et al. Sleep and athletic performance: The effects of sleep loss on exercise performance and physiological and cognitive responses to exercise. Sports Med. 2015; 45: 161-186. Ref.: https://goo.gl/d6Jwah