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Cited by 259Knee injuries and reconstruction techniquesSports injuries and preventionWinter Sports Injuries and Performance

“What’s my risk of sustaining an ACL injury while playing sports?” A systematic review with meta-analysis

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Montalvo, Alicia M, Schneider, Daniel K, Yut, Laura, Webster, Kate E, Beynnon, Bruce, Kocher, Mininder S, Myer, Gregory D·2019·British Journal of Sports Medicine
DOI 10.1136/bjsports-2016-096274PMC PMC6561829
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Abstract

Objective: To estimate the incidence proportion (IP) and incidence rate (IR) for ACL injury in athletes. Design: Systematic review with meta-analysis Data sources: The PubMed, CINAHL and SPORTDiscus electronic databases were searched from inception to 20 January 2017. Eligibility criteria for selecting studies: Studies were included if they reported total number of participants/population by sex, total number of ACL injuries by sex and total person-time by sex. Results: Fifty-eight studies were included. The IP and IR of ACL injury in female athletes were 3.5% (1 out of every 29 athletes) and 1.5/10 000 athlete-exposures over a period of 1 season-25 years. The IP and IR of ACL injury in male athletes were 2.0% (1 out of every 50 athletes) and 0.9/10 000 athlete-exposures over a period of 1–25 years. Female athletes had a higher relative risk (RR) for ACL injury compared with males (RR=1.5; 95% CI 1.2 to 1.9; P<0.01) and a higher incidence rate ratio (IRR) of ACL injury compared with males over 1 season–25 years (IRR=1.7; 95% CI 1.4 to 2.2; P<0.010). When accounting for participation level, the disparity in the IR between female and male athletes was highest for amateur athletes compared with intermediate and elite athletes (IRR=2.1; 95% CI 1.3 to 3.4; P<0.01; I²=82%). Amateur female athletes remained at higher risk of ACL injury than did with amateur male athletes. In studies where follow-up length was <1 year, female athletes had a higher IR of ACL injury than did to males (IRR=1.7; 95% CI 1.3 to 2.2; P<0.01). Where follow-up was 1 year and beyond, there was no sex difference in the IR of ACL injury (IRR=2.1; 95% CI 0.9 to 4.8; P=0.06; I²=65%). Summary/conclusions: One in 29 female athletes and 1 in 50 male athletes ruptured their ACL in a window that spanned from 1season to 25 years. The IR of ACL injury among female athletes in a season was 1.7 times higher than the IR of ACL injury among male athletes and the IP of ACL injury among female athletes was 1.5 times higher than the IP of ACL injury among male athletes. The reported sex disparity in ACL injury rates is independent of participation level and length of follow-up.

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  • ACL injuries are not limited to high level athletes; the largest difference in incidence rates between women and men was seen in recreational athletes.

    “However, ACL injuries are not limited to high level athletes; in one study, the largest difference in incidence rates between women and men was seen in recreational athletes.9”

    From Anterior cruciate ligament injury: towards a gendered environmental approach (2021) · cites this paper as [9]

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Research works printed but not linked: 2

  1. [44]Montalvo AM, Schneider DK, Silva P, Risk of sustaining anterior cruciate ligament injury in soccer: a systematic review and meta-analysis on the effects of sex and level of competition. Br J Sports Med 2018;In Press.
  2. [82]Oxford Centre for Evidence-based Medicine - Levels of Evidence. 2009 http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/

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Authors
Montalvo, A. M., Schneider, D. K., Yut, L., Webster, K. E., Beynnon, B., Kocher, M. S., & Myer, G. D.
Affiliations
  • Florida International University (US)
  • Cincinnati Children's Hospital Medical Center (US)
  • La Trobe University (AU)
  • University of Vermont (US)
  • Harvard University (US)
Corresponding author
Myer, Gregory D
ORCID
Venue
British Journal of Sports Medicine
Publisher
BMJ
Published
2018-03-07
Volume
53
Issue
16
Pages
1003-1012
ISSN
  • 0306-3674 (ISSN-L)
  • 1473-0480
DOI
10.1136/bjsports-2016-096274
PMC
PMC6561829
OpenAlex
W2792660174
Cited by
259
References
92
Citations by year
2026: 34 · 2025: 52 · 2024: 47 · 2023: 31 · 2022: 34 · 2021: 36 · 2020: 15 · 2019: 6 · 2018: 3
FWCI
3.33
Type
journal article
Language
en
Open access
Locations
  • British Journal of Sports Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
  • National Institutes of Health
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01AR067997, R01AR051477, R01AR050421)
Topics
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Winter Sports Injuries and Performance
Keywords
anterior cruciate ligament injury, anterior cruciate ligament rupture, female athletes, sex differences, injury incidence, incidence rates, recreational athletes, sports injury risk, knee injury prevention, follow-up duration, participation level, injury prevention programs, injury prevention research funding
MeSH terms
Anterior Cruciate Ligament Injuries, Athletic Injuries, Female, Humans, Male, Risk Factors, Sex Factors, Incidence, Sex Distribution

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