Epidemiology Of Anterior Cruciate Ligament Injuries In National Collegiate Athletic Association Athletes: 2014/15 - 2018/19

Abstract

PURPOSE: Approximately half of all anterior cruiciate ligament (ACL) injuries occur in young, athletic populations, including collegiate athletes. Following ACL injury, there is a heightened risk of secondary ACL injury and post-traumatic osteoarthritis, highlighting the detrimental nature of early life knee injury. Therefore, the purpose of this study was to describe the epidemiology of ACL injury in National Collegiate Athletic Association (NCAA) athletes. METHODS: ACL injuries reported by athletic trainers to the NCAA Injury Surveillance Program during 2014/15 - 2018/19 in 23 NCAA men’s and women’s sports were examined. Injury incidence (characterized as Injury Rate (IR) per 10,000 athlete exposures (AEs)) was examined both pooled and stratified by event type (practices/competitions). The distribution of ACL injuries was examined by injury mechanism (player contact/non-contact/other) using frequencies (%s). Differential injury incidence was examined across event types and sex (for sex-comparable sports) using Injury Rate Ratios (IRR); IRRs with 95% Confidence Intervals (CI) excluding 1.00 were considered statistically significant. RESULTS: A total of 729 ACL injuries were reported, resulting in IRs of 0.80/10,000 AEs and 0.95/10,000 AEs in men’s and women’s sports, respectively. ACL injury rates were most commonly reported in men’s football (N = 267, IR = 1.44) and women’s soccer (N = 118, IR = 2.60). Amongst all sports, competition related ACL rates were higher in men’s (IR = 2.37) and women’s sports (IR = 2.59) than practice related rates (IRs: men’s = 0.43, women’s = 0.48). Practice injury rates remained stable across the study period, while competition rates fluctuated. Injuries were more prevalently attributed to player contact in men’s sports (39.7%) than in women’s sports (22.9%). CONCLUSIONS: In most sex-comparable sports, overall ACL rates were higher in women’s sports compared to men’s sports in NCAA athletes from 2014/15 - 2018/19. Injury rates were greater in competition compared to practice in both men’s and women’s sports. This corroborates previous literature detailing higher ACL injury rates during competition and in females. Future research should evaluate the translation between injury reduction programming during practice to competition-related ACL injury programming.