Abstract
PurposeTo identify modifiable biomechanical and neuromuscular anterior cruciate ligament (ACL) injury risk factors for first-time ACL injury in adolescent female elite football and team handball players.MethodsAdolescent female elite football and handball players with no previous ACL injury participated in the present study. At baseline, players were tested during side-cutting manoeuvres performed in a 3-dimensional motion analysis laboratory with concomitant electromyography (EMG) measurements. Maximal isometric lower limb muscle strength was assessed by handheld dynamometry. Players were prospectively followed for 2 years after baseline testing, and all magnetic resonance imaging (MRI) verified ACL injuries were registered. The effect of 16 risk factor candidates on the relative risk (RR) of ACL injury was estimated using Poisson regression analysis.ResultsNinety players (age 16.9 ± 1.2 years) were included in the analyses. Nine first-time ACL injuries (injury incidence 10.0% (95% confidence interval (CI) 5.4–18.6%)) were registered during the 2-year follow-up period. Four risk factor candidates were significantly associated with the risk of ACL injury: (1) hip flexion angle at initial contact (IC) [RR 0.56, 95% confidence interval (CI) 0.34–0.92], (2) internal knee rotation angle at IC [RR 1.13, 95% CI 1.08–1.19], (3) semitendinosus EMG activity 50 ms prior to IC [RR: 0.62, 95% CI 0.43–0.89], and (4) external hip rotator strength [RR: 0.77, 95% CI 0.66–0.89].ConclusionFour distinct ACL injury risk factors related to the side-cutting manoeuvre were identified in a population of adolescent female elite football and team handball players with no previous ACL injury. As ACL injury typically occur during side-cutting, intervention programmes to modify these risk factors pose a promising strategy for ACL injury prevention in adolescent female elite football and team handball.Level of evidenceII.
Highlights
A major concern in female cutting sports is the fact that female gender is associated with an increased risk of sustaining an anterior cruciate ligament (ACL) injury [26]
As the only muscle strength parameter, maximal external hip rotator strength was associated with ACL injury risk
The risk of ACL injury decreased by 38% when ST pre-activity increased by 10%-points during side-cutting (RR 0.62, P = 0.01), Table 3
Summary
A major concern in female cutting sports is the fact that female gender is associated with an increased risk of sustaining an anterior cruciate ligament (ACL) injury [26]. Only a single prospective study has evaluated lower limb muscle activity during a side-cutting manoeuvre as ACL injury risk factor in adult female elite football and team handball players [37]. Adolescent female elite football and team handball players are at the highest risk of ACL injury [5], no prospective study has so far used concurrent 3D motion analysis and muscle activity recording to identify biomechanical and neuromuscular risk factors during a specific high-risk movement (i.e. side-cutting) in this athlete group. The aim of the present study was to identify biomechanical and neuromuscular ACL injury risk factors for sustaining first-time ACL injury during a side-cutting manoeuvre in adolescent female elite football and team handball players. Based on previous observations in the literature, it was hypothesised that the integrated biomechanical and neuromuscular analysis employed in the present study would enable to identify modifiable risk factors in a cohort of adolescent female elite football and team handball players
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