Most anterior cruciate ligament injuries sustained by female soccer players are the result of a noncontact injury, not direct impact, a new study shows.
Most ACL Injuries in Female Soccer Players Not From Direct Impact
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This may help explain why the rate of anterior cruciate ligament (ACL) in this population continues to rise despite improvements in injury prevention programs, the researchers said. ACL injuries account for up to 43% of the total injury burden during the season.
In the study, “Systematic Video Analysis of Anterior Cruciate Ligament Injuries in Professional Female Soccer Players’,” published on May 14, 2021 in The American Journal of Sports Medicine, the researchers describe the mechanisms, situational pattern and biomechanics of ACL injuries in women’s soccer.
Collecting data from 6 professional female leagues, 57 consecutive ACL injuries occurred across 3 seasons, 2017 to 2020. A combination of injury videos and biomechanical analysis were used to study the mechanism and situational patterns of the injuries. The month, timing within the match, and field location at the time of the injury were also recorded.
The 35 injury videos identified 19 (54%) noncontact injuries, 12 (34%) indirect contact injuries and 4 (11%) direct contact injuries. The most common situations where noncontact and indirect contact injuries occurred were pressing and tackling (n = 18), regaining balance after kicking in (n = 7), and being tackled (n = 4).
Biomechanical analysis also showed that 88% of the injuries were associated with multiplanar mechanisms with frequent knee valgus loading. The researchers also reported that 64% of the injuries happened during the first half of matches, typically the first 30 minutes.
“Female athletes showed remarkable similarities with elite male players in terms of the ACL mechanism and situational pattern of injury, and 88% of injuries involved no direct contact to the knee, with noncontact injuries being highly prevalent,” the researchers wrote.
“Injuries occurred during 3 main situations, with accompanying alterations in multiplanar biomechanics. Interventions aimed at reducing ACL injuries in women’s soccer should consider high-intensity defensive play at the beginning of the match. Instruction in the 3 main situations should be applied alongside appropriate neuromuscular training interventions.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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