Purpose: The literature has shown that anterior cruciate ligament (ACL) tear rates vary by
gender, by sport, and in response to injury-reduction training programs. However,
there is no consensus as to the magnitudes of these tear rates or their variations
as a function of these variables. For example, the female-male ACL tear ratio has
been reported to be as high as 9:1. Our purpose was to apply meta-analysis to the
entire applicable literature to generate accurate estimates of the true incidences
of ACL tear as a function of gender, sport, and injury-reduction training. Methods: A PubMed literature search was done to identify all studies dealing with ACL tear
incidence. Bibliographic cross-referencing was done to identify additional articles.
Meta-analytic principles were applied to generate ACL incidences as a function of
gender, sport, and prior injury-reduction training. Results: Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer,
2.67; lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was
0.32 for female subjects and 0.12 for male subjects. For basketball, the rates were
0.29 and 0.08, respectively. The rate for recreational Alpine skiers was 0.63, and
that for experts was 0.03, with no gender variance. The two volleyball studies had
no ACL tears. Training reduced the ACL tear incidence in soccer by 0.24 but did not
reduce it at all in basketball. Conclusions: Female subjects had a roughly 3 times greater incidence of ACL tears in soccer and
basketball versus male subjects. Injury-reduction programs were effective for soccer
but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear,
whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be
a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players
had no gender difference for ACL tear rate. Year-round female athletes who play soccer
and basketball have an ACL tear rate of approximately 5%. Level of Evidence: Level IV, therapeutic case series.
Key Words
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Article info
Footnotes
The authors report no conflict of interest.
Note: To access the supplementary tables accompanying this report, visit the December issue of Arthroscopy at www.arthroscopyjournal.org.
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© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
