Waldén Markus, Hägglund Martin, Magnusson Henrik, Ekstrand Jan
Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2011 Jan;19(1):11-9. doi: 10.1007/s00167-010-1170-9. Epub 2010 Jun 9.
Anterior cruciate ligament (ACL) injury causes long lay-off time and is often complicated with subsequent new knee injury and osteoarthritis. Female gender is associated with an increased ACL injury risk, but few studies have adjusted for gender-related differences in age although female players are often younger when sustaining their ACL injury. The objective of this three-cohort study was to describe ACL injury characteristics in teams from the Swedish men's and women's first leagues and from several European men's professional first leagues. Over a varying number of seasons from 2001 to 2009, 57 clubs (2,329 players) were followed prospectively and during this period 78 ACL injuries occurred (five partial). Mean age at ACL injury was lower in women compared to men (20.6 ± 2.2 vs. 25.2 ± 4.5 years, P = 0.0002). Using a Cox regression, the female-to-male hazard ratio (HR) was 2.6 (95% CI 1.4-4.6) in all three cohorts studied and 2.6 (95% CI 1.3-5.3) in the Swedish cohorts; adjusted for age, the HR was reduced to 2.4 (95% CI 1.3-4.2) and 2.1 (95% CI 1.0-4.2), respectively. Match play was associated with a higher ACL injury risk with a match-to-training ratio of 20.8 (95% CI 12.4-34.8) and 45 ACL injuries (58%) occurred due to non-contact mechanisms. Hamstrings grafts were used more often in Sweden than in Europe (67 vs. 34%, P = 0.028), and there were no differences in time to return to play after ACL reconstruction between the cohorts or different grafts. In conclusion, this study showed that the ACL injury incidence in female elite footballers was more than doubled compared to their male counterparts, but also that they were significantly younger at ACL injury than males. These findings suggest that future preventive research primarily should address the young female football player.
前交叉韧带（ACL）损伤会导致较长的休赛期，并且常常并发随后的新的膝关节损伤和骨关节炎。女性ACL损伤风险增加，但尽管女性运动员在遭受ACL损伤时往往年龄更小，很少有研究对年龄方面的性别差异进行校正。这项三队列研究的目的是描述瑞典男女顶级联赛球队以及几个欧洲男子职业顶级联赛球队中的ACL损伤特征。在2001年至2009年不同数量的赛季中，对57家俱乐部（2329名球员）进行了前瞻性跟踪，在此期间发生了78例ACL损伤（5例部分损伤）。女性ACL损伤时的平均年龄低于男性（20.6±2.2岁对25.2±4.5岁，P = 0.0002）。使用Cox回归分析，在所研究的所有三个队列中，女性与男性的风险比（HR）为2.6（95%可信区间1.4 - 4.6），在瑞典队列中为2.6（95%可信区间1.3 - 5.3）；校正年龄后，HR分别降至2.4（95%可信区间1.3 - 4.2）和2.1（95%可信区间1.0 - 4.2）。比赛中ACL损伤风险更高，比赛与训练的风险比为20.8（95%可信区间12.4 - 34.8），45例ACL损伤（58%）是由于非接触机制造成的。瑞典比欧洲更常使用腘绳肌肌腱移植（67%对34%，P = 0.028），各队列之间或不同移植方式在ACL重建后恢复比赛的时间上没有差异。总之，这项研究表明，精英女性足球运动员的ACL损伤发生率比男性同行高出一倍多，而且她们ACL损伤时的年龄明显比男性小。这些发现表明，未来的预防研究主要应针对年轻女性足球运动员。
