Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Am J Sports Med. 2021 Jun;49(7):1962-1972. doi: 10.1177/0363546520959619. Epub 2020 Oct 22.
BACKGROUND: The incidence of anterior cruciate ligament (ACL) injuries among adolescent athletes is steadily increasing. Identification of the highest risk sports for ACL injuries by sex and competitive setting (ie, practice vs match) is important for targeting injury prevention programs. PURPOSE: To identify the risk of ACL injuries in adolescent athletes by sport, sex, and setting across a variety of common US and international sports. STUDY DESIGN: Meta-analysis. METHODS: Essentially, 3 online databases (PubMed, Embase, and Cochrane Library) were searched for all studies of ACL injuries per athlete-exposure (AE) or hours of exposure in adolescent athletes. Injuries were then pooled and incidence rates (IRs) reported per 1000 AEs or hours of exposure, with the relative risk (RR) of injuries calculated for sex-comparable sports. IRs per competitive setting (match vs practice) were also calculated. RESULTS: A total of 1235 ACL injuries over 17,824,251 AEs were identified (IR, 0.069 [95% CI, 0.065-0.074]), with 586 of these injuries in girls across 6,986,683 AEs (IR, 0.084 [95% CI, 0.077-0.091]) versus 649 injuries in boys over 10,837,568 AEs (IR, 0.060 [95% CI, 0.055-0.065]). Girls had a higher overall rate of ACL injuries (RR, 1.40 [95% CI, 1.25-1.57]), with the most disproportionate risk observed in basketball (RR, 4.14 [95% CI, 2.98-5.76]). The risk of ACL injuries by sex was highest in girls' soccer (IR, 0.166 [95% CI, 0.146-0.189]) and boys' football (IR, 0.101 [95% CI, 0.092-0.111]). ACL injuries were over 8 (RR, 8.54 [95% CI, 6.46-11.30]) and 6 (RR, 6.85 [95% CI, 5.52-8.49]) times more likely to occur in a match versus a practice setting for female and male athletes, respectively. CONCLUSION: The risk of ACL injuries overall approached nearly 1 per 10,000 AEs for female athletes, who were almost 1.5 times as likely as male athletes to suffer an ACL injury across all adolescent sports. A multisport female athlete was estimated to have a nearly 10% risk of ACL injuries over her entire high school or secondary school career. Specifically, male and female adolescents playing soccer, basketball, lacrosse, and football appeared at particular risk of injuries, a finding that can be used to target an injury intervention.
背景：青少年运动员前交叉韧带（ACL）损伤的发病率稳步上升。确定 ACL 损伤风险最高的运动项目，包括性别和竞技环境（即练习与比赛），对于确定损伤预防方案非常重要。
目的：确定各种常见的美国和国际运动项目中，青少年运动员的 ACL 损伤风险与运动、性别和环境有关。
研究设计：荟萃分析。
方法：主要通过 3 个在线数据库（PubMed、Embase 和 Cochrane Library），对青少年运动员的 ACL 损伤每运动员-暴露（AE）或每小时暴露的所有研究进行检索。对损伤进行汇总，并按每 1000 个 AE 或每小时暴露的发生率（IR）报告，计算可比运动项目的性别相对风险（RR）。还计算了比赛（比赛与练习）环境下的损伤发生率（IR）。
结果：共确定了 1235 例 ACL 损伤，涉及 17824251 次 AE（IR 为 0.069[95%CI，0.065-0.074]），其中 6986683 次 AE 中女孩有 586 例（IR 为 0.084[95%CI，0.077-0.091]），10837568 次 AE 中男孩有 649 例（IR 为 0.060[95%CI，0.055-0.065]）。女孩的 ACL 损伤总体发生率较高（RR，1.40[95%CI，1.25-1.57]），在篮球中观察到的风险最高（RR，4.14[95%CI，2.98-5.76]）。在女孩足球（IR，0.166[95%CI，0.146-0.189]）和男孩足球（IR，0.101[95%CI，0.092-0.111]）中，性别与 ACL 损伤的风险最高。与练习相比，女性和男性运动员在比赛中发生 ACL 损伤的风险分别高出 8（RR，8.54[95%CI，6.46-11.30]）和 6（RR，6.85[95%CI，5.52-8.49]）倍。
结论：总体而言，女性运动员 ACL 损伤的风险接近每 10000 次 AE 发生 1 次，在所有青少年运动项目中，女性运动员 ACL 损伤的风险几乎是男性运动员的 1.5 倍。一名多运动的女运动员在整个高中或中学职业生涯中 ACL 损伤的风险估计接近 10%。具体而言，足球、篮球、曲棍球和足球项目中的男、女青少年运动员似乎特别容易受伤，这一发现可用于确定损伤干预的目标。
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