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. 2015 Mar;7(2):130-6.
doi: 10.1177/1941738114554768.

Anterior cruciate ligament injuries in pediatric athletes presenting to sports medicine clinic: a comparison of males and females through growth and development

Andrea Stracciolini  1 , Cynthia J Stein  2 , David Zurakowski  3 , William P Meehan 3rd  1 , Gregory D Myer  4 , Lyle J Micheli  2
Affiliations

Anterior cruciate ligament injuries in pediatric athletes presenting to sports medicine clinic: a comparison of males and females through growth and development

Andrea Stracciolini et al. Sports Health. 2015 Mar.

Abstract

Background: Limited data exist regarding the effect of the growth process on anterior cruciate ligament (ACL) injury risk in male versus female children.

Hypothesis: The proportion of ACL injuries/sports injuries presenting to clinic will vary by age, sex, and body mass index (BMI).

Study design: Cross-sectional epidemiologic study.

Level of evidence: Level 3.

Methods: The study group consisted of a randomly selected 5% probability sample of all children 5 to 17 years of age presenting to a sports medicine clinic from January 1, 2000 to December 31, 2009; 2133 charts were reviewed. Data collected included demographics, height and weight, injury mechanism, diagnosis, treatment, previous injury, and organized sports.

Results: A total of 206 ACL tears were analyzed (104 girls, 102 boys). Girls were slightly older than boys (15.1 ± 1.7 vs 14.3 ± 2.1 years; P < 0.01). Male-female comparison of ACL injury/total injury by age revealed that girls had a steeper increase by age than boys. Among 5- to 12-year-olds, boys had a higher ACL injury/total injury ratio than girls (all P < 0.01). Children 13 to 17 years of age showed no significant difference for sex in ACL injury/total injury ratio. As age advanced, the proportion of ACL injuries/total injuries increased for both girls (P < 0.01) and boys (P = 0.04). BMI was independently associated with an ACL injury (P < 0.01).

Conclusion: The proportion of ACL injuries/total injuries was similar for boys and girls aged 13 to 17 years. Girls showed a significantly steeper increase in ACL injury proportion versus boys through puberty.

Clinical relevance: This study will increase clinician awareness of ACL injury occurrence in young male and female athletes 5 to 12 years of age. Injury prevention efforts should target young girls before the onset of puberty and before injury occurs.

Keywords: BMI; children; injury prevention; knee; ligament injuries; sports injury risk factors.

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Conflict of interest statement

The authors report no potential conflicts of interest in the development and publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of patient selection for anterior cruciate ligament (ACL) injuries in children aged 5 to 17 years.
Figure 2.
Figure 2.
Male-female comparison of anterior cruciate ligament (ACL) injury/total injury ratio by age. The generalized linear model (GLM) indicated a difference in the slope of ACL injury proportion with age for girls when compared with boys (sex-by-age interaction test Wald χ2 = 10.37 on 1 degree of freedom, P < 0.001).
Figure 3.
Figure 3.
Multivariate logistic regression analysis depicting a body mass index (BMI)–specific relationship with anterior cruciate ligament (ACL) injury in children independent of age, sex, and sport.
See this image and copyright information in PMC

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