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Meta-Analysis
. 2019 Nov;53(21):1333-1340.
doi: 10.1136/bjsports-2016-097261. Epub 2018 Mar 29.

'What's my risk of sustaining an ACL injury while playing football (soccer)?' A systematic review with meta-analysis

Alicia M Montalvo  1 , Daniel K Schneider  2   3 , Paula L Silva  4 , Laura Yut  5 , Kate E Webster  6 , Michael A Riley  4 , Adam W Kiefer  2   4   7 , Jennifer L Doherty-Restrepo  1 , Gregory D Myer  7   8   9   10
Affiliations
Meta-Analysis

'What's my risk of sustaining an ACL injury while playing football (soccer)?' A systematic review with meta-analysis

Alicia M Montalvo et al. Br J Sports Med. 2019 Nov.

Abstract

Objective: To estimate the incidence proportion (IP) and incidence rate (IR) of ACL injury in football players.

Design: Systematic review with meta-analysis.

Data sources: PubMed, CINAHL and SPORTDiscus electronic databases were searched from inception to 20 January 2017.

Eligibility criteria for selecting study: Studies that reported the total number of participants/population by sex, total number of ACL injuries by sex and total person-time by sex were included.

Results: Twenty-eight studies were included. The IP and IR of ACL injury in female football players were 2.0% (95% CI 1.2% to 3.1%) and 2.0/10 000 athlete exposures (AEs) (95% CI 1.6 to 2.6; I2=91%) over a period of one season to 4 years. The IP and IR of ACL injury in male players were 3.5% (95% CI 0.7% to 8.2%) and 0.9/10 000 AEs (95% CI 0.7 to 1.1; I2=94%). Studies that evaluated matched cohorts of female and male players showed no difference in IP (relative risk=1.2; 95% CI 0.9 to 1.6; P=0.47) over a period of one season to 4 years. Women were at greater risk than men (incidence rate ratio (IRR)=2.2; 95% CI 1.6 to 3.1; I2=83%; P<0.001). When accounting for participation level, the difference in IR between women and men was greatest for intermediate players (IRR=2.9; 95% CI 2.4 to 3.6) compared with amateur (IRR=2.6; 95% CI 1.4 to 4.8) and elite (IRR=2.0; 95% CI 1.1 to 3.4) players.

Summary/conclusion: Overall, more men sustained ACL injury in football. There was no difference in the relative risk of ACL injury between female and male football players in a window that spanned one season to 4 years. The IR of ACL injury among women was 2.2 times higher than the IR of ACL injury among men. The reported sex disparity in ACL injury was independent of participation level.

Keywords: acl; epidemiology; knee; sports.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart summary of the literature search process.
Figure 2
Figure 2
Forest plot for the incidence proportion and 95% CI of ACL injury in football players for men and women combined.
Figure 3
Figure 3
Forest plot for incidence proportion and 95% CI of ACL injury for female football players.
Figure 4
Figure 4
Forest plot for incidence proportion and 95% CI of ACL injury for male football players.
Figure 5
Figure 5
Forest plot for RR and 95% CI of ACL injury for football players—woman versus man. <1=reduced RR in women; >1=reduced RR in men. RR, relative risk.
Figure 6
Figure 6
Forest plot for total incidence rate and 95% CI of ACL injury in football players for men and women combined.
Figure 7
Figure 7
Forest plot for incidence rate and 95% CI of ACL injury for female football players.
Figure 8
Figure 8
Forest plot for incidence rate and 95% CI of ACL injury for male football players.
Figure 9
Figure 9
Forest plot for incidence rate and 95% CI of ACL injury for football players—woman versus man. <1=reduced relative risk in women;>1=reduced relative risk in men. IRR, incidence rate ratio.
Figure 10
Figure 10
Forest plot for incidence rate and 95% CI of ACL injury in football players—woman versus man by participation level. <1=reduced relative risk in women; >1=reduced relative risk in men. IRR, incidence rate ratio.
Figure 11
Figure 11
Forest plot for incidence rate and 95% CI of ACL injury in football players—woman versus man by year of publication. <1=reduced relative risk in women; >1=reduced relative risk in men. IRR, incidence rate ratio.
See this image and copyright information in PMC

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