2015 ISAKOS Biennial Congress ePoster #1317

Risk Factors for Noncontact Anterior Cruciate Ligament Injury. A Prospective Three-Year Cohort Study

Junsuke Nakase, MD, PhD, Kanazawa, Ishikawa JAPAN
Katsuhiko Kitaoka, MD, Kanazawa, Ishikawa JAPAN
Yosuke Shima, MD, PhD, Kanazawa, Ishikawa JAPAN
Masahiro Kosaka, MD, Kanazawa, Ishikawa JAPAN
Hitoaki Numata, MD, Kanazawa, Ishikawa JAPAN
Takeshi Oshima, MD, PhD, Sydney, NSW AUSTRALIA
Hiroyuki Tsuchiya, Kanazawa, Ishikawa JAPAN

Kanazawa university hospital, Kanazawa, JAPAN

FDA Status Not Applicable

Summary: Our prospective 3-year cohort study assessed 290 female high school basketball and handball players to determine risk factors for noncontact anterior cruciate ligament injury. There were 27 (9.3%) noncontact anterior cruciate ligament tears. We found that increased hip abductor muscle strength and decreased femoral anteversion are risk factors for noncontact anterior cruciate ligament injury.

Rate:

Abstract:

Purpose

To prospectively evaluate risk factors for noncontact anterior cruciate ligament (ACL) injury in Japanese female high school basketball and handball players.
Study Design: Prospective cohort study.

Methods

Between 2009 and 2011, 317 new female high school basketball and handball players underwent detailed examinations for various parameters that were documented at their first-year of high school. The parameters assessed were height (cm), body weight (kg), anterior–posterior knee laxity (mm), general joint laxity (point), femoral anteversion (degree), navicular drop (mm), and muscle strength of knee flexion (Nm), extension (Nm), and hip abduction (N). All ACL injuries that occurred during these 3 years were recorded. The data were analyzed using SPSS for Windows 19.0. The parameters were compared using the Student t-test. Parameters with P values <0.2 were considered independent variables by logistic regression analysis (simultaneous). The level of significance for all statistical analyses was set at a = 0.05.

Results

Of the 317 players, 27 were excluded because they either had a history of ACL injury or could not complete the study. The remaining 290 players were observed during the 3 years, from start of high school until graduation. A total of 30 ACL tears occurred. Three of the ACL injuries were contact injuries, whereas the remaining 27 were noncontact ACL injuries (15 basketball players, 12 handball players, 18 left knees, 9 right knees, 67% non-dominant leg injury ). Fifteen players were injured during the games, whereas 12 were injured during practices.
The parameters were measured as follows for the control and ACL groups respectively: height, 161.3 ± 5.9 and 161.3±7.0 cm, P = 0.98; body weight, 55.2 ± 6.4 and 57.2 ± 7.1 kg, P = 0.12); anterior–posterior knee laxity, 4.0 ± 1.4 and 3.7 ± 1.1 mm, P = 0.28 mm;, general joint laxity, 2.6 ± 2.2 and 2.3 ± 2.0 points, P = 0.45; femoral anteversion, 16.6° ± 3.5° and 15.3° ± 3.3°, P = 0.07; navicular drop, 8.3 ± 3.6 and 8.4 ± 4.8 mm, P = 0.82; muscle strength of knee flexion, 48.6 ± 11.3 and 51.7 ± 13.6 Nm, P = 0.21; muscle strength of knee extension, 85.3 ± 19.2 and 88.9 ± 20.8 Nm, P = 0.37; and muscle strength of hip abduction, 209.3 ± 38.1 and 234.3 ± 41.1 N, P = 0.001. Muscle strength of hip abduction (P=0.001, 95% CI, 1.007-1.030) and femoral anteversion (P = 0.027, 95% CI, 0.746–0.983) were found to be independent risk factors in logistic regression analysis.

Conclusion

We found that increased hip abductor muscle strength and decreased femoral anteversion were risk factors for noncontact ACL injury. However, there was only a little difference. We could not screen for noncontact ACL injuries by anatomical measurement. These results indicate that prevention training for such injuries is needed for all female basketball and handball players.