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Anterior cruciate ligament injury in elite football: a prospective three-cohort study.
Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.ORCID iD: 0000-0002-6883-1471
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Physiotherapy.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Sports Medicine .
2011 (English)In: Knee Surgery, Sports Traumatology, Arthroscopy, ISSN 0942-2056, E-ISSN 1433-7347, Vol. 19, no 1, 11-19 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Springer , 2011. Vol. 19, no 1, 11-19 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-64457DOI: 10.1007/s00167-010-1170-9ISI: 000286529200003PubMedID: 20532869OAI: oai:DiVA.org:liu-64457DiVA: diva2:391485
Note

Titled "Anterior cruciate ligament injuries in elite football: the influence of gender and age" in while in manuscript.

Available from: 2011-01-25 Created: 2011-01-25 Last updated: 2017-12-11
In thesis
1. Epidemiology of injuries in elite football
Open this publication in new window or tab >>Epidemiology of injuries in elite football
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis was to study the injury characteristics in elite football, and risk factors for injury with special emphasis on anterior cruciate ligament injury. All five papers followed a prospective design using a standardised methodology. Individual training and match exposure was recorded for all players participating as well as all injuries resulting in time loss. Severe injury was defined as absence from play longer than 4 weeks.

In Paper I, all 14 teams in the Swedish men’s elite league were studied during the 2001 season. In this paper, all tissue damage regardless of subsequent time loss was also recorded. There were no differences in injury incidence between the two injury definitions during match play (27.2 vs. 25.9 injuries per 1000 hours, p=0.66) or training (5.7 vs. 5.2 injuries per 1000 hours, p=0.65). Significantly higher injury incidences for training injury, overuse injury and re-injury were found during the pre-season compared to the competitive season. Thigh strain was the single most common injury (14%).

In Paper II, 8% of all players in the Swedish men’s elite league 2001 had a history of previous ACL injury at the start of the study period. These players had a higher incidence of new knee injury during the season than players without previous ACL injury (4.2 vs. 1.0 injuries per 1000 hours, p=0.02). The higher incidence of new knee injury was seen both when using the player (relative risk 3.4, 95% CI 1.8-6.3) and the knee (relative risk 4.5, 95% CI 2.3-8.8) as the unit of analysis.

In Paper III, eleven clubs in the men’s elite leagues of five European countries were studied during the 2001-2002 season. The incidence of match injury was higher for the English and Dutch teams compared to the Mediterranean teams (41.8 vs. 24.0 injuries per 1000 hours, p=0.008) as well as the incidence of severe injury (2.0 vs. 1.1 injuries per 1000 hours, p=0.04). Players having international duty had a higher match exposure (42 vs. 28 matches, p<0.001), but a tendency to a lower training injury incidence (4.1 vs. 6.2 injuries per 1000 hours, p=0.051). Thigh strain was the most common injury (16%) with posterior strains being more frequent than anterior ones (67 vs. 36, p<0.0001).

In Paper IV, the national teams of all 32 countries that qualified for the men’s European Championship 2004, the women’s European Championship 2005 and the men’s Under-19 European Championship 2005 were studied during the tournaments. There were no differences in match and training injury incidences between the championships. Teams eliminated after the group stage in the women’s championship had a significantly higher match injury incidence compared to teams going to the semi-finals (65.4 vs. 5.0 injuries per 1000 hours, p=0.02). Non-contact mechanisms were ascribed for 41% of the match injuries and these injuries were more common in the second half.

In Paper V, all 12 clubs in the Swedish women’s elite league and 11 of 14 clubs in the men’s elite league were studied during the 2005 season. The prevalence of a history of previous ACL injury at the start of the study was three times higher among the female players (15% vs. 5%, p=0.0002). During the season, 16 new ACL injuries were recorded. There was a tendency to a lower mean age at injury among the women (20 vs. 24 years, p=0.069). Adjusted for age, no gender-related difference in the incidence of ACL injury was seen (relative risk 0.99, 95% CI 0.37-2.6). Age was associated with ACL injury incidence in women where the risk decreased by 24% for each year increase in age (relative risk 0.76, 95% CI 0.59-0.96).

Place, publisher, year, edition, pages
Institutionen för hälsa och samhälle, 2007. 64 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 993
Keyword
Elite, epidemiology, football, injuries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-8623 (URN)978-91-85715-30-5 (ISBN)
Public defence
2007-05-04, Aulan, Hälsans hus, Universitetssjukhuset, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2007-04-05 Created: 2007-04-05 Last updated: 2013-04-03

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Waldén, MarkusHägglund, MartinMagnusson, HenrikEkstrand, Jan

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