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Similar Risk of ACL Injuries for Both Boys and Girls in High School Athletics

Think female youth athletes are significantly more at risk of suffering injuries to their anterior cruciate ligaments (ACLs)? Think again.

A new study published online today in the Journal of Athletic Training found no significant gender difference in ACL injury rates among high school athletes. Athletes of both genders were found to be far more likely to suffer ACL injuries in competitions than in practices, however.

(For some brief background: The ACL is one of the four major ligaments of the knee. It's responsible for stabilizing the knee joint during actions that involve turning or pivoting.) 

All high schools with one or more National Athletic Trainers' Association-affiliated certified athletic trainers were invited to participate in the study using the High School Reporting Information Online (RIO) program. They reported injury and exposure data for nine high school sports from the 2007-08 to 2011-12 school years: for boys, they tracked football, soccer, basketball, baseball, and wrestling; for girls, they examined soccer, softball, basketball, and volleyball.

During the study period, the trainers reported 617 ACL injuries occurring in just under 9.5 million athletic exposures, defined as each time an athlete participated in one practice or competition. Of those 617 injuries, 459 resulted in surgery (74.4 percent). Nationally, an estimated 124,626 ACL injuries in boys and 91,002 ACL injuries in girls occurred in athletes participating in the nine sports examined between 2007-08 and 2011-12.

The study found that for athletes of both genders, ACL injuries were far more common in competitions than in practices.

Boys in the study suffered a total of 388 ACL injuries, with football (286 injuries) accounting for a grand majority (71.2 percent of all boys' ACL injuries). In total, boys suffered 17.4 ACL injuries per 100,000 athletic exposures in competitions, but only 2.5 ACL injuries per 100,000 athletic exposures in practices. Girls suffered 229 ACL injuries, with soccer (96) and basketball (92) accounting for most. Per 100,000 athletic exposures, females suffered 17.9 ACL injuries in competitions and 2.2 in practices.

While the study found no significant difference between boys' and girls' overall ACL-injury rates, girls did suffer far more ACL injuries in sex-comparable sports (soccer, basketball, and softball/baseball). Girls suffered 209 ACL injuries in those sports, compared to boys' 75 injuries, and had a higher injury rate than boys (8.9 vs. 2.6 ACL injuries per 100,000 athletic exposures, respectively).

"The key message here is that targeted injury prevention programs should be focused on athletes participating in sports with the highest risk of ACL injury," Dawn Comstock, an author of the study and an associate professor at the Colorado School of Public Health, said in a statement. "For example, we found boys playing football were four times as likely to sustain ACL injury as boys playing other sports. Similarly, girls were four times as likely to sustain an injury in soccer and basketball compared to volleyball and softball."

The authors of the study call for coaches and athletic trainers in sports with high rates of ACL injuries to "take special care to teach sport-specific skills (eg, planting and changing direction, jumping and landing) and address potential deficits in the neuromuscular strength and coordination of the stabilizing muscles about the knee join through stretching, plyometrics, and strength training drills."

There's much still to be learned about ACL-injury prevention, which the study authors acknowledge. They call for further research into modifiable risk factors, such as player-player contact, that could help reduce the risk of ACL injuries among youth athletes. 

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