ACL injuries are common, serious and can be career-threatening for football players. This systematic review and meta-analysis evaluated twenty-eight studies of ACL injuries in male and female players and attempted to quantify the risk of ACL injuries for players of different genders and participation levels1.
The results of the analysis showed that the incidence proportion (IP) and incidence rate (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 four years, respectively. The IP and IR of ACL injury in male football 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%).
When controlling for exposure, women had a 2.2 times increased incidence rate of ACL injury compared to men. It would be reasonable to expect that a higher proportion of women would sustain this injury compared to men given the rate of injury occurrence being more than double, however this was not the case. One possible explanation for this may be that men play more than twice as much football. As the number of female football teams are increasing, it is highly likely training and game time for female footballers will also increase. As a result of this increased exposure we may see an increase in the incidence rate in female player.
The higher rate of ACL injury amongst female footballers has remained steady, despite increasing evidence that ACL injury prevention programmes are effective. This may mean that these programmes are not being done and illustrates the need to address barriers to implementing such programmes.
This analysis included studies with a variety of designs, and significant statistical heterogenicity was seen. There was also the inclusion of re-injuries, and some studies only included non-contact mechanisms of injury. This may mean that the findings may be underestimates of the true rates. Regardless this meta-analysis demonstrates the need to include data on both female and male footballers simultaneously to allow for sex comparisons, and to plan appropriate injury prevention strategies.
11. Montalvo AM, Schneider DK, Silva PL, Yut L, et al. ‘What’s my risk of sustaining an ACL injury while playing football (soccer)?‘ A systematic review with meta-analysis. Br J Sports Med. 2019 Nov;53(21):1333-1340.