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Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement

¹ IOC Medical Commission and Karolinska Institutet, Stockholm, Sweden
² IOC Medical Commission, Lausanne, Switzerland
³ Department of Orthopedics, University of Minnesota, Minnesota, USA
⁴ University of Vermont College of Medicine, Vermont, USA
⁵ Faculty of Sports Sciences, University of Waseda, Tokyo, Japan
⁶ Sports Medicine Centre, Duke University, Durham, North Carolina, USA
⁷ Department of Orthopedic Surgery, University of Ioannina, Ioannina, Greece
⁸ Cincinnati Children’s Sports Medicine Biomechanics Centre, Human Performance Laboratory, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
⁹ Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
¹⁰ Chivas USA and LA Galaxy, Pepperdine University, FIFA Medical Committee, FMARC Member, Malibu, California, USA
¹¹ Harvard Medical School Division of Sports Medicine, Children’s Hospital, Boston, USA
¹² Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark
¹³ Department of Orthopedics, Lund University, Lund, Sweden
¹⁴ IOC Medical and Scientific Department, Lausanne, Switzerland
¹⁵ Department of Exercise and Sports Science, University of North Carolina at Greensboro, North Carolina, USA
¹⁶ Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
¹⁷ Medsport, University of Michigan, Michigan, USA
¹⁸ Scientific Activities IOC and Orthopaedic Center, Ullevaal University Hospital and Oslo Sports Trauma Research Center, Oslo, Norway

Correspondence to:
Professor Emeritus Per Renström, Flötviksvägen 51, Hässelby, 16572 Sweden; per.renstrom{at}telia.com

The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes. Because female athletes have a much higher incidence of ACL injuries in sports such as basketball and team handball than male athletes, the IOC Medical Commission invited a multidisciplinary group of ACL expert clinicians and scientists to (1) review current evidence including data from the new Scandinavian ACL registries; (2) critically evaluate high-quality studies of injury mechanics; (3) consider the key elements of successful prevention programmes; (4) summarise clinical management including surgery and conservative management; and (5) identify areas for further research. Risk factors for female athletes suffering ACL injury include: (1) being in the preovulatory phase of the menstrual cycle compared with the postovulatory phase; (2) having decreased intercondylar notch width on plain radiography; and (3) developing increased knee abduction moment (a valgus intersegmental torque) during impact on landing. Well-designed injury prevention programmes reduce the risk of ACL for athletes, particularly women. These programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training. They emphasise proper landing and cutting techniques. This includes landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion and, where possible, landing on two feet. Players are trained to avoid excessive dynamic valgus of the knee and to focus on the "knee over toe position" when cutting.