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399 Epidemiology of non-contact ACL injuries in team ball-sports: a systematic review with meta-analysis and meta-regression of 2748 injuries across 42 million player-hours and -exposures combined
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  1. Lionel Chia1,
  2. Danilo De Oliveira Silva2,
  3. Matthew Whalan3,
  4. Fuller Colin4,
  5. Marnee McKay1,
  6. Justin Sullivan1,
  7. Pappas Evangelos1,5
  1. 1The University of Sydney, NSW, Australia
  2. 2La Trobe University, NSW, Australia
  3. 3Football Australia, NSW, Australia
  4. 4Colin Fuller Consultancy, NOTT, UK
  5. 5University of Wollongong, NSW, Australia

Abstract

Background Not all ACL injuries are preventable. The epidemiology of non-contact ACL injuries is not known.

Objective To estimate the incidence and proportion of non-contact to total ACL injuries by sex, age, sport, participation level, and exposure type.

Design Systematic review, meta-analysis and meta-regression

Setting Team ball-sports (soccer, rugby, basketball, volleyball, American and Australian football, floorball, lacrosse, hockey, baseball, softball)

Participants Athletes participating in team ball-sports regardless of sex, age, and participation level

Interventions Six electronic databases were searched from inception to July 2020. Cohort studies of team ball-sports reporting number of knee injuries as a function of exposure and injury mechanism were included.

Main Outcome Measurements Proportion of non-contact to total ACL injuries and non-contact ACL injury incidence by unit of exposure, sex, age group, sport, participation level, and exposure type.

Results Forty-three studies covering 12 sports were included. The overall proportion of non-contact to total ACL injuries was 54% (95% CI 47–60%, I 2=90%; females: 62%, 95% CI 54–70%, I 2=83%; males: 47%, 95% CI 39–54%, I 2=86%). Injury incidence was higher in females (0.20 per 1000 player-hours, 95% CI 0.12–0.33, I 2=92%; 0.07 per 1000 player-exposures, 95% CI 0.04–0.14, I 2=98%) than males (0.08 per 1000 player-hours, 95% CI 0.04–0.14, I 2=94%; 0.05 per 1000 player-exposures, 95% CI 0.03–0.08, I 2=97%). Injury incidence during competition was much higher (0.53 per 1000 player-hours, 95% CI 0.35–0.81, I 2=80%; 0.35 per 1000 player-exposures, 95% CI 0.17–0.71, I 2=96%) than training (0.03 per 1000 player-hours (95% CI 0.02–0.05, I 2=60%; 0.02 per 1000 player-exposures, 95% CI 0.01–0.05, I 2=86%). Heterogeneity between studies was generally high.

Conclusions Non-contact ACL injuries represented over half of all ACL injuries sustained. The proportion of non-contact to total ACL injuries and injury incidence were higher in females than males. Injuries mostly occurred in competition settings. More research is required to fully understand the influence of sport, age group, and participation level on injury proportion and incidence. difficult.

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