Strength and biomechanical risk factors for non-contact ACL injury in elite female footballers: A prospective study

Tyler Collings, Laura Diamond, Rod Barrett, Ryan G. Timmins, Jack Hickey, William du Moulin, Morgan Williams, Kate Beerworth, Matthew Bourne

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Abstract

Purpose
To determine if a pre-season field-based test battery was prospectively associated with non-contact ACL injury in elite female footballers.

Methods
In total, 322 elite senior and junior female Australian Rules Football and soccer players had their isometric hip adductor and abductor strength, eccentric knee flexor strength, countermovement jump (CMJ) kinetics, and single-leg hop kinematics assessed during the 2019 pre-season. Demographic and injury history details were also collected. Footballers were subsequently followed for 18 months for ACL injury.

Results
15 non-contact ACL injuries occurred during the follow-up period. Prior ACL injury (odds ratio [OR] = 9.68, 95% confidence interval [95%CI] = 2.67-31.46), a lower isometric hip adductor to abductor strength ratio (OR = 1.98, 95%CI = 1.09-3.61), greater CMJ peak take-off force (OR = 1.74, 95%CI = 1.09-3.61), and greater single-leg triple vertical hop average dynamic knee valgus (OR = 1.97, 95%CI = 1.06-3.63) and ipsilateral trunk flexion (OR = 1.60, 95%CI = 1.01-2.55) were independently associated with increased risk for subsequent ACL injury. A multivariable prediction model consisting of CMJ peak take-off force, dynamic knee valgus, and ACL injury history that was internally validated classified ACL injured from uninjured footballers with 78% total accuracy. Between-leg asymmetry in lower limb strength and CMJ kinetics were not associated with subsequent ACL injury risk.

Conclusions
Pre-season field-based measures of lower limb muscle strength and biomechanics were associated with future non-contact ACL injury in elite female footballers. These risk factors can be used to guide ACL injury screening practices and inform the design of targeted injury prevention training in elite female footballers.
Original languageEnglish
Pages (from-to)1242-1251
Number of pages10
JournalMedicine and Science in Sports and Exercise
Volume54
Issue number8
Early online date24 Mar 2022
DOIs
Publication statusPublished - 24 Mar 2022

Keywords

  • ACL
  • Injury prevention
  • physical therapy/rehabilitation
  • Female athlete

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