ACL Injuries Aren’t Just for Girls: The Role of Age in Predicting Pediatric ACL Injury

Abstract

Background: Female athletes have a higher rate of anterior cruciate ligament (ACL) injuries than male athletes; however, the role of age in mediating this injury risk has not been explored. The purpose of this study was to characterize the relationship between age and sex in predicting ACL injury in the pediatric population. Hypothesis: Prepubescent boys are more likely to sustain an ACL injury than prepubescent girls. Study Design: Descriptive epidemiological study. Level of Evidence: Level 4. Methods: Data were collected from the Statewide Planning and Research Cooperative System database for the state of New York from 1996 to 2016. The database was queried for patients aged ≤19 years who had been diagnosed with an ACL tear using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 844.2 or the ICD-10 (10th Revision) codes S83.512A/S83.511A/S83.519A. Patient age and sex at time of ACL injury diagnosis were recorded. Chi-square analysis was used to compare the frequency of ACL injury between groups, with statistical significance set at P < 0.05. Results: A total of 20,128 patients aged ≤19 years were diagnosed with an ACL tear (10,830 males, 9298 females; male:female, 1.16:1). In all, 129 patients aged <12 years sustained an ACL tear (85 boys, 44 girls; male:female, 1.93:1), and 19,999 of those patients were aged 12 to 19 years (10,745 males, 9254 females; male:female, 1.16:1). Chi-square analysis demonstrated a significant relationship between sex and age group ( P < 0.006). Additional analysis revealed that female athletes were most at risk for ACL injury from ages 12 to 16 years, with 4025 male and 5095 female athletes sustaining ACL injuries in this group (male:female, 1:1.27; P < 0.0001). Conclusion: Prepubescent boys (aged <12 years) are more likely to sustain an ACL injury than same-aged female peers. Clinical Relevance: This study demonstrates that the risk of ACL injury varies with age and sex throughout childhood and adolescence, further guiding treatment and prevention for these pediatric athletes.

Iliotibial Band Autograft Provides the Fastest Recovery of Knee Extensor Mechanism Function in Pediatric Anterior Cruciate Ligament Reconstruction

“…The distribution of sex also differed among groups, with a higher percentage of males in the IT (75% male) and HT (55% male) groups. The difference in sex is likely related to the difference in age since ACL injury is more common in boys at younger ages (<12 years) and girls at older ages (≥12 years) [ 28 ]. To account for these differences, we included sex and age as covariates in our analysis.…”

Unique Considerations for the Pediatric Athlete During Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction

“…[2][3][4]6,22 In children younger than 12, a higher ACL injury rate is reported in boys. 1,2,[23][24][25] Increased rates in female athletes begin around puberty, 1,24 at around age 12. In both sexes, the rate of ACL injuries increase as they progress through puberty.…”

“…In both sexes, the rate of ACL injuries increase as they progress through puberty. 1,2,4,24 The overall injury rate is highest in late adolescence for both sexes (15-18 years). [1][2][3][4] Periods of rapid growth and development may contribute to ACL injury risk.…”

“…1,2,4,24 The overall injury rate is highest in late adolescence for both sexes (15-18 years). [1][2][3][4] Periods of rapid growth and development may contribute to ACL injury risk. The femur and tibia grow at a fast rate, which creates a longer lever and increases torque at the knee.…”

“…Level of Evidence: Level V.O ver the last 2 decades, anterior cruciate ligament (ACL) injuries and surgical intervention in children and adolescents have been increasing. [1][2][3][4][5][6][7] This increase is often attributed to increased participation in competitive organized sports, 8 early sports specialization, 9 and year-round training and competition. 10 Furthermore, advancements in surgical techniques allow for early reconstruction of the ACL in the…”