Interaction of Potential Intrinsic and Extrinsic Risk Factors in ACL Injured Recreational Female Skiers

Abstract

The aim of this study was to investigate the interaction of potential intrinsic and extrinsic risk factors in ACL injured recreational female skiers. 93 female recreational skiers who had suffered a non-contact ACL injury and 93 age-matched controls completed a self-reported questionnaire relating to intrinsic risk factors (menstrual history, BMI, previous knee injuries, self reported weekly sports participation) and extrinsic risk factors (type of ski used, time of last binding adjustment, snow condition, weather and slope difficulty). A logistic regression model revealed the following independent ACL injury risk factors for female recreational skiers: icy snow conditions (odds ratio, 24.33; 95% confidence interval, 6.8-86.5, P<0.001), skiing during snowfall (odds ratio, 16.63; 95% confidence interval, 1.8-152.1, P=0.013), use of traditional skis (odds ratio, 10.49; 95% confidence interval, 2.0-54.5, P=0.005), and preovulatory phase of menstrual cycle (odds ratio, 2.59; 95% confidence interval, 1.2-5.5, P=0.013). In conclusion, ACL injuries in female recreational skiers are the result of a complex interaction of intrinsic and extrinsic risk factors.

Effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate ligament injury risk: a systematic review

“…Table IV summarises the main methodological criteria and results for the included studies. Seven studies in this review investigated lower-limb biomechanics 26,27,[31][32][33][34][35] , five neuromuscular control 26,27,33,34,36 , and ten ACL injury risk 25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] . The studies were separated into four main outcome measure categories for review: I) lower-limb kinematics; II) lower-limb kinetics; III) neuromuscular control; IV) ACL injury risk.…”

“…A total of 17 studies of varying quality met the inclusion criteria for this systematic review and were evaluated. Strong evidence from this review indicates that female athletes have a significantly greater risk of ACL injury in the pre-ovulatory phase during dynamic sporting activity 25,38,41,43,45 . Strong evidence from this review indicates a sub-group of female athletes with significantly greater anterior knee laxity in the preovulatory phase, in whom significantly greater knee valgus and knee external rotation moments represent possible mechanisms behind greater ACL injury risk 27,31,32 .…”

“…Ten studies investigated ACL injury risk in female participants during the menstrual cycle 25,[37][38][39][40][41][42][43][44][45] . Strong evidence from eight studies reported significantly greater ACL injury risk in female participants in the pre-ovulatory compared to post-ovulatory phase during sporting activity 25,37,38,40,41,[43][44][45] .…”

“…Strong evidence from eight studies reported significantly greater ACL injury risk in female participants in the pre-ovulatory compared to post-ovulatory phase during sporting activity 25,37,38,40,41,[43][44][45] . Limited evidence from one good quality study reported significantly greater ACL injury risk in female participants in the ovulatory compared to pre and post-ovulatory phases during sporting activity 37 .…”

“…In 2016 these reviews have at least three limitations. First, all are now dated and therefore do not benefit from important recent trials concerning biomechanical analysis and ACL injury [25][26][27] . Second, two of the reviews focused on the effects of menstrual cycle on ACL injury risk in female athletes only 18,23 , and the other reviewed the effects of menstrual cycle on ACL laxity in female athletes only 24 .…”