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

Journal article

Collings, Tyler J., Diamond, Laura E., Barrett, Rod S., Timmins, Ryan G., Hickey, Jack T., du Moulin, William S., Williams, Morgan D., Beerworth, Kate A. and Bourne, Matthew N.. (2022). Strength and biomechanical risk factors for noncontact ACL injury in elite female footballers : A prospective study. Medicine and Science in Sports and Exercise. 54(8), pp. 1242-1251. https://doi.org/10.1249/MSS.0000000000002908
AuthorsCollings, Tyler J., Diamond, Laura E., Barrett, Rod S., Timmins, Ryan G., Hickey, Jack T., du Moulin, William S., Williams, Morgan D., Beerworth, Kate A. and Bourne, Matthew N.
Abstract

Purpose
This study aimed to determine if a preseason field-based test battery was prospectively associated with noncontact anterior cruciate ligament (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 preseason. Demographic and injury history details were also collected. Footballers were subsequently followed for 18 months for ACL injury.

Results
Fifteen noncontact 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 an increased risk of 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
Preseason field-based measures of lower limb muscle strength and biomechanics were associated with future noncontact 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.

KeywordsACL; injury prevention; rehabilitation; female athlete; strength; biomechanics
Year2022
JournalMedicine and Science in Sports and Exercise
Journal citation54 (8), pp. 1242-1251
PublisherLippincott Williams & Wilkins
ISSN0195-9131
Digital Object Identifier (DOI)https://doi.org/10.1249/MSS.0000000000002908
Scopus EID2-s2.0-85131397042
Open accessPublished as green open access
Page range1242-1251
FunderSports Medicine Australia (SMA)
Australian Government
Vald Performance Pty Ltd
Author's accepted manuscript
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Open
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All rights reserved
File Access Level
Controlled
Output statusPublished
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OnlineAug 2022
Publication process dates
Deposited08 Dec 2022
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Eccentric hamstring strength and hamstring injury risk in Australian footballers
Opar, David A., Williams, Morgan D., Timmins, Ryan G., Duhig, Steven and Shield, Anthony J.. (2015). Eccentric hamstring strength and hamstring injury risk in Australian footballers. Medicine and Science in Sports and Exercise. 47(4). https://doi.org/10.1249/MSS.0000000000000465
The effect of previous hamstring strain injury on the change in eccentric hamstring strength during preseason training in elite Australian footballers
Opar, David A., Williams, Morgan D., Timmins, Ryan G., Hickey, Jack, Duhig, Steven J. and Shield, Anthony J.. (2015). The effect of previous hamstring strain injury on the change in eccentric hamstring strength during preseason training in elite Australian footballers. American Journal of Sports Medicine. 43(2), pp. 377-384. https://doi.org/10.1177/0363546514556638
Biceps femoris long head architecture: A reliability and retrospective injury study
Timmins, Ryan Gregory, Shield, Anthony, Williams, Morgan, Lorenzen, Christian and Opar, David. (2015). Biceps femoris long head architecture: A reliability and retrospective injury study. Medicine and Science in Sports and Exercise. 47(5), pp. 905 - 913. https://doi.org/10.1249/MSS.0000000000000507
Biceps femoris long head architecture: The association with hamstring injury and response to training
Timmins, Ryan Gregory. (2015). Biceps femoris long head architecture: The association with hamstring injury and response to training [Thesis]. https://doi.org/10.4226/66/5a9cbd05b0b98
Reduced biceps femoris myoelectrical activity influences eccentric knee flexor weakness after repeat sprint running
Timmins, R. G., Opar, D. A., Williams, M. D., Schache, A. G., Dear, N. M. and Shield, A. J.. (2014). Reduced biceps femoris myoelectrical activity influences eccentric knee flexor weakness after repeat sprint running. Scandinavian Journal of Medicine & Science in Sports. 24(4), pp. e299-e305. https://doi.org/10.1111/sms.12171
The financial cost of hamstring strain injuries in the Australian Football League
Hickey, Jack, Shield, Anthony J., Williams, Morgan D. and Opar, David A. (2014). The financial cost of hamstring strain injuries in the Australian Football League. British Journal of Sports Medicine. 48(8), pp. 729-730. https://doi.org/10.1136/bjsports-2013-092884
Rate of torque and electromyographic development during anticipated eccentric contraction is lower in previously strained hamstrings
Opar, David A., Williams, Morgan D., Timmins, Ryan G. and Dear, Nuala M. (2013). Rate of torque and electromyographic development during anticipated eccentric contraction is lower in previously strained hamstrings. The American Journal of Sports Medicine. 41(1), pp. 116-125. https://doi.org/10.1177/0363546512462809
Knee flexor strength and bicep femoris electromyographical activity is lower in previously strained hamstrings
Opar, David A., Williams, Morgan D., Timmins, Ryan G., Dear, Nuala M. and Shield, Anthony J. (2013). Knee flexor strength and bicep femoris electromyographical activity is lower in previously strained hamstrings. Journal of Electromyography and Kinesiology. 23(3), pp. 696-703. https://doi.org/10.1016/j.jelekin.2012.11.004