• Female soccer and basketball players have the highest rates of ACL injuries
• Female soccer players have more non contact ACL injuries than male soccer players
• Male and female basketball players have similar rates of contact and non contact ACL injuries
• The rates of ACL injuries can be reported as injuries/1000 hrs of exposure or injuries/exposure
• NCAA data is reported as injuries/exposure
• Athletes have a higher rate of injury and a greater number of injuries during match play as compared to practice or training time
• Many theories for etiology of increased risk for females versus males but poor definitive evidence for one cause
• Most likely multifactorial
• Theories:
  • extrinsic ((body movement in sport, muscular strength and coordination, shoe-surface interface, and level of skill and conditioning)
  • intrinsic (joint laxity, limb alignment, notchimensions, and ligament size).

Rates of injuries in NCAA have not changed significantly despite awareness and modifications in training techniques over the past 19 years:

• 13 year follow up NCAA study from 1990-2002 of male and female soccer and basketball players by Agel et al:
  • Results reported as injury/1000 athlete exposures
  • The rate of anterior cruciate ligament injury for male soccer players was 0.11 compared to 0.08 for male basketball players (P = .002).
  • The rate of anterior cruciate ligament injury for female soccer players was 0.33 and for female basketball players was 0.29 (P = .04).
  • No significant difference was seen in basketball comparing frequency of contact versus non contact injuries between men (70.1%) and women (75.7%).
  • In soccer, there was a significant difference in frequency of injury for male (49.6%) and female (58.3%) athletes when comparing contact and non contact injuries ( P < .05)
• 4 year sampling study of NCAA in 1989-1993 by Arendt et al:
  • Rate per 1000 athlete exposures (a practice or a game is one exposure):
    • Women’s soccer .31
    • Men’s soccer .13
    • Women’s basketball .26
    • Men’s basketball .07
    • Women’s soccer 60-70% non contact
    • Men’s soccer 50% non contact