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Non-contact anterior cruciate ligament injury differences in males and females: a meta-analysis
Alex, Keith
Rios-Ochoa, Jose
Place of Publication:
Denver, CO
Metropolitan State University of Denver
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Conference poster


General Note:
Presented at the 2020 Metropolitan State University of Denver Undergraduate Research Conference
General Note:
Faculty mentor: Jeffrey Simpson
General Note:
Department of Biology

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Auraria Institutional Repository
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Auraria Library
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All applicable rights reserved by the source institution and holding location.


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INTRODUCTION ABSTRACT RESULTS SUMMARY AND CONCLUSIONS Background: Anterior Cruciate Ligament (ACL) is one of the biggest concerns for athletes when it comes to injuries. The recurrence of ACL ruptures more likely in females than males due to certain factors discussed below. Hypothesis: Female athletes are more likely to rupture a previously non contact ACL injury than male athletes due to the biomechanics of the lower extremity. Study Design: A Meta Analysis Research Project Methods: Systematic review was conducted from multiple published articles; Descriptive analysis are used as well as three dimensional motion analysis during the DL (double legged) DVJ (Double Vertical Jump) and SL (Single Legged drop landing tasks). Researchers used retroreflective markers which were secured to the bilateral upper extremities, trunk, pelvis, hips, thighs, knees, shanks, an kle s, and feet to calculate joint centers and tract segmented motions. Other researchers separated ACL injuries based on contact and non contact i njuries. Contact were excluded injuries. These methods were used to analyze vertical jump tests. Results: Multiple results were observed at to see the correlation between each study that had similar results when comparing to recurr ent ACL injury in females and males. Results from each study were broken down from ipsilateral graft tear and contralateral graft te ar. Contact to contact action were excluded from these experiments. Based on one study, the odds of an ipsilateral retear were not significa ntl y different for hamstring autograft (odds ratio [OR], 1.60; 95% CI, 0.89 2.90; P = .12) but were 5.2 times greater for an allograft (OR, 5.20; 9 5% CI, 2.60 10.44; P < .01) The odds of an ipsilateral retear decreased by 0.09 for every yearly increase in age (OR, 0.91; 95% CI, 0.87 0.9 4; P < .01) and increased by 0.11 for every increased point on the Marx activity score (OR, 1.11; 95% CI, 1.03 1.20; P < .01) (12). Risk of a co ntralateral ACL tear showed that younger age and higher activity level were found to be significant risk factors for tearing the contrala ter al ACL. The odds of a contralateral ACL tear were not significantly different as a function of sex, sport played, graft type, or medial o r l ateral meniscal tear status (P > .05) (12). Similar study results showed within the 23 participants after an ACLR with subsequent ACL injury, 16 (69.6%) sustained contralateral ACL injuries, and 7 (30.4%) sustained an ipsilateral graft retear; 19 (82.6%) were female and 4 (17.4 %) were male (14). There was no difference in mean time from surgery to RTS between the participants in the ACLR group who sustained secon d i njury (8.3 +/ 2.0 months) and those who did not sustain a second ACL injury (8.2 +/ 2.7 months) (14). Standing long jump (SLJ) and ( SLH) studies results showed that less than or equal to 79% height , bilateral SLH less than or equal to 69% height have a higher risk of non contact time loss lower quadrant risk. Moreover, prior history of ACLR (anterior cruciate ligament reconstruction) resulted in a greater risk of non contact time loss ACL sprain than those without. Conclusion: The purpose of this research was to see the difference between female and male anatomy and how vertical tests affect the biomechanics of the lower extremity. There were certain factors that may have caused females to reinjure the ACL injury more fre quently than males. These factors include Q angle, the kinematics of the knee joint, hip joint, and ankle joint. While there were con clu sive data that supports the higher Q angle could increase another ACL rupture in females. In addition, the kinematic alterations post ACL su rge ry have been a contributing factor due to mechanical instability, and altered biomechanics in the knee joint may affect the quality of lif e w hich may lead to osteoarthritis. The anterior cruciate ligament (ACL) is one of the most common ligaments injured by athletes, with approximately 200 , 000 250 , 000 injuries annually ( 2 , 3 ) These cost athletes within United States an estimated $ 7 . 6 billion in reconstructive surgery and $ 17 . 7 billion in rehabilitation yearly ( 3 ) . Even after surgery and rehabilitation, the long term effects are still present and may negatively impact athletic performance . ACLR grafts Surgical grafts (Hamstring tendon, patellar tendon, cadaver graft, and LARS), are factors that allow at most 65 % of athletes ability to returned to pre injury performance level and only 55 % of athletes return to sport competitively . Athletes who had ACLR are at high risk of ACL rupture, osteoarthritis of the knee, and 7 24 % higher risk of contralateral ACL tear post reconstruction . A better understanding of these causes could prevent reoccurrence of contralateral ACL injury or ipsilateral graft tear, as well as important financially, but the well being of the athletes . References : Keep to a minimum and make them small ,but still readable font, remember the letter size will be blown up during printing . [1] The American Journal of Sports Medicine , vol. 43, no. 7, 2015, pp. 1583 1590., doi:10.1177/0363546515578836. [ 2 ] Paterno, Mark V . , et al . of Second ACL Injuries 2 Years After Primary ACL Reconstruction and Return to Sport . The American Journal of Sports Medicine , vol . 42 , no . 7 , 2014 , pp . 1567 1573 . , doi : 10 . 1177 / 0363546514530088 . [ 3 ] Jason Brumitt, Alma Mattocks, Amy Engilis, Dale Isaak, Jeremy Loew, Prior history of anterior cruciate ligament (ACL) reconstruction is associated with a greater risk of subsequent ACL injury in female collegiate athletes . J . Sci . Med . Sport . 12 , 1309 1313 ( 2019 ) . [ 4 ] Dhong Won Lee, Sang Jin Yang, Seung Ik Cho, Jung Ho Lee, Jin Goo Kim, Single leg vertical jump test as a functional test after anterior cruciate ligament reconstruction . Knee . 25 , 1016 1026 ( 2018 ) . [5] Orthopaedic Journal of Sports Medicine , vol. 7, no. 3, 2019, p. 232596711983106., doi:10.1177/2325967119831061. Non Contact Anterior Cruciate Ligament Injury Differences in Males and Females: A Meta Analysis 1 Keith Alex , 2 Jose Rios Ochoa , 1 Jeffery Simpson , DC, CCSP 1 Metropolitan State University of Denver The purpose of this research was to observe the difference between female and male biomechanics and how females are more likely to reinjure another ACL rupture in non contact tests . There are following factors that might contribute to this outcome : The Q angle, and the kinematics of the knee joint Kaeding et al and Paterno, Mark V . , et al showed similar results when it pertains to percentage of injuries that occurred between male and female athletes . Kaeding et al does speculate that the potential risk of graft retear would be the allow an immediate return to sport . Paterno, Mark V . , et al results showed that out of 23 participant ( 19 female 4 male), 16 sustained a contralateral ACL injury and 7 sustained an ipsilateral graft retear . The rate of injuries within 24 month of return to sports, female athletes in the ACLR group was 5 times greater than female in the control group . Q angle plays a huge role in the reoccurrence of ACL injury . larger Q angle values observed in the females studied may help to explain the difference in ACL injury rates . Kinematic alterations have been reported in the short term post ACL injury during demanding hop activities . Consequences of such kinematic alteration may include mechanical instability, further triggering the development of osteoarthritis (OA) due to altered biomechanics in the knee joint and thus may affect the quality of life . There were inconclusive data that explains that the menstrual cycle does not affect women in the recurrence of ACL injury . However, the use of oral contraceptives does decrease the ACL injury . Although, it decreases its knee laxity, it is still beneficial for female athletes who are active and play sports . Future Investigations : To further the study in the future, we believed to narrow down the specific tests that is being conducted in each experiment . Have a better comparison of male and female athletes in each studies . Experimental Approach Special Thanks for Dr. Jeffery Simpson and Jose Rios Ochoa Relative risk of Injury per functional performance test (FPT) scores and prior history of Anterior Cruciate Ligament Reconstruction (ACLR) Based on Standing Long jump & Single leg hop Visual examples of Single Leg Vertical Jump Tests & Single Leg Hop in Lee et al Study Risk Factors for Ipsilateral Graft Retear & Contralateral ACL Tear The hypothesis for this research is that female athletes are more likely to rupture a previous non contact ACL injury than male athletes due to the biomechanics of the lower extremity. For our experimental approach, we gathered multiple research analysis to assess correlation between each studies and determine a pattern of results and conclude whether the hypothesis is conclusive or not. Distribution of Second Injuries by Graft Source Patient Demographics in Kaeding et al Study