Longitudinal assessment of noncontact anterior cruciate ligament injury risk factors during maturation in a female athlete

A case report

Gregory D. Myer, Kevin R. Ford, Jon G. Divine, Eric J. Wall, Leamor Kahanov, Timothy Hewett

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Objective: To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury. Background: In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured. Differential Diagnosis: Partial or complete tear of the ACL. Measurements: The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort. Findings: The injury occurred in the year after the third assessment during the athlete's club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth. Conclusions: During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury.

Original languageEnglish (US)
Pages (from-to)101-109
Number of pages9
JournalJournal of Athletic Training
Volume44
Issue number1
StatePublished - Jan 2009
Externally publishedYes

Fingerprint

Athletes
Knee
Wounds and Injuries
Hip
Basketball
Menarche
Body Height
Anterior Cruciate Ligament
Puberty
Thigh
Anterior Cruciate Ligament Injuries
Rupture
Body Mass Index
Differential Diagnosis
Cohort Studies
Research Personnel
Magnetic Resonance Imaging
Prospective Studies
Growth

Keywords

  • Anterior cruciate ligament injury mechanisms
  • Female athlete triad
  • High-risk athletes
  • Knee injuries
  • Lower extremity injuries
  • Neuromuscular adaptations
  • Neuromuscular spurt

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Medicine(all)

Cite this

Longitudinal assessment of noncontact anterior cruciate ligament injury risk factors during maturation in a female athlete : A case report. / Myer, Gregory D.; Ford, Kevin R.; Divine, Jon G.; Wall, Eric J.; Kahanov, Leamor; Hewett, Timothy.

In: Journal of Athletic Training, Vol. 44, No. 1, 01.2009, p. 101-109.

Research output: Contribution to journalArticle

Myer, Gregory D. ; Ford, Kevin R. ; Divine, Jon G. ; Wall, Eric J. ; Kahanov, Leamor ; Hewett, Timothy. / Longitudinal assessment of noncontact anterior cruciate ligament injury risk factors during maturation in a female athlete : A case report. In: Journal of Athletic Training. 2009 ; Vol. 44, No. 1. pp. 101-109.
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