Timing of Noncontact Anterior Cruciate Ligament Injury According to Developmental Stage in Japanese Female Athletes.

OBJECTIVES

This study aimed to identify the timing of high incidence of noncontact anterior cruciate ligament (ACL) injuries in female athletes by developmental stage.

DESIGN

Cross-sectional study.

SETTING

Orthopedic clinic specializing in sports injuries.

PARTICIPANTS

The study included 335 female athletes, from elementary school to college, diagnosed with ACL injuries by orthopedic surgeons at our clinic.

ASSESSMENT OF RISK FACTORS: The developmental stage at the time of noncontact ACL injury.

MAIN OUTCOME MEASURES: The primary outcome was noncontact ACL injury incidence by developmental stage. Using the Pubertal Development Scale, a multiple-choice self-administered questionnaire, we assessed the developmental stage at the time of ACL injury, and having classified participants into 5 stages-prepubertal, early pubertal, middle pubertal, late pubertal, and postpubertal-we identified the period with highest incidence of ACL injuries.

RESULTS

Noncontact ACL injuries by developmental stage were 0 in prepuberty and early puberty, 5 (1.9%) in middle puberty, 221 (84.0%) in late puberty, and 37 (14.1%) in postpuberty. The distribution significantly deviated from an even distribution (χ2(2) = 310.02, P < 0.001), with more than expected in late puberty (adj. residual = 2.6) and fewer in middle puberty (adj. residual = -3.1). Contact injuries also deviated (χ2(2) = 26.34, P < 0.001), with fewer in late puberty (adj. residual = -2.6) and more in middle puberty (adj. residual = 3.1).

CONCLUSIONS

In female athletes, late puberty seems to be the period of highest incidence of noncontact ACL injuries, suggesting that it could be 1 of risk factors for ACL injury.