Increased risk of ACL reconstruction in young athletes

ACL injuries in young women

Two new studies conducted in Scandinavia have further confirmed something the sports medicine community is all too aware of: that the boom in sporting activity amongst the young could be storing up a heap of long-term problems.

According to one study, conducted by Oslo University Hospital, adolescents who participate in both level I sports such as football and handball and in sport competitions had a significantly increased risk of undergoing primary ACL reconstruction.

University Hospital researchers tracked 7,644 adolescents – 3,808 boys and 3,836 girls – who were included in the Young-Nord-Trøndelag Health Study from 2006 to 2008. Level of sport participation and sport competitions were included as main risk factors of interest, and the endpoint was primary ACL reconstruction recorded in the Norwegian National Knee Ligament Registry between January 2006 and December 2013.

The results demonstrated that level I sports had an ACL reconstruction incidence rate over 3 times higher than level II or level III sports, which was also seen in sex-stratified and age-adjusted analyses. And compared with adolescents who did not compete in sports, the patients who participated in sport competitions had a 4-times higher incidence of ACL reconstruction.

Women affected more than men with ACL injuries

Meanwhile, a study conducted at Sweden’s Karolinska Institutet reports that an average of three in every ten adolescent elite athletes suffer an injury, with the worst affected being young women – and the risk of injury increases with low self-esteem, especially in combination with less sleep and higher training volume and intensity.

The study, headed by Philip von Rosen, researcher at the Department of Neurobiology, Care Sciences and Society at the Instituet, consisted of surveys taken by 680 elite athletes representing 16 different sports at 24 schools around the country on injury occurrence and the volume and intensity of their training programmes.

“Our studies show that the incidence of injury is high in adolescent elite athletes,” said von Rosen. “During the average week, one in three of them was injured. Over a year, almost all of them had been injured at least once and around 75 per cent reported that they had been seriously injured at least once during the year.”

Lack of sleep and self-esteem a huge factor

To ascertain the possible risk factors behind the ACL injuries, the participants were also asked every term about their self-esteem, nutrient intake and self-rated stress and sleep. Those who increased the volume and intensity of their training while reducing the duration of their sleep showed a 100 per cent rise in risk of injury. And an athlete with low self-esteem who increased the volume and intensity of his or her training while cutting back on sleep had three times the risk of injury compared to an athlete with average self-esteem who had not changed his or her training or sleeping habit.

In smaller research groups, students also talked about negative psychological consequences of ACL injuries, such as guilt, frustration and anger, and how injuries made them consider quitting elite sport altogether.

Both studies clearly point to a problem that is only going to get worse over time, as the risks and rewards of professional sport continue to mount up – and demonstrate that the problems for younger athletes are mental as well as physical and both aspects should be incorporated into our approach to training and developing the next generation of athletes.