Anterior cruciate ligament injuries in Australian football: should women and girls be playing? You're asking the wrong question

Aaron Fox, Jason Bonacci, Samantha Hoffmann, Sophia Nimphius, Natalie Saunders, Aaron Fox, Jason Bonacci, Samantha Hoffmann, Sophia Nimphius, Natalie Saunders

Abstract

Anterior cruciate ligament (ACL) injuries have been a rising concern in the early years of the women's Australian Football League (AFLW), eliciting headlines of a 'knee crisis' surrounding the league. There has been a focus on female biology as the primary factor driving the high rate of ACL injuries in the AFLW. Emphasising Australian football (AF) as being dangerous predominantly due to female biology may be misrepresenting a root cause of the ACL injury problem, perpetuating gender stereotypes that can restrict physical development and participation of women and girls in the sport. We propose that an approach addressing environmental and sociocultural factors, along with biological determinants, is required to truly challenge the ACL injury problem in the AFLW. Sports science and medicine must therefore strive to understand the whole system of women in AF, and question how to address inequities for the benefit of the athletes.

Keywords: Australian football; anterior cruciate ligament; female; injury.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

References

    1. Australian Football League 2018 annual report, 2018.
    1. Agel J, Rockwood T, Klossner D. Collegiate ACL injury rates across 15 sports. Clin J Sport Med 2016;26:518–23. 10.1097/JSM.0000000000000290
    1. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 2007;42:311–9.
    1. Sewell E. Knee crisis growing. herald sun, February 9th 2019.
    1. Wood L. Acl link probe. herald sun, February 18 2020.
    1. Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. Am J Sports Med 2006;34:299–311.
    1. Benjaminse A, Gokeler A, Fleisig GS, et al. . What is the true evidence for gender-related differences during plant and cut maneuvers? A systematic review. Knee Surg Sports Traumatol Arthrosc 2011;19:42–54. 10.1007/s00167-010-1233-y
    1. Beaulieu ML, McLean SG. Sex-dimorphic landing mechanics and their role within the noncontact ACL injury mechanism: evidence, limitations and directions. BMC Sports Sci Med Rehabil 2012;4:10 10.1186/1758-2555-4-10
    1. Bruton MR, O'Dwyer N, Adams R. Sex differences in the kinematics and neuromuscular control of landing: biological, environmental and sociocultural factors. J Electromyogr Kinesiol 2013;23:747–58. 10.1016/j.jelekin.2013.04.012
    1. Weiss DS, Shah S, Burchette RJ. A profile of the demographics and training characteristics of professional modern dancers. J Danc Med Sci 2008;12:41–6.
    1. Liederbach M, Dilgen FE, Rose DJ. Incidence of anterior cruciate ligament injuries among elite ballet and modern dancers. Am J Sports Med 2008;36:1779–88. 10.1177/0363546508323644
    1. Orishimo KF, Liederbach M, Kremenic IJ, et al. . Comparison of landing biomechanics between male and female dancers and athletes, part 1: influence of sex on risk of anterior cruciate ligament injury. Am J Sports Med 2014;42:1082–8.
    1. Orishimo KF, Kremenic IJ, Pappas E, et al. . Comparison of landing biomechanics between male and female professional dancers. Am J Sports Med 2009;37:2187–93. 10.1177/0363546509339365
    1. Hewett TE, Myer GD, Ford KR, et al. . Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 2005;33:492–501. 10.1177/0363546504269591
    1. Nimphius S, McBride JM, Rice PE, et al. . Comparison of quadriceps and hamstring muscle activity during an isometric squat between Strength-Matched men and women. J Sports Sci Med 2019;18:101–8.

Source: PubMed

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