Background

Adolescents present a high incidence of ACL injury compared with other age groups. Examining the risk factors that predispose adolescents to primary noncontact ACL injury is a key strategy to decrease the number of injuries in this population.

Objective

The aim of this systematic review was to summarise the existing literature investigating extrinsic risk factors that have been linked with primary noncontact ACL injury risk (identified either using ACL injury occurrence or using screening tests measuring biomechanical mechanisms for noncontact ACL injury) in adolescents including research investigating: (1) the association between extrinsic risk factors and primary noncontact ACL injury risk; and (2) whether primary noncontact ACL injury risk was different in populations or groups exposed to different extrinsic risk factors in adolescents.

Methods

The same search strategy was used in MEDLINE, SPORTDiscus, CINAHL, PubMed and Embase. Articles were included if: written in English; published in peer-reviewed journals; investigating and discussing primary noncontact ACL injury risk associated with extrinsic risk factors; they were original research articles with an observational design; and participants presented a mean age ranging between 14 and 18 years. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (QATOCCS) was used to assess the quality and risk of bias of the articles included in this systematic review.

Results

The systematic review included 16 eligible articles published up to August 2022 about extrinsic risk factors for primary noncontact ACL injury including: sport (8 studies); sport exposure amount (5); sport level (3); sport season (1); environment (2); equipment (1). Differences in biomechanical risk factors predisposing to ACL injury were reported by sport in female adolescents playing basketball and soccer; however, no good evidence of differences in primary noncontact ACL injury rate by sport was reported in both male and female adolescents. There was contrasting evidence about associations between sport exposure and biomechanical and neuromuscular risk factors predisposing to ACL injury or primary noncontact ACL injury rate in both male and female adolescent players from different sports. There was weak evidence of differences in biomechanical risk factors predisposing to ACL injury by environmental condition in both male and female adolescents playing soccer and season phase in male adolescents playing basketball. Lastly, few good-quality articles suggested that higher sport level might be associated with increased primary noncontact ACL injury rate in female adolescents playing basketball and floorball and that bracing might not prevent primary noncontact ACL injuries in both male and female adolescent players from different sports.

Discussion

The findings emphasise the need for further research to clarify the evidence about extrinsic risk factors and primary noncontact ACL injury in adolescents to develop ACL injury prevention guidelines that would help practitioners and researchers identify adolescents at risk and design future interventions. Future epidemiological studies should collect data about extrinsic factors as well as data about primary noncontact injury separately from secondary injuries or contact injuries to better inform primary noncontact ACL injury prevention in adolescents.

Registration

https://doi.org/10.17605/OSF.IO/VM82F (11/08/2021).

中文翻译：

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14 至 18 岁青少年原发性非接触性前十字韧带损伤的外在危险因素：系统评价

背景

与其他年龄段相比，青少年 ACL 损伤的发生率较高。检查青少年易患原发性非接触性 ACL 损伤的危险因素是减少该人群损伤数量的关键策略。

客观的

本系统综述的目的是总结现有文献，调查与青少年原发性非接触性 ACL 损伤风险相关的外在风险因素（通过 ACL 损伤发生或使用测量非接触性 ACL 损伤生物力学机制的筛查测试来确定），包括调查研究：（1）外在危险因素与原发性非接触性 ACL 损伤风险之间的关联； (2)在青少年中暴露于不同外在危险因素的人群或群体中，原发性非接触性 ACL 损伤风险是否不同。

方法

MEDLINE、SPORTDiscus、CINAHL、PubMed 和 Embase 使用了相同的搜索策略。如果符合以下条件，文章将被纳入： 用英语撰写；在同行评审期刊上发表；调查和讨论与外在危险因素相关的原发性非接触性 ACL 损伤风险；它们是具有观察性设计的原创研究文章；参与者的平均年龄在 14 岁到 18 岁之间。观察队列和横断面研究质量评估工具（QATOCCS）用于评估本系统评价中文章的质量和偏倚风险。

结果

该系统评价包括截至 2022 年 8 月发表的 16 篇符合条件的文章，涉及原发性非接触性 ACL 损伤的外在风险因素，包括：运动（8 项研究）；运动暴露量（5）；运动水平（3）；运动季节（1）；环境（2）；设备 (1).女性青少年篮球和足球运动报告了导致 ACL 损伤的生物力学危险因素的差异；然而，没有充分的证据表明男性和女性青少年因运动造成的原发性非接触性 ACL 损伤率存在差异。对于来自不同运动项目的男性和女性青少年运动员，运动暴露与易患 ACL 损伤或原发性非接触性 ACL 损伤率的生物力学和神经肌肉危险因素之间的关联存在对比证据。微弱的证据表明，踢足球的男性和女性青少年以及打篮球的男性青少年在赛季阶段的环境条件导致 ACL 损伤的生物力学危险因素存在差异。最后，很少有高质量的文章表明，较高的运动水平可能与打篮球和福乐球的女性青少年的原发性非接触性 ACL 损伤率增加有关，并且支具可能无法预防来自不同运动项目的男性和女性青少年运动员的原发性非接触性 ACL 损伤。

讨论

研究结果强调需要进一步研究来澄清有关青少年外在危险因素和原发性非接触性 ACL 损伤的证据，以制定 ACL 损伤预防指南，帮助从业者和研究人员识别处于危险中的青少年并设计未来的干预措施。未来的流行病学研究应收集有关外在因素的数据以及与继发性损伤或接触性损伤分开的原发性非接触性损伤的数据，以便更好地为青少年原发性非接触性 ACL 损伤的预防提供信息。

登记

https://doi.org/10.17605/OSF.IO/VM82F (11/08/2021)。