Anterior cruciate ligament injuries in netball: the elephant in the room - Part 2
Table 1. Distribution of sporting activities as the cause for ACL injuries in men and women4.
Netball is a high-risk sport involving rapid acceleration, deceleration, pivoting, change-of-direction running along with jump landing. It is played across 70 countries with over 20 million participants worldwide, with reported injury rates of 11.3-14 per 1,000 playing hours for recreational athletes and 19.35 per 1,000 playing hours for elite athletes respectively5,6. Australian netball have reported the incidence of ACL injuries between 17.2-22.4%7,8. Upon receiving the ball, the ‘footwork rule’ restricts players to a one-step landing, thus players pivot on the touchdown foot prior to releasing the ball9. This one-step landing creates a high vertical ground reaction force of up to 3.5-5.7 of body weight, with or without the ball causing shear, compression and rotational forces on the lower limb10,11,12. Two distinct patterns of ACL injuries have been identified in netball: ‘indirect contact’ and ‘non-contact’. Approximately 80% of ACL injuries in netball are ‘non-contact’ and often associated with twisting from cutting or pivoting manoeuvres, landing awkwardly from a jump, knee hyperextension and sudden deceleration while the foot is firmly planted. Knee abduction collapse during single leg landing is associated with 83.3% of ‘non-contact’ ACL injuries13-15.
It is important to consider the physical, mental and financial consequences of athletes sustaining an ACL injury. Following an ACL reconstruction, return-to-play rates are lower in females than males under 25 years of age (39% versus 52%) and 26-35 years of age (18% versus 36%)16. Long-term consequences include a four-fold increased risk of developing post-traumatic osteoarthritis17. With the short and long-term consequences of ACL injuries having a significant impact on female athletes, it is essential to identify potential modifiable risk factors to help mitigate the risk of ACL injuries.