Anterior cruciate ligament injuries in netball: the elephant in the room

By Wahid Abdul
ST8 Trauma & Orthopaedics, Wales Deanery

Angus Robertson
Consultant Trauma & Orthopaedic Surgeon, Cardiff and Vale University Health Board

The last decade has seen a huge explosion, and quite rightly so, in the awareness of women’s sport, including football, boxing and cricket in the United Kingdom.  Media interests has led to live televised sporting events to showcase Women’s Super League in football, Women’s Ashes series in cricket and Women’s World Boxing Championship.  With greater attention on female professional athletes participating in sports comes greater awareness of injuries.

It is generally accepted in the Orthopaedic and sporting communities that female athletes are at greater risk of sustaining noncontact Anterior Cruciate Ligament (ACL) injuries than their male counterparts, with some studies reporting a two to ninefold greater risk1-2.  With an increasing ageing population and medical co-morbidities such as cardiovascular disease on the rise, there has been a real national drive in preventing modifiable risk factors such as obesity.  Over the last two decades, there has been a 29-fold increase in the rates of paediatric and adolescent ACL reconstructions3.  Although the observation for this is multifactorial, one key explanation includes the greater uptake of sports involving cutting and pivoting activities among children and adolescents from grassroots level.

ACL injuries in women’s football has recently gained media attention due to several international footballers, most noticeably the England Lionesses, sustaining ACL injuries ruling them out of this summer’s World Cup.  While ACL injuries in female athletes seem to be synonymous with football at present, other sports which involve cutting and pivoting activities such as netball often seem to be forgotten.  With England, Scotland, and Wales participating this summer at the Women’s Netball World Cup in Cape Town, South Africa, the time to highlight importance of ACL injuries in netball is now.

The National Ligament Registry report published in 2022 reported that 86% of ACL injuries were sustained secondary to sporting activities, including football (47.8%), skiing (12.2%), rugby (11.8%), other (6.2%) and netball (5.3%)4.  Perhaps this explains why a greater emphasis has been placed on ACL injuries sustained in football instead of netball?  However, when one truly analyses the number of female athletes sustaining ACL injuries that require surgery, netball (n=653) was only second to snow skiing (n=1,068) with football being third-most common (n=454) [Table 1].  Given how a greater number of female athletes sustain ACL injuries requiring surgery in netball compared to football, surely we should be focusing on raising awareness of ACL injuries in netball and investigating how we can mitigate such risks?

Continue to Part 2 of Anterior cruciate ligament injuries in netball: the elephant in the room