Understanding ACL injuries in volleyball: a systematic review of epidemiology and risk factors

This systematic review aimed to comprehensively assess the epidemiological profile of anterior cruciate ligament (ACL) injuries among volleyball athletes, focusing on incidence, prevalence, injury mechanisms, and athlete characteristics such as sex, age, and court position. Following PRISMA-S guidelines, a thorough search was performed in PubMed, Web of Science, and SCOPUS, covering publications until December 26, 2024. Eligible studies included peer-reviewed cohort research reporting the incidence or prevalence of ACL injuries specifically in volleyball players. The methodological quality of these studies was critically evaluated using the adapted STROBE checklist. From an initial pool of 1,491 titles, 15 studies met the inclusion criteria, encompassing data from 3,313,248 athletes aged 10-70 years. The analysis revealed a substantial variation in ACL injury rates, largely influenced by factors such as exposure time, competition level, and injury mechanism. Notably, non-contact mechanisms were the most frequent cause of ACL injuries, predominantly occurring during spike landings in competitive settings. Female athletes, particularly high school players and those in the outside hitter position, exhibited the highest incidence of ACL injuries. These findings underscore the significant impact of athlete sex, playing level, and positional role on ACL injury risk in volleyball. The predominance of non-contact injuries highlights a critical need for sport-specific, targeted prevention strategies, especially among high-risk groups, such as adolescent female athletes and outside hitters. By identifying these key risk factors, this review provides a foundational understanding to inform tailored interventions, ultimately enhancing athlete safety and performance.