Beyond Return-To-Sport: Mapping ACL Injury History in Currently Active Female Football Players From Youth to Senior...

This study determines the prevalence of ACL injury history among currently active female football players across age groups and playing levels and examines the association between ACL injury history and activity-related knee pain.

A total of 1026 active Danish female youth- and senior-league football players were invited to an online questionnaire (response rate: 751 [73%]) on (1) ACL injury history and (2) present knee pain during physical activity. Prevalence was calculated separately according to age (youth vs senior) and playing level (non-elite vs elite). Logistic regression analyses investigated factors associated with the prevalence of ACL injury history and activity-related knee pain, respectively.

The prevalence of ACL injury history was 5.0% (95% confidence interval [CI] 3.3%-7.4%) in youth football and 14.8% (95% CI 10.6%-19.8%) in senior football. The prevalence of activity-related knee pain was comparable between youth (24.6%, 95% CI 20.8%-28.7%) and senior football players (26.0%, 95% CI 20.7%-31.9%). Comparable prevalence of ACL injury history and knee pain was reported at elite and non-elite level. ACL injury history was strongly associated with activity-related knee pain (OR = 5.4-8.7, p < 0.0001).

Playing with a previous ACL injury is common in active female football players, particularly at senior levels (nearly 1 in 6 elite players). The strong association between ACL injury history and activity-related knee pain underscores the long-term negative consequences. This study highlights the need for secondary and tertiary prevention strategies in female football.