Longitudinal assessment of noncontact anterior cruciate ligament injury risk factors during maturation in a female athlete: a case report.
OBJECTIVE
To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury.


BACKGROUND
In prospective studies, previous investigators have examined cross-sectional measures of anatomic, hormonal, and biomechanical risk factors for ACL injury in young female athletes. In this report, we offer a longitudinal example of measured risk factors as the participant matured.


METHODS
Partial or complete tear of the ACL.


METHODS
The participant was identified from a cohort monitored from 2002 until 2007. No injury prevention training or intervention was included during this time in the study cohort.


RESULTS
The injury occurred in the year after the third assessment during the athlete's club basketball season. Knee examination, magnetic resonance imaging findings, and arthroscopic evaluation confirmed a complete ACL rupture. The athlete was early pubertal in year 1 of the study and pubertal during the next 2 years; menarche occurred at age 12 years. At the time of injury, she was 14.25 years old and postpubertal, with closing femoral and tibial physes. For each of the 3 years before injury, she demonstrated incremental increases in height, body mass index, and anterior knee laxity. She also displayed decreased hip abduction and knee flexor strength, concomitant with increased knee abduction loads, after each year of growth.


CONCLUSIONS
During puberty, the participant increased body mass and height of the center of mass without matching increases in hip and knee strength. The lack of strength and neuromuscular adaptation to match the increased demands of her pubertal stature may underlie the increased knee abduction loads measured at each annual visit and may have predisposed her to increased risk of ACL injury.
Myer
Gregory D
GD
Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA. greg.myer@cchmc.org
Ford
Kevin R
KR
Divine
Jon G
JG
Wall
Eric J
EJ
Kahanov
Leamor
L
Hewett
Timothy E
TE
D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy; D001265:Athletic Injuries / Q000534:rehabilitation*; D001490:Basketball / Q000293:injuries*; D001696:Biomechanical Phenomena; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D053580:Muscle Strength; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012307:Risk Factors; D012741:Sexual Maturation; D013997:Time Factors