Epidemiology

The estimated annual incidence of anterior cruciate ligament (ACL) tears in the US is 68.6 per 100,000 person-years.[9]​ About 70% of ACL tears occur during sports activities. Based on US National Collegiate Athletic Association data from 2004-2013, the highest average annual rate of injury was 0.17 per 1000 athlete-exposures for men and 0.23 for women.[10]

The female-to-male ratio has generally ranged from 2:1 to 8:1, and varies across sports.[11][12][13][14][15] One systematic review and meta-analysis found that among sex-comparable sports, female adolescent athletes are 1.5 times as likely as male adolescent athletes to sustain an ACL injury.[16]​​ Non- or minimal-contact injuries account for most ACL injuries (up to 70%), especially in females.[1][10]​​​[17][18]​​​ One study suggests a higher rate for white European American basketball players than for nonwhite players.[19]

​The 15-45 years age group is at highest risk. In one national registry of 18,668 patients with ACL injury, the average age of patients undergoing ACL reconstruction surgery was 30.[20] Injuries occur primarily among active people, especially in sports involving cutting, pivoting, and decelerating (e.g., soccer, basketball, skiing) or contact (e.g., football). Nonsports related activities resulting in ACL injury include falls, work-related injuries, and road traffic accidents.[20]​ In children, falling off of a bike while trying to plant the ipsilateral foot is a common mechanism of ACL avulsion from the tibial eminence.[8]

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