Date of Award


Document Type

Open Access Master's Thesis

Degree Name

Master of Science in Biological Sciences (MS)

Administrative Home Department

Department of Biological Sciences

Advisor 1

Erich J. Petushek

Advisor 2

John J. Durocher

Committee Member 1

Brigitte Morin

Committee Member 2

Robert A. Larson


Well controlled Anterior Cruciate Ligament (ACL) injury prevention neuromuscular training reduces the risk of ACL injury by 50%, but despite the efficacy of these programs, ACL injury rates have not decreased. This lack of decrease in injury incidence may be due in part to limited knowledge on who is most at risk for sustaining an ACL injury, and there is no formal clinical tool available to estimate the personalized or group risk of ACL injury. The purpose of this study was to better understand what groups of athletes are most at risk of sustaining a primary ACL injury, as the first step in mitigating risk and decreasing the substantial public health and financial burden of ACL injuries. To accomplish this goal, we conducted a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and through specific inclusion/exclusion criteria to analyze specific subgroupings of athletes. 7,038 studies were identified in the initial database search and 80 studies were included in the final subgroup meta-analysis. Analyses revealed that female athletes had a greater risk of ACL injury compared to male athletes. However, this project pointed out gaps in the current epidemiological prevalence of ACL injuries and the extra precaution people should take about the overgeneralization of sex and sport types for risk assessment. For example, it is well known that for sex comparable sports, females are at greater risk for ACL injury compared to males – however, the absolute risk level for various female sports is substantially low (e.g., female high school volleyball and female college lacrosse). In addition, female professional sports have overall higher ACL injury rates and prevention programs appear less effective for this group warranting more rigorous and targeted prevention efforts. Future studies should also utilize rigorous epidemiological approaches to assess injury rates as there are many sports, sex, and levels that do not have sufficient data to determine absolute prevalence or risk level. When more information is discovered, a personalized risk assessment tool can then be developed to then determine the most at-risk populations to allocate resources and prevention efforts to reduce the number of ACL injuries.