Sex, military occupation, and rank are associated with risk of anterior cruciate ligament injury in tactical-athletes
medRxiv
2021
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Article Description
Background: ACL injury is frequent within the U.S. military and represents a significant loss to readiness. Since recent changes to operational tempo, there has not been an analysis of ACL injury risk. There is sparse evidence on salient risk factors for ACL injury across all service members. Hypothesis/Purpose: The aim of this study is to evaluate military occupation, sex, rank, and branch of service on ACL injury risk in the U.S. military from 2006 to 2018. Study Design: Descriptive Epidemiology Study. Methods: The Defense Medical Epidemiology Database was queried for the number of U.S. military members with ICD diagnosis codes 717.83 (Old disruption of ACL), 844.2 (Sprain of knee cruciate ligament), M23.61 (Other spontaneous disruption of ACL), and S83.51 (Sprain of ACL of knee) on their initial encounter from 2006 to 2018. Relative risk (RR) and chi-square statistics were calculated to assess sex and military occupation effects on ACL injury. A multivariable negative binomial regression model evaluated changes in ACL injury incidence with respect to sex, branch of service, and rank. Results: The study period displayed a significant decrease in the ACL injury rate at 0.18 cases per 1000 person-years or relative decrease of 4.08% each year (p < 0.001) after averaging over the main and interactive effects of sex, rank, and branch of service. The interaction effect of time with sex indicated a steeper decline in ACL injury incidence in males as compared to females. The risk of ACL injury by sex was modified by rank. Furthermore, the incidence of ACL injury among military personnel varied depending on occupation. Conclusion: Despite the decline in incidence among military members over time, the rates of ACL injury remain much higher than the general U.S. population. Sex, rank, branch of service, and military occupation were found to be risk factors for ACL injury. Clinical Relevance: These results are evidence to support inquiry into the specific hazards associated with these factors. It is critical for policy makers to understand the salient risk factors for ACL injury to guide appropriate proactive measures to prevent injury.
Bibliographic Details
Cold Spring Harbor Laboratory
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