Growing anterior cruciate ligament (ACL) injury incidence is reported in countries across Europe, North America and in Australia for 5-14-year-olds, yet research on injury risk reduction predominantly focuses on populations aged > 13 years. For injury risk reduction, it is crucial to understand (i) which modifiable risk factors are associated with ACL injury in children (6-13 years) and (ii) how these risk factors are assessed. Articles were grouped according to sex/gender and/or maturational/age differences and examined modifiable risk factors during different physical screening tasks. The included articles (n = 40) predominantly examined intrinsic risk factors in girls aged 10-13 years. Factors mechanically linked to increased ACL loading at this age included increased peak knee adductor moments, knee valgus angles, hip and knee extension, and ground reaction forces. Assessment focused on laboratory-based assessments (e.g., motion capture, force plates). This review concluded that modifiable risk factors are present in children aged 6-13 years and that injury risk reduction strategies should be implemented as early as possible regardless of sex/gender. Further, screening strategies need updating to be childhood specific and feasible for the wide community. Additional research on extrinsic risk factors, norm values and children aged 6-9 years could allow for more targeted risk reduction strategies.
Keywords: Paediatric athletes; gender; knee injury prevention; maturity.
Increasing rates of ACL injuries in children aged 5 to 14 years are reported in countries across Europe, North America and in AustraliaResearch on modifiable risk factors focuses on internal risk factors in children aged 10-13 years and neglects external risk factors as well as younger children (6-10 years)Screening strategies to determine risk of ACL injury risk in children are laboratory based as opposed to cost-effective and quicker-to-analyse in-field assessmentResearch is warranted to examine external risk factors and in-field screening strategies in childhood.