Elsevier

The Knee

Volume 23, Issue 4, August 2016, Pages 681-685
The Knee

Psychological traits regarding competitiveness are related to the incidence of anterior cruciate ligament injury in high school female athletes

https://doi.org/10.1016/j.knee.2016.04.015Get rights and content

Abstract

Background

The purpose of this study was to investigate the relationship between psychological competitive ability and the incidence of noncontact ACL injuries among high school female athletes.

Methods

A three-year prospective cohort study was conducted using 300 15-year-old high school female athletes with no previous injuries or symptoms in their lower limbs (106 handball players and 194 basketball players). At baseline, their psychological competitive abilities were assessed using a self-administered questionnaire—the Diagnostic Inventory of Psychological Competitive Ability (DIPCA.3). After the baseline examination was performed at high school entry, all players were prospectively followed for 36 months to document any subsequent incidence of ACL injury, according to their coaches. An unpaired t-test with Welch's correction was performed to compare the differences in the psychological competitive abilities between the injured and uninjured players.

Results

Of the 300 players, 25 (8.3%) experienced a noncontact ACL injury during the three-year observation period. The injured players had significantly higher total DIPCA.3 scores for psychological competitive ability than the uninjured players (169.9 ± 18.8 vs. 159.2 ± 21.6, P = .036). Additionally, the injured players had significantly higher scores than the uninjured players in the following categories: aggressiveness, volition for self-realization, volition for winning, judgment, and cooperation. However, no significant differences were observed in patience, self-control, ability to relax, concentration, confidence, decision, and predictive ability.

Conclusions

High psychological competitive ability was associated with the incidence of noncontact ACL injuries in high school female athletes.

Level of evidence

Level II (prospective cohort study).

Introduction

Although reconstruction surgery for anterior cruciate ligament (ACL) injuries has improved and shown stable results, many challenges still remain for this sports injury (e.g., it still requires a long recovery time and is associated with meniscal tears) [1], [2]. In addition, an ACL injury is one of the most costly sports injuries [3], [4]. A noncontact ACL injury is prevalent among high school female athletes, especially in those who play ball sports such as handball, basketball, soccer, and volleyball [5], [6], and it is a very serious issue since it not only interferes with their sports activities but also puts them at risk for the early development of osteoarthritic changes in the future [7], [8], [9]. Therefore, the prevention of ACL injuries as well as an accurate diagnosis and proper treatment have significant importance in maintaining the future quality of life in these patients.

Identifying and understanding the risk factors of this injury are essential for developing an effective prevention program, and many researchers have conducted studies that focus on multilateral aspects, such as anatomical, neuromuscular, hormonal, biomechanical, and environmental factors [5], [10], [11], [12], [13]. However, psychological factors have been rarely reported on, and no consistent findings have been reported, although psychological factors along with strength and technical skills are known to have a significant influence on athletes [14], [15]. In a competitive sport situation, the exertions of performance and also the incidence of injury can be influenced by psychological factors [16]. Therefore, in addition to physical characteristics, the mental and psychological characteristics of athletes can become risk factors for ACL injuries.

The purpose of this prospective study was to evaluate the relationship between the psychological competitive ability and the incidence of ACL injuries in high school female handball and basketball players who are known to have a high incidence of ACL injuries.

Section snippets

Materials and methods

We prospectively investigated the risk factors for ACL injuries in high school female athletes (handball and basketball players) over a three-year period. We included 303 15-year-old participants with no previous injuries or symptoms in their lower limbs who joined the handball club (107 subjects) or basketball club (196 subjects) from April 2009 to April 2011. During the study period, the level of the competitions was standardized for the teams, which were ranked among the top four in each

Results

No significant differences in the baseline height, weight, or body mass index were observed between the ACL injured and uninjured groups (P = 0.93, 0.12, 0.08, respectively) (Table 1). In the ACL injured group, 14 players were injured during their competitive matches, whereas the other 11 were injured during training. Regarding the time of injury, seven players were injured in the first year, 13 were injured in the second year, and five were injured in the third year. There was no significant

Discussion

The principal finding of this investigation was that a higher psychological competitive ability was associated with the incidence of noncontact ACL injuries in high school female athletes. This is the first prospective study on the relationship between psychological competitive ability and the incidence of noncontact ACL injuries in high school female athletes who have a high incidence of noncontact ACL injuries.

We used the DIPCA.3 to assess the psychological factors associated with the

Conclusions

This three-year prospective cohort study found that a high psychological competitive ability is associated with noncontact ACL injuries in high school female handball and basketball players. Therefore, the psychological characteristics of these athletes are potential risk factors for noncontact ACL injuries.

Conflict of interest

No conflicts of interests are declared.

Acknowledgments

The authors wish to acknowledge all the high school female athletes for their participation in this study. We also thank the members of the project group who significantly contributed to the data collection and study discussion.

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