2025 ISAKOS Biennial Congress ePoster
Obstacle Course Races Present a Notable Risk for Anterior Cruciate Ligament Injury, Especially in High-Impact Landing Maneuvers and For Female Athletes
Natasja Lessiohadi, BA, New Orleans, Louisiana UNITED STATES
James Pai, MS, New Orleans , Louisiana UNITED STATES
William Goodman, BS, New Orleans , Louisiana UNITED STATES
Nicholas E. Ganek , BA, New Orleans , Louisiana UNITED STATES
Ariel Kesick, MS, New Orleans, Louisiana UNITED STATES
Mia Rumps, MS UNITED STATES
Mary K. Mulcahey, MD, Western Springs, IL UNITED STATES
Loyola University Medical Center, Maywood, Illinois, UNITED STATES
FDA Status Not Applicable
Summary
This systematic review investigated the incidence of anterior cruciate ligament (ACL) and associated musculoskeletal injuries in obstacle course races (OCRs), uncovering higher injury rates among females and on terrains such as rubber matting, which underscores the necessity for further research aiming to develop tailored preventive strategies and safer OCR course designs.
ePosters will be available shortly before Congress
Abstract
Objectives: The primary purpose of this study was to determine the incidence rate of anterior cruciate ligament (ACL) and associated musculoskeletal (MSK) injuries in recreational and military training obstacle course races (OCRs). The secondary purpose was to determine if there are any risk factors or features of OCRs impacting the rate of ACL injury in race participants.
Materials And Methods
This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were identified using the following electronic databases: PubMed, MEDLINE, EMBASE, Cochrane Database, and Scopus. Studies meeting the following criteria were included: published in English between 2000-2023, included participants in recreational/military OCRs, categorized injuries relevant to the ACL, knee, or lower extremities, or categorized risk factors for ACL injury in context relevant to OCRs. Systematic reviews, narrative reviews, and non-peer reviewed studies were excluded. Full text was reviewed for all studies that met inclusion criteria. Incidence rate (IR) and Male:Female IR ratio (IRR) analyses were performed on data collected. IR by gender was compared using two sample t-test.
Results
The initial search identified 2,896 studies, 16 of which met inclusion criteria. From studies specifically describing ACL injuries in male and female athletes, there were 46,892 total athlete exposures (AEs) (5,939 female and 40,953 male AE’s), with 9 total female and 12 total male ACL injuries. The total IR of ACL injuries in OCRs was 0.45/1000 ± 0.40 athlete exposures (AEs). Females had a higher IR than males (1.51/1000 ± 1.42/1000 AEs vs. 0.29/1000 ± 0.23/1000 AEs, IRR=5.14 ± 5.25, P=0.001). Risk factors for ACL injury associated with OCRs included rubber matting terrain and obstacles requiring high impact landings/deceleration maneuvers.
Conclusion
OCRs require many high impact and pivoting landings, thus presenting a notable risk for ACL and associated MSK injuries. The risk and IR of injury is increased in females and on specific terrain (e.g. rubber matting). This review indicates an opportunity to investigate biomechanical and physiological differences that increase ACL injury risks in females and to examine how terrain influences injury rates in OCRs, which could guide specialized training methods and safer course designs. Further, the paucity of data on ACL injuries in amateur (non-military) OCRs highlights a need to conduct targeted studies assessing amateur OCR participants, injury rates, and risk factors in order to enhance and refine safety guidelines for recreational OCR organizations.