Fears of ACL increase unfounded: Netball Australia

Maddy Proud was the fourth to suffer an ACL injury during the 2019 Super Netball season. Chris Hyde/Getty Images

Fears of an increase in ACL injuries during this season's Super Netball competition have been unfounded according to Netball Australia's head physiotherapist Alanna Antcliff, who states there's been no statistical rise in knee injuries in more than three years.

With six season-ending ACL injuries suffered during the 2019 season -- including two in Round 14 -- players and pundits were vocal with their concerns around the apparent increase, however Antcliff says numbers don't back up these claims.

"The actual stats this year are on par on previous years, so it's not exactly the case [of more injuries]," Antcliff told ESPN. "When you have a cluster it makes it seem like it's a catastrophe, but actually the injury rates are equivalent with where they have been in previous years.

"At per hundred athletes, it's exactly the same with where they were in 2017. We had a good year last year, we only had three ACL injuries across the whole league but that's probably more a positive anomaly, whereas this year and 2017 are on par with where we were."

Despite the decrease in ACL ruptures in 2018, Antcliff says all the same practices were in place across the last three years and while several injury factors can be curbed, ACL injuries aren't 100 percent preventable.

"We're talking about three ACL injuries in over 100 athletes and this is six ACL injuries over a larger pool of athletes - it's 175 athletes, so relatively speaking, you really can't read into that at all," she says.

"For any of the players that have done their ACL it's not that they're not preparing as best as they can, these injuries are not 100 percent preventable and absolutely, talking [about] some of the injuries that have happened recently, I challenge anyone to not injure themselves in some of those mechanisms no matter how prepared you are."

The apparent increase had Australian Netball Players' Association president Nat Medhurst speculating that longer pre-seasons and heavy training loads were contributing to the spate of knee injuries during the season, however Antcliff believes a longer pre-season has the opposite impact on players.

"I can only go on the data we've got recently and it's not several years of consecutive data so I'd have reservations around interpreting it too closely, but certainly in those longer pre-seasons, players actually had a lower injury rate per week," Antcliff told ESPN.

"My suspicion as to why that is the case is because they had a longer period of time to gradually build into their training as opposed to those shorter pre-seasons which tend to be a little bit more congested and players are going from periods of relative inactivity and ramping in, it's harder to do over a shorter period of time. So in actual fact the longer pre-seasons tend to be more protective of injury as opposed to what you suggested (shorter pre-seasons)."

Her statistical interpretation was also backed up by Netball Australia's chief medical officer Dr Susan White who stated: "There's no evidence for that, certainly not for ACL. In this stage in the research that's not something that could contribute to ACL risk."

One of the biggest issues Antcliff and Netball Australia's medical staff have to deal with are the intrinsic risks netball players face, one of the biggest issues being female athletes are at a higher risk of rupturing their ACL than men.

According to research, women are four to five times more likely to rupture their ACL than males with other intrinsic factors including a player's knee anatomy -- smaller notches in knees are associated with higher risk -- and family history also playing a role, all risks that can't be changed.

However, White says measures are being taken across the elite level to nullify other factors.

"We don't necessarily know what it is about being female, but we know being female increases the risk and you can't actually change that," White told ESPN. "We also know issues around anatomy of knees, and we also know they seem to run in families, all things we can't change. The thing that we've found that is associated that you can change is the mechanics of the knee on landing, so how your knee is positioned when you land, particularly when you get bumped off balance.

"There is a preventative program that's been developed and it's been shown to decrease lower limb injuries. Research is incredibly supportive of the fact that it decreases lower limb injuries around 50 per cent if it's done, which is significant in men and women, but more so in women where it can decrease by up to 60 percent, and of those injuries ACL's are a part of that."

Antcliff said the league was trying to make the game safer for athletes.

"We've got a variety of things that we have in place to assist in that from a community level right through to the elite level with the reference to the SSN groups in particular," Antcliff said.

"Ensuring that you are very well drilled at how to land and how to change direction, with enough talent so that you are able to be robust enough to be able to handle the physicality that's required on a netball court. It's really more about that initial injury point that you need to fine tune to help prevent these injuries."

Over the years calls have been made to change the stepping rule. Currently the rule sees players suddenly stopping with one foot considered the 'landing foot' while the other is available for pivoting. But according to White and Antcliff a change in the current stepping rule to allow for an extra stride would make no impact to decrease ACL injuries.

"I think that the main thing in regards to ACL injuries is the time stamp of injury is within milliseconds of landing, so regardless of whether you take another step or you don't the injury has already occurred at that initial contact," Antcliff told ESPN.

"I think talking about that extra step is an interesting topic but I think the key is in actually really controlling how you contact the ground and then the rest really takes care of itself."

White said she believed netball was a safe sport.

"The best way to look at it is to say you'll never completely get rid of the risk, we don't completely understand all the factors," White said. "My take out of it is those numbers are actually pretty low when you look at the amount of netball they're playing and the amount of girls playing at that level."