Does Fatigue Influence ACL Injury Risk?

This question is a nice topic of debate between researchers & clinicians.

A recent review by Bourne et al (2019) showed that there is no current evidence to suggest that there is a link; however Benjaminse et al (2019) recommend that we train our athletes to resist fatigue to reduce ACL injury risk.

Whatever side of the fence you sit on however; van Melick et al (2019) showed in a group of ACLR soccer players that fatigue significantly affected movement quality (as per Landing Error Scoring System - LESS) as compared to a group of soccer athletes who'd never had an ACLR.

When the athletes were fresh, both groups scored on average 4 on the LESS. However immediately after an on-field training session, the ACLR group scored on average 7 compared to 4 in the group who had never previously had an ACLR.

The big question remains from van Melick and colleagues paper is; does this impaired movement quality lead to a 2nd ACL injury?

I've reviewed this article (and another by Dr Nicky van Melick) in issue #14 of Learn.Physio Research Reviews which you can read here

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