This prospective cohort study aims to investigate whether the mechanical properties of the anterior cruciate ligament (ACL) undergo measurable changes throughout a competitive basketball season in female collegiate athletes. Female athletes are at a significantly higher risk for non-contact ACL injuries compared to males. Beyond acute injuries, cumulative stress from high-intensity sports may lead to subclinical alterations in the ligament's biomechanical properties, potentially increasing injury risk.

Using non-invasive shear wave elastography (SWE) and countermovement jump (CMJ) tests, the study will monitor 60 elite players before and after the University Basketball League (UBL) season. The findings will help identify potential signs of cumulative loading and contribute to the development of early detection markers for injury risk in female athletes.

[Introduction and Rationale] The anterior cruciate ligament (ACL) is a critical stabilizer of the knee joint, particularly during high-demand athletic activities involving pivoting, rapid deceleration, and landing. Female athletes exhibit a significantly higher incidence (2 to 9 times) of non-contact ACL injuries compared to their male counterparts. While acute trauma is a well-recognized mechanism, emerging evidence suggests that cumulative loading over a competitive season may lead to subclinical alterations in the ligament's mechanical properties. These changes, such as decreased stiffness, may predispose athletes to injury by compromising joint stability and neuromuscular control. However, objective in vivo data regarding the seasonal adaptation of the ACL in elite athletes remains sparse.

[Study Design and Participants] This prospective cohort study will recruit 60 elite female collegiate basketball players from Division I teams of the University Basketball Association (UBA). The research is designed to track longitudinal changes in ACL integrity and functional performance across a full competitive season.

[Study Procedures]

Participants will undergo standardized assessments at two distinct time points:

Pre-season Assessment (Baseline): Conducted in October, prior to the start of the competitive UBL season.

Post-season Assessment: Conducted in April, following the conclusion of the competitive basketball season.

During each session, two primary modalities will be employed:

1. Imaging-based Assessment (Shear Wave Elastography):

   Shear Wave Elastography (SWE) will be utilized to non-invasively quantify the mechanical properties of the ACL. The assessment will focus on:

   Shear Wave Speed (m/s) Shear Modulus (kPa) These metrics serve as direct indicators of tissue stiffness and structural integrity. Measurements will be taken with the knee in a consistent, standardized position to ensure reproducibility.

2. Functional Biomechanical Performance (Countermovement Jump):

Participants will perform Countermovement Jumps (CMJ) on KFORCE force plates to evaluate lower limb dynamic performance. This functional test provides insight into the athlete's neuromuscular status. Key variables collected will include:

Jump Height (cm) Reactive Strength Index (RSI): Calculated as the ratio of jump height to ground contact time.

Force Metrics: Including eccentric and concentric impulse to analyze force production and absorption strategies.

[Research Goal] By integrating imaging-based mechanical data with functional biomechanical outcomes, this study seeks to identify potential "fatigue" markers or adaptive responses in the ACL resulting from seasonal athletic demands. The findings aim to bridge the gap between clinical imaging and athletic performance, ultimately informing individualized injury prevention strategies and early detection protocols for female athletes at risk.

Inclusion Criteria:

• Female collegiate basketball players currently active in Division I
• Aged between 18 and 35 years
• At least 5 years of formal basketball training experience
• No prior history of anterior cruciate ligament (ACL) rupture in either knee
• Ability to participate in both pre-season and post-season testing sessions

Exclusion Criteria:

• Lower limb injury during the study period resulting in interruption of training for one month or longer
• Bilateral knee surgery for any reason during the course of the study

Only female athletes are recruited due to the significantly higher risk of ACL injuries in this population.

Elite female collegiate basketball teams