A Randomized Controlled Trial to Prevent Non-contact ACL Injury in Female Collegiate Soccer Players
Authors:
Julie R. Gilchrist MD, Center for Disease Control, Atlanta, GA
Bert R. Mandelbaum MD, Santa
Monica Orthopaedics, Santa Monica, CA
Heidi Melancon MPH, Centers for Disease and Prevention Control, Atlanta, GA
George W. Ryan PhD, Centers for Disease and Prevention Control, Atlanta, GA
Letha Y. Griffin MD, PhD, Peachtree Orthopaedic Clinic, Atlanta, GA
Holly J. Silvers MPT, Santa Monica
Orthopaedics, Santa Monica, CA
Diane S. Watanabe MA, ATC, Santa
Monica Orthopaedics, Santa Monica, CA
Randall W. Dick,
MS, FACSM, NCAA, Indianapolis, IN
Objective: Neuromuscular and proprioceptive training programs have shown promise in decreasing non-contact anterior cruciate ligament (ACL) injuries; however, most are difficult to implement, needing special training or equipment. An on-field warm-up was designed to facilitate implementation of such training for soccer teams. To evaluate the program’s effectiveness in reducing non-contact ACL injuries, we conducted a randomized controlled trial in the fall 2002 soccer season.Methods: All NCAA Division I women’s soccer teams were invited to participate. Teams were randomly assigned to intervention or control groups. Intervention teams (IT) received a videotape and instruction manual for the alternative warm-up and were asked to complete it three times per week during the season. Control teams (CT) performed their customary warm up. All teams reported athlete’s weekly participation in games and practices (exposures) and lower extremity injuries which occurred in a game or practice, required medical care by athletic trainer or physician, and caused missed days. IT failing to complete the program more than 12 times were excluded from the analysis. Data were entered into an Access database and analyzed using SAS version 8.2. Injury rates were calculated based on athlete-exposures (A-E) and are expressed as rate per 1000 A-E. The study was limited by the inability to control for drills and exercises done in practice in both groups and limited power for comparing subgroups.Results: Sixty-one teams with 1394 athletes completed the study (833 control athletes and 561 intervention). There were 7 ACL injuries in IT (rate of 0.15) vs. 19 in CT (0.28) (p=0.13). In practices, no ACL injuries occurred in IT vs. 7 in CT (0.13) (p<0.01); in games the difference was non-significant (IT 7 vs. CT 12; p=0.66). Non-contact ACL injuries occurred at over three times the rate in CT (n=10; 0.15) than in IT (n=2; 0.04) (p<0.01). The difference in rates of non-contact ACL injuries between IT and CT approached significance in the second half of the season (weeks 6-11; IT 0.00 vs. CT 0.12) (p=0.08). See table.Conclusions: Results support that this alternative warm-up can significantly reduce the risk of non-contact ACL injuries in collegiate female soccer players. The program may provide greater protection with continued use.
Griffin LY, Prevention of Noncontact ACL Injuries. American
Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports
Medicine. Rosemont, IL. 2001.
www.aclprevent.com
Acknowledgements: We would like to acknowledge the financial and intellectual contributions of FIFA and specifically, Dr. Jiri Dzorak.
