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TEAM PHYSICIAN XS & OS

ACL Injury Prevention BY LEE DIEHL, MD

Anterior Cruciate Ligament
(ACL) injury rates are increasing among
youth athletes. Despite surgical repair,
up to 20% will suffer re-injury within
two years. Improper mechanics during
dynamic movements in sport lead to
valgus forces at the knee (knocked
knee position), which places high stress
directly to the ACL and contributes to
injury risk. Dynamic valgus stress to the
knee resulting from poor neuromuscular
control is the largest risk factor for
ACL injury and is modifiable through
prevention programs. Here we discuss
the important facts.

Injury Prevalence

ACL injuries are most commonly
non-contact, occurring during dynamic
movements involving cutting, pivoting,
landing after a jump, and decelerating. plyometrics, balance (neuromuscular) References
Athletes between the ages of 15 and 25 training, and strength training. Commonly 1. Griffin L, Albohm M, Arendt E, et al.
are at the greatest risk of injury. Female used training programs include: Understanding and preventing noncontact
athletes are at a four- to six-fold increased • PEP Program (Prevent Injury and anterior cruciate ligament injuries: a review
risk of injury compared to their male Enhance Performance) by the Santa of the Hunt Valley II meeting, January
2005. Am J Sports Med. 2006;34:1512–32.
counterparts. 1 Monica Sports Medicine Research 2. Sadoghi P, von Keudell A, Vavken P.
Foundation (www.aclstudygroup.com/ Effectiveness of anterior cruciate ligament
Prevention Programs
pdf/pep-program.pdf) injury prevention training programs.
The goal of ACL prevention programs is 6 J Bone Joint Surg Am. 2012;94:769–76.
to decrease the risk and/or prevent ACL • FIFA 11+ Program 3. Donnell-Fink LA, Klara K, Collins JE, et al.
injury. These programs have demonstrated Effectiveness of knee injury and anterior
a risk reduction of up to 52% in female IOC Injury Prevention App cruciate ligament tear prevention programs:
athletes and 85% in male athletes. 2,3 The International Olympic Committee a meta-analysis. PLoS One. 2015;10(12):1–17.
It is recommended that prevention (IOC) medical and scientific teams have 4. Myer GD, Sugimoto D, Thomas S, et al.
programs be implemented for younger developed the Get Set–Train Smarter The influence of age on the effectiveness
of neuromuscular training to reduce
4
athletes when they are most effective. app, which provides athletes with sport- anterior cruciate ligament injury in female
A typical program is comprised of specific, evidence-based workout routines athletes: a meta-analysis. Am J Sports Med.
three training sessions per week, each to help prevent injuries. The app features 2013;41(1):203–15.
lasting 20–30 minutes. For maximal videos with easy-to-follow instructions 5. Sugimoto D, Myer GD, Bush HM, et al.
effectiveness the program should be on how to perform each exercise correctly Compliance with neuromuscular training
initiated in pre-season and continued and has three levels of difficulty. and anterior cruciate ligament injury risk
throughout the season. Compliance reduction in female athletes: a meta-
with a program is essential to its success. The Get Set–Train Smarter analysis. J Athl Train. 2012;47(6): 714–23.
A decrease in compliance results in a app is available to download 6. Soligard T, Myklebust G, Steffen K, et al.
decrease in ACL injury reduction rates. 5 on iOS and Android and is Comprehensive warm-up programme to
prevent injuries in young female footballers:
A comprehensive training program accessible for free. cluster randomised controlled trial. BMJ.
must consist of three exercise components: 2008;337:a2469.

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