A new study, “Evidence-Based Best-Practice Guidelines for Preventing Anterior Cruciate Ligament Injuries in Young Female Athletes: A Systematic Review and Meta-analysis” published online July 12, 2018 in the American Journal of Sports Medicine, suggests that anterior cruciate ligament (ACL) neuromuscular training programs (NMT) needs to target younger athletes.
ACL Injury Prevention Should Start at Earlier Age
1 min read Premium comments
Secondary#anteriorcruclateligamentinjuryprevention#youngathletes
The main purpose of this systematic review and meta-analysis was to evaluate the common and effective of components of ACL NMT programs and develop an efficient, user-friendly tool to assess the quality of these programs.
Overall, 18 studies were included, with a total of 27,231 participants, 347 of whom sustained an ACL injury. According to the data, NMT reduced the risk of ACL injury from 1 in 54 to 1 in 111 (OR: 0.51; 95% CI, 0.37-0.69). And the overall mean training volume was 18.17 hours for the entire NMT (24.1 minutes per session, 2.51 times per week).
Erich Petushek, Ph.D., CSCS, assistant professor, College of Human Medicine at the Marquette Campus at Michigan State University and colleagues found that interventions seem to be more effective in the middle school or high school aged athletes than it was with college or professional-aged athletes (OR: 0.38; 95% CI, 0.24-0.60 vs. OR: 0.65; 95% CI, 0.48-0.89).
All the interventions included some form of implementer training. Increased landing stabilization and lower body strength exercises during each session improved prophylactic benefits.
The researchers wrote, “Considering the aggregated evidence, we recommend that ACL NMT programs target younger athletes and use trained implementers who incorporate lower body strength exercises (i.e. Nordic hamstrings, lunges, and heel-calf raises) with a specific focus on landing stabilization (jump/hop and hold) throughout their sport season.”
They added, “Clinicians, coaches, athletes, parents and practitioners can use the developed checklist to gain insight into the quality of their current ACL NMT practices and can use the tool to optimize programming for future ACL NMT to reduce ACL injury risk.”
Petushek told OTW that the American Journal of Sports Medicine checklist includes questions on whether the program includes lunges, hamstring exercises and heel/calf raises and the number of landing stabilization exercises per session.
React:
Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
Join the conversation
Orthopedic professionals are discussing this. Sign in and upgrade to read every comment and add your voice.