ACL Injury Prevention: What Does Research Tell Us?
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Purpose of Review
Mechanisms leading to anterior cruciate ligament (ACL) injury have been identified, yet re-injury or a secondary injury persists in the athletic population. The purpose of this review is to identify risk factors associated with ACL injury and investigate programs to prevent injury.
Faulty mechanics during dynamic movement that cause excessive valgus force at the knee increases the risk of ACL injury. Faulty mechanics may be a result of lateral displacement of the trunk, unequal limb loading, and lack of control to avoid the valgus knee position. Altered movements that place the ACL at risk are best identified in a fatigued state; however, could be recognized in a standard dynamic assessment. The faulty movement patterns are modifiable and should be addressed in an injury prevention program. Prevention programs include various modes of exercise such as plyometrics, neuromuscular training, and strength training.
This review concludes that those programs which utilize neuromuscular training and strength training at a young age show the most promise in reducing ACL injuries. An ongoing thorough dynamic examination is necessary for all athletes while adjusting the intervention program in order to decrease the risk of ACL injury.
KeywordsKnee injury Anterior cruciate ligament (ACL) Prevention program Neuromuscular training Plyometrics Strength training
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 2.Allografts in Sports Medicine: What do we know, need to know, and need to do? Round table discussion: American Orthopedic Society for Sports Medicine; 2006. Park City, UTGoogle Scholar
- 5.Dodwell E, LaMont L, Green D, et al. 20years of pediatric anterior cruciate ligament reconstruction in New York state. 2014;42:675–680.Google Scholar
- 14.• Hewett TE, Ford KR, Hoogenboom BJ, et al. Understanding and preventing ACL injuries: current biomechanical and epidemiologic considerations—update 2010. North American J Sports Phys Ther. 2010;5(4):234–50. Identifies biomechanical risk factors and mechanisms associated with ACL injury in high-risk individuals. Google Scholar
- 15.• Myer GD, Ford KR, Di Stasi SL, et al. High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: is PFP itself a predictor for subsequent ACL injury? Br J Sports Med. 2015;49:118–22. Identifies a large knee abduction moment during landing and reduced hamstrings-to-quadriceps ratio in ACL-injured athletes. CrossRefPubMedGoogle Scholar
- 17.Myer GD, Ford KR, Brent JL, et al. Differential neuromuscular training effects on ACL injury risk factors in “high-risk” versus “low-risk” athletes. BMC Musculoskel Dis. 2007;8(39).Google Scholar
- 23.National Collegiate Athletic Association. NCAA injury surveillance system summary. Indianapolis: National Collegiate Athletic Association; 2002.Google Scholar
- 36.Moore I, Ranson C, Mathema P. Injury risk in international rugby union: three-year injury surveillance of the welsh national team. Orth J Sports Med. 2015;3:1–9.Google Scholar
- 39.Orishimo K, Kremenic I. Effect of fatigue on single leg hop landing biomechanics. J App Biomech. 2006;10:1–10.Google Scholar
- 57.• Atkins S, Hesketh C, Sinclair J. The presence of bilateral imbalance of the lower limbs in elite youth soccer players of different ages. J Strength Cond Res. 2016;30:1007–13. Describes the impact lateral displacement of the pelvis has on force distribution and joint forces. CrossRefPubMedGoogle Scholar
- 70.Soligard T, Myklebust G, Steffen K, et al. Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ. 2008;337Google Scholar
- 75.• Myer GD, Sugimoto D, Thomas S, et al. The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a meta-analysis. Am J Sports Med. 2013;41(1):203–15. This study displayed age influence on ACL injury reduction. CrossRefPubMedGoogle Scholar
- 77.• Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33(4):492–501. The study explained the significance of faulty biomechanics and its relationship with risk for ACL injury. CrossRefPubMedGoogle Scholar
- 78.Hewett TE, Torg JS, Boden BP. Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism. Br J Sports Med. 2009;43(6):417–22.CrossRefPubMedPubMedCentralGoogle Scholar
- 86.• Sugimoto D, Myer GD, Foss KD, et al. Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses. Sports Med. 2014;44(4):551–62. This study generated evidence of inverse dose-response relationship.CrossRefPubMedPubMedCentralGoogle Scholar