This paper examines the effectiveness of implementing neuromuscular and proprioceptive training programs in female athletes and their ability to decrease the incidence of anterior cruciate ligament (ACL) injury. The relationship of sex, age, and training on the incidence of ACL injury is pivotal in developing a comprehensive neuromuscular and proprioceptive training program to decrease ACL injuries occurring in female athletes. Based on the 2-year results, ACL incidence has remained consistently lower in the intervention group versus the control group. A prophylactic neuromuscular and proprioceptive training program may have a direct benefit in decreasing the number of ACL injuries incurred by female athletes. This research foundation endorses further epidemiologic and biomechanic studies to determine the exact mechanism of ACL injury and the most effective intervention that will effectively decrease ACL injuries in this high-risk population.
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References and Recommended Reading
FIFA: Womens Soccer Statistics. http://www.fifa.com/en/development/ medicalsection/0,1236,3,00.html The FIFA website includes a section devoted to F-MARC (Medical Assessment and Research Centre). This website provides detailed medical information that is specific to soccer. It includes injury prevention techniques, nutritional and hydration guidelines, and guidelines for participation with regard to age and competitive level.
Harmon KG, Ireland ML: Gender differences in noncontact anterior cruciate ligament injuries. Clin Sports Med 2000, 19:287–302.
Arendt E, Dick R: Knee injury patterns among men and women in collegiate basketball and soccer NCAA data and review of literature. Am J Sports Med 1995, 23:694–701.
Lindenfeld T, Schmitt D, Hendy M, et al.: Incidence of injury in indoor soccer. Am J Sports Med 1994, 22:364–371.
Malone T, Hardaker W, Garrett W: Relationship of gender to anterior cruciate ligamentsin intercollegiate basketball players. J South Orthop Assoc 1993, 2:36–39.
Update on the consensus for female ACL injuries* American Orthopedic Society for Sports Medicine Annual Meeting. Orlando: June 30–July 3; 2002.
Lohmander LS, Ostenberg A, Englund M, et al.: High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 2004, 50:3145–3152.
Galey S, Konieczko EM, Arnold CA, et al.: Immunohistological detection of relaxin binding to anterior cruciate ligaments. Orthopedics 2003, 26:1201–1204.
Liu SH, al-Shaikh R, Panossian V, et al.: Primary immunolocalization of estrogen and progesterone target cells in the human anterior cruciate ligament. J Ortho Res 1996, 14:526–533.
Sciore P, Frank CB, Hart DA: Identification of sex hormone receptors in human and rabbit ligaments of the knee by reverse transcription-polymerase chain reaction: evidence that receptors are present in tissue from both male and female subjects. J Orthop Research Soc 1998, 16:604–610.
Hama H, Yamamuro T, Takeda T: Experimental studies on connective tissue of the capsular ligament. Influences of aging and sex hormones. Acta Orthopaedica Scandinavica 1976, 47:473–479.
Samuel CS, Butkus A, Coghlan JP, et al.: The effect of relaxin on collagen metabolism in the nonpregnant rat pubic symphysis: the influence of estrogen and progesterone in regulating relaxin activity. Endocrinology 1996, 137:3884–3890.
Griffin LY, Agel J, Albohm MJ, et al.: Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 2000, 8:141–150. This article was the catalyst that spurred numerous research studies involving the four risk factors that are associated with ACL injury in the female athlete. The risk factors include anatomy, hormones, environment, and biomechanics.
Torg JS, Quedenfeld TC, Landau S: The shoe-surface interface and its relationship to football knee injuries. J Sports Med 1974, 2:261–269.
Heidt RS Jr, Dormer SG, Cawley PW, et al.: Differences in friction and torsional resistance in athletic shoe-turf surface interfaces. Am J Sports Med 1996, 24:834–842.
Ekstrand J, Nigg B: Surface-related injuries in soccer. Sports Med 1989, 8:56–62.
Delfico A, Garrett W: Mechanisms of injury of the ACL in soccer players. Clinics in Sports Med 1998, 17:779–785.
Kirkendall DT, Garrett WE Jr: The anterior cruciate ligament enigma. Injury mechanisms and prevention. Clin Orthop Rel Res 2000, 372:64–68.
Markolf KL, Burchfield DM, Shapiro MM, et al.: Combined knee loading states that generate high anterior cruciate ligament forces. J Ortho Res 1995, 12:930–935.
Caraffa A, Cerulli G, Projetti M, et al.: Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc 1996, 4:19–21.
Ettlinger CF, Johnson RJ, Shealy JE: A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am J Sports Med 1995, 23:531–537.
Heidt RS Jr, Sweeterman LM, Carlonas RL, et al.: Avoidance of soccer injuries with preseason conditioning. Am J Sports Med 2000, 28:659–662.
Hewett TE, Lindenfeld TN, Riccobene JV, et al.: The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study [comment]. Am J Sports Med 1999, 27:699–706.
Lloyd DG: Rationale for training programs to reduce anterior cruciate ligament injuries in Australian football. J Orthop Sports Phys Ther 2001, 21:645–654.
Mandelbaum B, Silvers H, Watanabe D, et al.: Effectiveness of a neuromuscular and proprioceptive training program in preventing the incidence of ACL injuries in female athletes: twoyear follow up. Am J of Sports Med 2005, 33:1003–1110. This article thoroughly describes the research methodology surrounding the implementation of the PEP ACL Injury Prevention Protocol in the female soccer-playing population.
Gilchrist J, Mandelbaum B, Melancon H, et al.: A Randomized Controlled Trial to Prevent Non-contact ACL Injury in Female Collegiate Soccer Players. American Orthopedic Society for Sports Medicine Specialty Day: San Francisco; February 2004.
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Silvers, H.J., Giza, E. & Mandelbaum, B.R. Anterior cruciate ligament tear prevention in the female athlete. Curr Sports Med Rep 4, 341–343 (2005). https://doi.org/10.1007/s11932-005-0020-x
- Anterior Cruciate Ligament
- Anterior Cruciate Ligament Injury
- Female Athlete
- National Collegiate Athletic Association
- Neuromuscular Training