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The 2012 ABJS Nicolas Andry Award: The Sequence of Prevention: A Systematic Approach to Prevent Anterior Cruciate Ligament Injury

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Clinical Orthopaedics and Related Research®

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Abstract

Background

ACL injuries are common, often devastating injuries that lead to short-term disability and long-term sequelae, many of which lack effective treatment, such as osteoarthritis. Therefore, prevention of ACL injury is currently the only effective intervention for these life-altering sequelae, while much of the literature has a rehabilitative focus.

Questions/Purposes

The primary long-term purpose of our multidisciplinary collaborative research team has been to develop ACL injury prevention programs by determining which factors related to ACL injury should be altered, followed by how and when they should be altered.

Methods

Our primary study objectives were to determine: (1) modifiable risk factors; (2) how these factors can best be modified; and (3) when is the best time to diminish these risk factors. Throughout the course of various studies, we determined the modifiable factors related to increased ACL injury risk. Our research team then focused on exploring numerous ways to augment these factors to maximize prevention efforts. We developed a sequence of prevention models that provide a framework to monitor progress toward the ultimate goal of preventing ACL injuries.

Results

The modifiable factors shown in our work include biomechanical and neuromuscular functionality. When targeted in physical training, we have determined that these factors can be enhanced to effectively aid in the prevention of ACL injuries. Preliminary data have shown that childhood and early adolescence may be valuable periods to implement such training.

Conclusions

Current evidence has led to the evolution of clinical assessment tools for high-risk athletes and interventions for large populations and specific high-risk individuals. Targeted intervention implemented at the specified developmental stage of highest risk may be the final step toward the maximal reduction of ACL injury risk in young athletes.

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Acknowledgements

This comprehensive body of research was the result of a large team of individuals who have helped contribute to the data collection process. We thank all coauthors and colleagues who helped us find solutions to the important and devastating ACL injury dilemma.

Author information

Authors and Affiliations

  1. Departments of Physiology & Cell Biology and Orthopaedic Surgery, The Ohio State University Sports Medicine Sports Health & Performance Institute, 2050 Kenny Road, Suite 3100, Columbus, OH, 43221-3502, USA

    Timothy E. Hewett PhD, Gregory D. Myer PhD & Carmen E. Quatman MD, PhD

  2. Family Medicine, School of Allied Medical Professions and Biomedical Engineering, The Ohio State University, Columbus, OH, USA

    Timothy E. Hewett PhD

  3. Athletic Training Division, School of Allied Medical Professions and Biomedical Engineering, The Ohio State University, Columbus, OH, USA

    Timothy E. Hewett PhD & Gregory D. Myer PhD

  4. Cincinnati Children’s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH, USA

    Timothy E. Hewett PhD, Gregory D. Myer PhD, Kevin R. Ford PhD, Mark V. Paterno PhD, PT & Carmen E. Quatman MD, PhD

  5. Departments of Pediatrics, Orthopaedic Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Timothy E. Hewett PhD & Gregory D. Myer PhD

  6. Department of Biomedical Engineering, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Timothy E. Hewett PhD

  7. Rocky Mountain University of Health Professions, Departments of Athletic Training, Sports Orthopaedics, Pediatric Science and Health Promotion and Wellness, Provo, UT, USA

    Gregory D. Myer PhD

  8. Department of Physical Therapy, School of Health Sciences, High Point University, High Point, NC, USA

    Kevin R. Ford PhD

  9. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    Kevin R. Ford PhD

  10. Department of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Mark V. Paterno PhD, PT

Authors
  1. Timothy E. Hewett PhD
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  2. Gregory D. Myer PhD
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  3. Kevin R. Ford PhD
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  4. Mark V. Paterno PhD, PT
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  5. Carmen E. Quatman MD, PhD
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Corresponding author

Correspondence to Timothy E. Hewett PhD.

Additional information

One of more of the authors has received funding from the National Institutes of Health grants R01-AR049735 (TEH), R01-AR056259 (TEH), R01-AR055563 (TEH), and R03-AR057551 (KRF); The Orthopaedic Research and Education Foundation (OREF) (TEH); National Football League Charities (TEH); University of Toledo College of Medicine Pre-Doctoral Fellowship (CEQ); and the American College of Sports Medicine Foundation Plus One Active Research Grant on Wellness Using Internet Technology (CEQ).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at Cincinnati Children’s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH, USA.

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Hewett, T.E., Myer, G.D., Ford, K.R. et al. The 2012 ABJS Nicolas Andry Award: The Sequence of Prevention: A Systematic Approach to Prevent Anterior Cruciate Ligament Injury. Clin Orthop Relat Res 470, 2930–2940 (2012). https://doi.org/10.1007/s11999-012-2440-2

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  • DOI: https://doi.org/10.1007/s11999-012-2440-2

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