Preventing ACL Injuries

Peter N Ove, MDSports Medicine, Arthroscopic Knee and

Shoulder SurgeryOrthopaedics and Sports Medicine

pove@osmc.net

What is the ACL?

ACL Injuries

ACL injuries

ACL Injuries

ACL injury can be career ending Even if get back, risk for further

surgery, re-injury, arthritis Focus on preventable ACL injuries

Valgus, slight flexion, and rotation

Landing differences

Some proposed risk factors for ACL tear

Bracing: no conclusive evidence Footwear: increased friction

coefficient more risky Playing surface: lower friction

(wooden vs artificial, turf vs. grass?, even vs uneven surface) better

Environmental conditions: outdoor turf, grass cold better than hot weather

Epidemiology

ACL tears 4-6x more common in girls than boys

Why? Anatomy & Physiology Hormonal, ligament/house size,

biomechanics Technique Environment, other factors’

contribution notwithstanding

ACL Injuries-non contact injuries

ACL Injuries in Girls

38,000 estimated female ACL injuries each year

Estimated 2,200 at the collegiate level

May be 4 times as high at HS level (8000-9000!!)

ACL Injuries in Girls

Increased Participation in sports (Title IX) Female basketball

players are 2x more likely to suffer an ACL tear than their male counterparts

Female soccer players are 4x more likely to suffer an ACL tear than their male counterparts

Why?Theories To Explain Gender Differences

Anatomical Differences

Biomechanical Factors

Hormonal Influences

Neuromuscular Differences

Anatomic Differences

Women tend to have a more “knock-kneed” leg alignment

The femoral notch, in women tends to be narrower

Biomechanical Differences Compared with men,

women: Have less muscle mass Are slower at the rate of

muscle force development (ms)

Have a stronger, quicker reacting quadriceps relative to hamstrings

Tend to be more upright when landing

Tend to be “quad dominant”

Neuromuscular Differences Ligament Dominance

Knee ligaments rather than knee muscles absorb the landing forces during sports maneuvers

Quadriceps Dominance Quads react more quickly to forces than the

hamstrings Leg Dominance

The non-dominant knee is at greater risk because it’s weaker

How Can The Incidence of ACL Injuries Be Reduced?

ACL injury prevention programs have demonstrated a reduction in the rate of ACL injuries in 14-18 year old girls by 74-83%!! Helping to change the position of the knee

when landing or cutting and pivoting Decreasing landing forces on the knee

when landing from a jump

ACL Injuries

Landing Differences

Strategies to Avoid Injury

• Avoid vulnerable positions

• Increase flexibility • Increase strength• Increase balance

through agility training

• Include sports specific exercises into the training program

Research-proven ACL injury prevention programs:

-Preseason

-In-season

-Multi-year

Randomized Trials in high school, college, and professional athletes; female and male

Examples: Sportsmetrics, PEP, Frappier, BAPS

Prevent ACL

• Technique changes– Landing properly– Accelerated round turns, multi-step stop

deceleration• Balance, proprioceptive training• Neuromuscular training

– Correct imbalances (leg, muscle groups)– Improve strength, flexibility via

plyometrics, weight training with proper alignment and technique

Successful

Reduction in ACL injuries by 5X in many studies

Usually most impressive statistics when you separate out non-contact injuries

Improvement in performance (vertical jump)

Conclusion

The research and development of training programs to prevent ACL injuries is evolving rapidly

More attention needs to be placed on implementing these programs to younger athletes during their developmental years

Thank you