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      Evidence-Based Best-Practice Guidelines for Preventing Anterior Cruciate Ligament Injuries in Young Female Athletes: A Systematic Review and Meta-analysis

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          Abstract

          Injury prevention neuromuscular training (NMT) programs reduce the risk for anterior cruciate ligament (ACL) injury. However, variation in program characteristics limits the potential to delineate the most effective practices to optimize injury risk reduction.

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          Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study.

          Timothy Hewett, Gregory D. Myer, Kevin R. Ford … (2005)
          Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes. Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk. Cohort study; Level of evidence, 2. There were 205 female athletes in the high-risk sports of soccer, basketball, and volleyball prospectively measured for neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads using kinetics (joint moments) during a jump-landing task. Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament. Nine athletes had a confirmed anterior cruciate ligament rupture; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture. Knee abduction angle (P<.05) at landing was 8 degrees greater in anterior cruciate ligament-injured than in uninjured athletes. Anterior cruciate ligament-injured athletes had a 2.5 times greater knee abduction moment (P<.001) and 20% higher ground reaction force (P<.05), whereas stance time was 16% shorter; hence, increased motion, force, and moments occurred more quickly. Knee abduction moment predicted anterior cruciate ligament injury status with 73% specificity and 78% sensitivity; dynamic valgus measures showed a predictive r2 of 0.88. Knee motion and knee loading during a landing task are predictors of anterior cruciate ligament injury risk in female athletes. Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury. The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective, targeted interventions.
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            Risk of Secondary Injury in Younger Athletes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

            Amelia J Wiggins, Ravi K Grandhi, Daniel Schneider … (2016)
            Injury to the ipsilateral graft used for reconstruction of the anterior cruciate ligament (ACL) or a new injury to the contralateral ACL are disastrous outcomes after successful ACL reconstruction (ACLR), rehabilitation, and return to activity. Studies reporting ACL reinjury rates in younger active populations are emerging in the literature, but these data have not yet been comprehensively synthesized.
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              A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen.

              Chadwick C. Prodromos, Yung Han, Julie Rogowski … (2007)
              The literature has shown that anterior cruciate ligament (ACL) tear rates vary by gender, by sport, and in response to injury-reduction training programs. However, there is no consensus as to the magnitudes of these tear rates or their variations as a function of these variables. For example, the female-male ACL tear ratio has been reported to be as high as 9:1. Our purpose was to apply meta-analysis to the entire applicable literature to generate accurate estimates of the true incidences of ACL tear as a function of gender, sport, and injury-reduction training. A PubMed literature search was done to identify all studies dealing with ACL tear incidence. Bibliographic cross-referencing was done to identify additional articles. Meta-analytic principles were applied to generate ACL incidences as a function of gender, sport, and prior injury-reduction training. Female-male ACL tear incidences ratios were as follows: basketball, 3.5; soccer, 2.67; lacrosse, 1.18; and Alpine skiing, 1.0. The collegiate soccer tear rate was 0.32 for female subjects and 0.12 for male subjects. For basketball, the rates were 0.29 and 0.08, respectively. The rate for recreational Alpine skiers was 0.63, and that for experts was 0.03, with no gender variance. The two volleyball studies had no ACL tears. Training reduced the ACL tear incidence in soccer by 0.24 but did not reduce it at all in basketball. Female subjects had a roughly 3 times greater incidence of ACL tears in soccer and basketball versus male subjects. Injury-reduction programs were effective for soccer but not basketball. Recreational Alpine skiers had the highest incidences of ACL tear, whereas expert Alpine skiers had the lowest incidences. Volleyball may in fact be a low-risk sport rather than a high-risk sport. Alpine skiers and lacrosse players had no gender difference for ACL tear rate. Year-round female athletes who play soccer and basketball have an ACL tear rate of approximately 5%. Level IV, therapeutic case series.
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                Author and article information

                Journal
                Title: The American Journal of Sports Medicine
                Abbreviated Title: Am J Sports Med
                Publisher: SAGE Publications
                ISSN (Print): 0363-5465
                ISSN (Electronic): 1552-3365
                Publication date Created: July 12 2018
                Publication date (Electronic): July 12 2018
                Page: 036354651878246
                Affiliations
                [1 ]Department of Radiology, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
                [2 ]School of Health and Human Performance, Northern Michigan University, Marquette, Michigan, USA
                [3 ]The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
                [4 ]Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
                [5 ]Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital, Boston, Massachusetts, USA
                [6 ]Department of Pediatrics, College of Human Medicine, Michigan State University, East Lansing, Michigan, USA
                [7 ]Kalamazoo College, Kalamazoo, Michigan, USA
                [8 ]Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan, USA
                [9 ]The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
                [10 ]Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA
                Article
                DOI: 10.1177/0363546518782460
                PMC ID: 6592422
                PubMed ID: 30001501
                SO-VID: 281623d3-9a2a-450f-8878-1b042bd615e8
                Copyright © © 2018
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                http://journals.sagepub.com/page/policies/text-and-data-mining-license

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