Evaluation of the effectiveness of anterior cruciate ligament injury prevention programme training components: a systematic review and meta-analysis.

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Abstract

Anterior cruciate ligament (ACL) injury prevention programmes have shown mixed results, which may be due to differing emphasis on training components. The purpose of this study was to (1) quantify the overall and relative duration of each training component encompassed within these programmes and (2) examine the effect of these durations on ACL injury rates.

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Most cited references 27

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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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Neuro-musculoskeletal and performance adaptations to lower-extremity plyometric training.

Goran Markovic, Pavle Mikulic (2010)

Plyometric training (PLY) is a very popular form of physical conditioning of healthy individuals that has been extensively studied over the last 3 decades. In this article, we critically review the available literature related to lower-body PLY and its effects on human neural and musculoskeletal systems, athletic performance and injury prevention. We also considered studies that combined lower-body PLY with other popular training modalities, as well as studies that applied PLY on non-rigid surfaces. The available evidence suggests that PLY, either alone or in combination with other typical training modalities, elicits numerous positive changes in the neural and musculoskeletal systems, muscle function and athletic performance of healthy individuals. Specifically, the studies have shown that long-term PLY (i.e. 3-5 sessions a week for 5-12 months) represents an effective training method for enhancing bone mass in prepubertal/early pubertal children, young women and premenopausal women. Furthermore, short-term PLY (i.e. 2-3 sessions a week for 6-15 weeks) can change the stiffness of various elastic components of the muscle-tendon complex of plantar flexors in both athletes and non-athletes. Short-term PLY also improves the lower-extremity strength, power and stretch-shortening cycle (SSC) muscle function in healthy individuals. These adaptive changes in neuromuscular function are likely the result of (i) an increased neural drive to the agonist muscles; (ii) changes in the muscle activation strategies (i.e. improved intermuscular coordination); (iii) changes in the mechanical characteristics of the muscle-tendon complex of plantar flexors; (iv) changes in muscle size and/or architecture; and (v) changes in single-fibre mechanics. Our results also show that PLY, either alone or in combination with other training modalities, has the potential to (i) enhance a wide range of athletic performance (i.e. jumping, sprinting, agility and endurance performance) in children and young adults of both sexes; and (ii) to reduce the risk of lower-extremity injuries in female athletes. Finally, available evidence suggests that short-term PLY on non-rigid surfaces (i.e. aquatic- or sand-based PLY) could elicit similar increases in jumping and sprinting performance as traditional PLY, but with substantially less muscle soreness. Although many issues related to PLY remain to be resolved, the results of this review allow us to recommend the use of PLY as a safe and effective training modality for improving lower-extremity muscle function and functional performance of healthy individuals. For performance enhancement and injury prevention in competitive sports, we recommend an implementation of PLY into a well designed, sport-specific physical conditioning programme.

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Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention.

Timothy Hewett, Kevin R. Ford, Gregory D. Myer (2006)

Female athletes have a 4 to 6 times higher incidence of anterior cruciate ligament injury than do male athletes participating in the same landing and pivoting sports. This greater risk of anterior cruciate ligament injury, coupled with a geometric increase in participation (doubling each decade), has led to a significant rise in anterior cruciate ligament injuries in female athletes. The gender gap in anterior cruciate ligament injury, combined with evidence that the underpinnings of this serious health problem are neuromuscular in nature, leads to the development of neuromuscular interventions designed to prevent injury. A systematic review of the published literature yielded 6 published interventions targeted toward anterior cruciate ligament injury prevention in female athletes. Four of 6 significantly reduced knee injury incidence, and 3 of 6 significantly reduced anterior cruciate ligament injury incidence in female athletes. A meta-analysis of these 6 studies demonstrates a significant effect of neuromuscular training programs on anterior cruciate ligament injury incidence in female athletes (test for overall effect, Z = 4.31, P < .0001). Examination of the similarities and differences between the training regimens gives insight into the development of more effective and efficient interventions. The purpose of this "Current Concepts" review is to highlight the relative effectiveness of these interventions in reducing anterior cruciate ligament injury rates and to evaluate the common training components between the training studies. In addition, the level of rigor of these interventions, the costs and the difficulty of implementation, the compliance with these interventions, and the performance benefits are discussed. This review summarizes conclusions based on evidence from the common components of the various interventions to discuss their potential to reduce anterior cruciate ligament injury risk and assess their potential for combined use in more effective and efficient intervention protocols.

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Author and article information

Journal

Journal ID (iso-abbrev): Br J Sports Med

Title: British journal of sports medicine

ISSN (Electronic): 1473-0480

ISSN (Print): 0306-3674

Publication date (Electronic): Jan 2015

Volume: 49

Issue: 2

Affiliations

[1 ] Department of Physical Therapy, High Point University, High Point, North Carolina, USA Applied Neuromechanics Research Laboratory, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.

[2 ] Applied Neuromechanics Research Laboratory, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.

[3 ] Department of Mathematics and Statistics, University of North Carolina at Greensboro, Greensboro, North Carolina, USA.

Article

Publisher Item ID: bjsports-2013-092358

DOI: 10.1136/bjsports-2013-092358

PubMed ID: 23922282

SO-VID: 449e112d-928a-46fe-954e-782120e15471

Copyright statement: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.