Editorial Type:
Article Category: Research Article
 | 
Online Publication Date: 01 Sept 2008

RISK FACTOR SCREENING AND PREVENTION

Page Range: 536 – 537
DOI: 10.4085/1062-6050-43.5.536
Save
Download PDF

What We Know

  1. Various training programs that incorporate elements of balance training, plyometric training, education, strengthening, and feedback alter biomechanical and neuromuscular variables thought to contribute to ACL injury.1–5

  2. Various intervention programs reduce the incidence of ACL injuries.6–8

  3. The protective effects of ACL injury prevention training programs appear to be transient.9–11

What We Don't Know

  1. What are the mechanisms underlying the success of various injury prevention programs? Specifically, which elements of an injury prevention program (strengthening, plyometrics, etc) produce the desired protective effect?

  2. How much training stimulus (ie, duration and timing) is required to produce the desired protective effect, and how long does the effect last?

  3. At what age should an injury prevention program be implemented to reduce potential neuromuscular and biomechanical risk factors?

  4. Do intervention programs need to be tailored to specific sports, specific ages, or an individual athlete's needs?

  5. Do intervention programs influence athletic performance?

Where Do We Go From Here?

  1. We should continue conducting prospective, randomized controlled studies to evaluate the ability of prevention strategies to alter neuromuscular and biomechanical risk factors and prevent ACL injury.

  2. Evidence is emerging that the efficacy of ACL injury prevention programs is not uniform across all individuals (abstracts 29 and 31). Further research is needed to establish the characteristics of “responders” and “nonresponders” to an ACL injury prevention program.

  3. To determine the optimal approach to alter biomechanical and neuromuscular risk factors thought to contribute to ACL injury, we should evaluate various intervention modalities (individually or in combination).

  4. We need to develop and standardize screening tools to identify at-risk individuals who will benefit most from intervention programs.

  5. How athletes of different stages of maturation respond to injury prevention programs should be evaluated.

  6. The optimal timing of an intervention with respect to the competitive season should be determined.

  7. Programs that improve compliance should be developed, and we need to understand why people comply or do not comply with programs.

  8. The dose-response relationship with intervention and prevention programs should be investigated.

  9. Whether injury prevention programs affect athletic performance should be evaluated.

  10. Registries for ACL injury should be established to enable monitoring of long-term trends in ACL injury incidence, including sex differences.

  11. Standard definitions for ACL injury should be developed to facilitate cross-study comparisons (eg, direct contact, indirect contact, and noncontact injury).

REFERENCES

  • 1
    Hurd, W. J.
    ,
    T. L.Chmielewski
    , and
    L.Snyder-Mackler
    . Perturbation-enhanced neuromuscular training alters muscle activity in female athletes.Knee Surg Sports Traumatol Arthrosc2006. 14 (
    1
    ):60–69.
  • 2
    Myer, G. D.
    ,
    K. R.Ford
    ,
    J. L.Brent
    , and
    T. E.Hewett
    . The effects of plyometric vs. dynamic stabilization and balance training on power, balance, and landing force in female athletes.J Strength Cond Res2006. 20 (
    2
    ):345–353.
  • 3
    Myer, G. D.
    ,
    K. R.Ford
    ,
    S. G.McLean
    , and
    T. E.Hewett
    . The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics.Am J Sports Med2006. 34 (
    3
    ):445–455.
  • 4
    Onate, J. A.
    ,
    K. M.Guskiewicz
    ,
    S. W.Marshall
    ,
    C.Giuliani
    ,
    B.Yu
    , and
    W. E.Garrett
    . Instruction of jump-landing technique using videotape feedback: altering lower extremity motion patterns.Am J Sports Med2005. 33 (
    6
    ):831–842.
  • 5
    Pollard, C. D.
    ,
    S. M.Sigward
    ,
    S.Ota
    ,
    K.Langford
    , and
    C. M.Powers
    . The influence of in-season injury prevention training on lower-extremity kinematics during landing in female soccer players.Clin J Sport Med2006. 16 (
    3
    ):223–227.
  • 6
    Hewett, T. E.
    ,
    T. N.Lindenfeld
    ,
    J. V.Riccobene
    , and
    F. R.Noyes
    . The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study.Am J Sports Med1999. 27 (
    6
    ):699–706.
  • 7
    Mandelbaum, B. R.
    ,
    H. J.Silvers
    ,
    D. S.Watanabe
    , et al    . Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up.Am J Sports Med2005. 33 (
    7
    ):1003–1010.
  • 8
    Petersen, W.
    ,
    C.Braun
    ,
    W.Bock
    , et al    . A controlled prospective case control study of a prevention training program in female team handball players: the German experience.Arch Orthop Trauma Surg2005. 125 (
    9
    ):614–621.
  • 9
    Graves, J. E.
    ,
    A. D.Martin
    ,
    L. A.Miltenberger
    , and
    M. L.Pollock
    . Physiological responses to walking with hand weights, wrist weights, and ankle weights.Med Sci Sports Exerc1988. 20 (
    3
    ):265–271.
  • 10
    Häkkinen, K.
    ,
    M.Alen
    ,
    W. J.Kraemer
    , et al    . Neuromuscular adaptations during concurrent strength and endurance training versus strength training.Eur J Appl Physiol2003. 89 (
    1
    ):42–52.
  • 11
    Petibois, C.
    and
    G.Déléris
    . Effects of short- and long-term detraining on the metabolic response to endurance exercise.Int J Sports Med2003. 24 (
    5
    ):320–325.
Copyright: the National Athletic Trainers' Association, Inc
  • Download PDF