Sports Medicine Research: In the Lab & In the Field: Another View on the Effectiveness of Team-Based ACL Prevention Programs (Sports Med Res)


Wednesday, August 22, 2012

Another View on the Effectiveness of Team-Based ACL Prevention Programs

Preventing ACL Injuries in Team-Sport Athletes: A Systematic Review of Training Interventions

Stojanovic MD & Ostojic SM. Research in Sports Medicine. 2012; 20:3-4, 223-238. 
doi 10.1080/15438627.2012.680988 (Full text available for free online)

Anterior cruciate ligament (ACL) injury prevention programs have been integrated into team sports in efforts to prevent or decrease the overall incidence of ACL injuries.  A wide variety of programs have been studied on various populations.  The purpose of this systematic review was to analyze the literature on ACL intervention programs in team sports to see where we currently stand.  A systematic literature search yielded 9 studies that met the inclusion criteria of original research that assessed the influence of intervention programs on ACL injuries rates among male or female team sport athletes.  The studies included 13,884 athletes (5,713 intervention & 8,171 control athletes).  Most (5) of the studies evaluated a multifaceted intervention approach to reducing the risk of ACL injuries, which typically included stretching, proprioception, strength training, and plyometric/agility drills. The other articles focused on balance or plyometric programs.  The authors evaluated the study quality, utilizing a yes/no checklist of 10 criteria that was adapted from a couple of different research groups (can be found in full text).  The quality scores ranged from 3 to 8 (maximum score of 10), with an average score of 6.2.  The overall quality of the studies was considered to be moderate with lack of randomization and blinding being highlighted as major weaknesses in the literature.  Results of ACL intervention programs varied in the 9 included studies.  The strongest quality study demonstrated favorable results for an ACL intervention program that consisted of a multifaceted approach, including stretching, strength training, plyometric/agility drills, and proprioceptive activities.  Of the remaining 8 studies, 4 found lower ACL injuries in the intervention group, where the other 4 did not.  Two of the studies that did not show a beneficial effect with the intervention had moderate quality but focused on only balance or plyometric programs. Among, the other two studies that found no beneficial effect for multifaceted interventions, one had a poor quality score and the other study may not have had a sufficient number of athletes.

Clinically, ACL intervention programs that take a multifaceted approach appear to have a potential benefit for reducing the risk of ACL injuries, however, there is a lack of research to identify what program components may be the most critical.  I think it is important to interpret these findings with caution, as there are so many different components of an intervention program. The most telling finding of this study is that despite the focus on this area, there is still a void in high quality research surrounding the efficacy of ACL intervention programs, as only 3 of the included 9 studies were randomized controlled trials (RCTs) and there was no blinding involved in any. These authors also attempted to focus their analysis on both males and females; however, only 2 of the selected studies had participants that were either male or female, the other 7 focused on females only.  ACL injury rates are higher in the female population; however, the absolute number of ACL injuries is higher in the male population.  Therefore, there is a lack of literature on the effectiveness of these programs on reducing ACL injuries among males. Has anyone implemented any intervention programs at their school?  If so, are they gender specific or neutral? Do you think that there could be one gender neutral intervention program designed, or should there be gender specific programs designed based on weaknesses that have been found in either?

Written by: Nicole Cattano 
Reviewed by: Jeffrey Driban

Related Posts:
Stojanovic MD, & Ostojic SM (2012). Preventing ACL Injuries in Team-Sport Athletes: A Systematic Review of Training Interventions. Research in Sports Medicine, 20 (3-4), 223-38 PMID: 22742077


Anonymous said...

The only major intervention program that I have seen implemented by a team was an ankle sprain/ACL prevention program that focused on proper landing technique. It focused a lot on gluteus medius strength, proper landing mechanics, core stability,flexibility, and over all leg strength. We didn't have any major ankle or knee injuries that season. I wish more team's coaches would be willing to put in as much time and effort as that one was. It seems to me that there probably isn't any one particular program that is the silver bullet in injury prevention. I think it's more a matter of proper training and conditioning. At the high school where I work, there are a lot of kids who are not exactly in athletic shape but sign up to play sports, and then inevitably get injured due to their lack of training and conditioning. I think an emphasis needs to be placed on overall strength training and conditioning, which I imagine will have global benefits for preventing all kinds of injuries, instead of focusing on just one injury. Does anyone have any thoughts on this?

Nicole Cattano said...

Natalie-I definity agree with you. I work at a University and often see similar outcomes with the "out of shape" athlete being more susceptible to injury. For the intervention program at your high school, I think that it is great that your coaches took an interest in this. A couple of logisitcal questions that always seem to come up: how much longer did it add to a team warm up/work out and who ran it?

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