Effectiveness of Anterior Cruciate
Ligament Injury Prevention Training Programs
Sadoghi P,
von Keudell A, and Vavken P. J Bone Joint Surg Am. 2012; 94:1-8.
von Keudell A, and Vavken P. J Bone Joint Surg Am. 2012; 94:1-8.
Due to the
high numbers of anterior cruciate ligament (ACL) injuries, and the potential
for long-term joint degeneration, many ACL injury prevention programs have been
created and implemented in hopes of preventing ACL injuries from occurring.
While many programs exist, the effectiveness of these programs has not been
comprehensively evaluated. Therefore, Sadoghi and colleagues performed a
systematic review of literature examining if ACL injury prevention programs
decrease the risk of ligament injuries. Studies which were prospective,
controlled studies that directly compared ACL injury prevention programs with
no treatment in human subjects were eligible for inclusion. A total of 723 articles
were initially identified but 714 were excluded, leaving 8 articles for analysis.
Six of the 8 studies concluded that patients who underwent an ACL injury
prevention program had a significantly lower rate of ACL injuries. The
remaining 2 studies concluded that there was no difference in the rate of knee
injuries following the ACL injury prevention program compared to the control
groups. Pooled analysis of the data concluded that, overall, there was a
significant reduction in the number of ACL injuries among participants that
completed an ACL injury prevention program. This effect was seen in both male
and female athletes. The authors also attempted to identify a “best” program
for preventing ACL injuries. While the authors concluded that no “best” program
exists there was agreement among studies which were successful in decreasing
ACL injury rates. Those programs included at least 10 minutes of exercises, 3
times per week, and focused on neuromuscular training.
high numbers of anterior cruciate ligament (ACL) injuries, and the potential
for long-term joint degeneration, many ACL injury prevention programs have been
created and implemented in hopes of preventing ACL injuries from occurring.
While many programs exist, the effectiveness of these programs has not been
comprehensively evaluated. Therefore, Sadoghi and colleagues performed a
systematic review of literature examining if ACL injury prevention programs
decrease the risk of ligament injuries. Studies which were prospective,
controlled studies that directly compared ACL injury prevention programs with
no treatment in human subjects were eligible for inclusion. A total of 723 articles
were initially identified but 714 were excluded, leaving 8 articles for analysis.
Six of the 8 studies concluded that patients who underwent an ACL injury
prevention program had a significantly lower rate of ACL injuries. The
remaining 2 studies concluded that there was no difference in the rate of knee
injuries following the ACL injury prevention program compared to the control
groups. Pooled analysis of the data concluded that, overall, there was a
significant reduction in the number of ACL injuries among participants that
completed an ACL injury prevention program. This effect was seen in both male
and female athletes. The authors also attempted to identify a “best” program
for preventing ACL injuries. While the authors concluded that no “best” program
exists there was agreement among studies which were successful in decreasing
ACL injury rates. Those programs included at least 10 minutes of exercises, 3
times per week, and focused on neuromuscular training.
Overall, this
study is interesting because it demonstrated that ACL prevention programs have
a positive effect on decreasing the number of ACL injuries in both male and
female athletes. These results must be interpreted cautiously though because
the length to follow-up was not clearly reported. Interestingly, this study was
unable to identify a “best” ACL prevention program but emphasizes that
neuromuscular training for 10 minutes, 3 times a week is a minimum. Perhaps
this study could not identify a “best” program because one does not exist, or a
“best” program does exist but not enough data is available to make that
conclusion. Maybe the key to ACL injury prevention lies in finding not which
neuromuscular exercises are best for the average athlete but which
neuromuscular exercises are most sport specific for the athlete being trained.
While little can be inferred from this study alone, it would be interesting for
future research to look into whether generalized ACL prevention or sport-specific
programs are more effective. Tell us what you have found in your practice with
ACL injury prevention programs. This study suggests that there is a decrease in
the number of ACL injuries seen but does not give a follow-up time to determine
when these gains are seen. A study recently reviewed here concluded that the duration of the
prevention program impacts the length of time you benefit from it. Have you
seen this in your practice? If so, when do you feel is an appropriate follow-up
time?
study is interesting because it demonstrated that ACL prevention programs have
a positive effect on decreasing the number of ACL injuries in both male and
female athletes. These results must be interpreted cautiously though because
the length to follow-up was not clearly reported. Interestingly, this study was
unable to identify a “best” ACL prevention program but emphasizes that
neuromuscular training for 10 minutes, 3 times a week is a minimum. Perhaps
this study could not identify a “best” program because one does not exist, or a
“best” program does exist but not enough data is available to make that
conclusion. Maybe the key to ACL injury prevention lies in finding not which
neuromuscular exercises are best for the average athlete but which
neuromuscular exercises are most sport specific for the athlete being trained.
While little can be inferred from this study alone, it would be interesting for
future research to look into whether generalized ACL prevention or sport-specific
programs are more effective. Tell us what you have found in your practice with
ACL injury prevention programs. This study suggests that there is a decrease in
the number of ACL injuries seen but does not give a follow-up time to determine
when these gains are seen. A study recently reviewed here concluded that the duration of the
prevention program impacts the length of time you benefit from it. Have you
seen this in your practice? If so, when do you feel is an appropriate follow-up
time?
Written by: Kyle
Harris
Harris
Reviewed by: Jeffrey
Driban
Driban
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von Keudell, A. (2012). Effectiveness of Anterior Cruciate Ligament Injury Prevention Training Programs The Journal of Bone and Joint Surgery (American), 94 (9) DOI: 10.2106/JBJS.K.00467