A Nationwide Follow-Up
Survey on the Effectiveness of an Implemented Neuromuscular Training Program to
Reduce Acute Knee Injuries in Soccer Players

M, Larsen K, Forssblad M, Nasmark A,Walden
M, & Hagglund M.  Orthop J Sports Med. Published online December 2018;
DOI: 10.1177/2325967118813841
Take Home Message: The
implementation of an injury prevention program nationwide was related to a reduction in knee injuries among soccer
players, especially females.

Knee injuries are relatively common
in soccer players and can result in considerable time loss. There are many
neuromuscular training injury prevention programs, including the Knee Control
Program, which reduces the number of ACL injuries among female adolescent
soccer players.  Sweden implemented the Knee
Control Program nationwide in 2010, which created a great opportunity to study
its effectiveness at a national level. Hence, the authors evaluated the
effectiveness of this program to reduce acute knee injuries among soccer
players at a national level. The authors also assessed the dissemination and
implementation of this program.  In
Sweden, all soccer players over 15 years of age are registered and use the same
insurance company. The authors retrospectively found over 17,500 players with a
knee injury, including 9,318 soccer players with an acute cruciate ligament injury
between 2006 to 2015.  After
implementation of the Knee Control Program
there was a decrease in “cruciate ligament” injuries by 6 to 13% and overall knee
injuries by 8 to 21% compared to the years prior to implementation.  There were no decreases in major knee
injuries among athletes between the ages of 15 to 17 years.  About 90% of the 24 districts held at least
one educational workshop over a 5-year period, and it was heavily aimed at
female soccer teams.

Knee injuries were reduced among national
soccer players, especially females, after implementation of the Knee Control
Program.  The authors noted that the
program had very early positive effects on female soccer players, which led to
more education and positive attention within this population.  The authors were concerned about the lack of
efficacy among adolescents 15 to 17 years of age given their high risk for a knee
injury.  The authors suggested that this
age group may be more aware of knee injuries, which lead to an increase in
diagnoses.  However, I wonder if this
group is limited by poor motivation or neuromuscular pattern development.  I also wonder if they might have benefited
more if these programs were implemented at an earlier age when these types of
programs may be most effective.  This
study is paramount in looking at such a large time period within a national
cohort of soccer players that included adolescent, amateur, and professional
players.  The program was associated with
almost 100 fewer knee injuries per year,
which seems impactful, especially since the authors concluded that the program
has only been partially implemented nationwide. 
It also remains unknown how well teams complied/adhered to the program,
which is important since compliance is related to the efficacy of these
programs. Despite, potential issues with compliance/adherence and
implementation, this program effectively reduced knee injuries in soccer
nationwide. Clinicians need to encourage coaches, parents, players, and other
stakeholders to adopt evidence-based neuromuscular training injury prevention
Questions for Discussion:  Are
there any strategies that have worked for you in creating team buy into
an injury prevention program? What do you think we need to do as a profession
to improve the implementation and adherence to injury prevention programs
by: Nicole Cattano
by: Jeffrey Driban