ACL Injury Prevention: What Does Research Tell Us?

Abstract

Faulty mechanics during dynamic movement that cause excessive valgus force at the knee increases the risk of ACL injury. Faulty mechanics may be a result of lateral displacement of the trunk, unequal limb loading, and lack of control to avoid the valgus knee position. Altered movements that place the ACL at risk are best identified in a fatigued state; however, could be recognized in a standard dynamic assessment. The faulty movement patterns are modifiable and should be addressed in an injury prevention program. Prevention programs include various modes of exercise such as plyometrics, neuromuscular training, and strength training. This review concludes that those programs which utilize neuromuscular training and strength training at a young age show the most promise in reducing ACL injuries. An ongoing thorough dynamic examination is necessary for all athletes while adjusting the intervention program in order to decrease the risk of ACL injury.

Meta‐analysis of meta‐analyses of anterior cruciate ligament injury reduction training programs

“…A large number of literature and narrative reviews have been conducted in order to summarize the evidence for the efficacy of ACL prevention training programs. [10][11][12] These vary greatly in terms of scope and quality. Systematic reviews performed with use of meta-analyses are a valid means for summarization of the combined results of multiple intervention studies, and have gained acceptance because they are a single source of up-to-date information for the health care provider to make an evidence based practice decision.…”

Effects of verbal knee alignment instructions on knee kinematics, kinetics and the performance of a single-leg jump in female adolescent soccer players

“…After the landing of the second jump, the participant was given approximately three seconds to regain stability. The sequence of two jumps including a quick change in mediolateral direction was used in this study as this type of sportrelated movement has been associated with noncontact ACL injuries [4,5].…”

“…Injuries to the anterior cruciate ligament (ACL) are receiving a great deal of attention because of the high incidence of injury and increased risk of early onset of osteoarthritis [4]. The majority of the ACL injuries are non-contact in nature and most of these occur during sudden changes in direction and pivoting [5]. The position of the lower extremity while completing these tasks is thought to be a factor contributing to ACL rupture [6].…”

“…More specifically, excessive knee valgus during pivoting manoeuvres (e.g. while running and landing) is a risk factor of ACL injury [5] since this position of the knee increases the relative ACL strain [7].…”

Additional perspectives on ‘ACL rupture is a single leg injury but a double leg problem…’

“…Indeed, risk factors for injury are multifactorial, 6 but several authors conclude that one important sensorimotor risk factor is altered movement patterns (in specific increased frontal plane knee motion, poor trunk positioning or landing techniques). 7 Therefore, quantification of altered movement patterns should be included in test batteries. One such quantifiable measurement, reliable and valid for individuals with ACL injury, is the Test for Substitution Patterns.…”