Comparison of four alternative national universal anterior cruciate ligament injury prevention programme implementation strategies to reduce secondary future medical costs

Abstract

The HR 12-25 programme was the most effective implementation strategy. Estimation of the break-even cost of health expenditure savings will enable optimal future programme design, implementation and expenditure.

Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015

“…The rising incidence of ACL reconstruction during 2000–2015 can be attributed to several factors, including increasing medical and public awareness of the procedure, diagnostic improvements, the availability of magnetic resonance imaging, and increased access to orthopaedic surgeons 3 , 25 , 26 . About 72% of ACL reconstructions in Australia are sport‐related; the sports most frequently involved are Australian rules football, rugby union, rugby league, netball, basketball, soccer, and skiing 2 , 4 . The rise of ACL injury in young people has been attributed to earlier specialisation by younger athletes, longer sporting seasons, more intense training, higher levels of competition, 1 and a lack of free play 25 .…”

“…ACL ruptures were once thought to be uncommon in the skeletally immature, 1 but recent evidence suggests that the global burden of ACL injury falls increasingly on adolescents and young adults 2 , 3 . The short term consequences of ACL rupture include the inability to participate in sport, reconstructive surgery, and prolonged rehabilitation 4 . In the long term, regardless of whether or not an ACL reconstruction is performed, almost all individuals who tear an ACL are at increased risk of osteoarthritis and disability, 4 ‐ 6 and this risk is substantially increased by concurrent meniscal injury 4 …”

“…The short term consequences of ACL rupture include the inability to participate in sport, reconstructive surgery, and prolonged rehabilitation 4 . In the long term, regardless of whether or not an ACL reconstruction is performed, almost all individuals who tear an ACL are at increased risk of osteoarthritis and disability, 4 ‐ 6 and this risk is substantially increased by concurrent meniscal injury 4 …”

Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005–2015

“…It is therefore recommended that young athletes be encouraged to partake in preseason training programs focused on strengthening, neuromuscular, and proprioceptive training, under the appropriate supervision of qualified personnel [46]. Given the increasing rate of ACL injury in Australian children and adolescents, and the demonstrated effectiveness of prevention programs, a national ACL injury prevention program for youth could improve health outcomes while simultaneously reducing medical costs [48]. However, whilst ACL injury prevention using neuromuscular training has been found to be successful in the adolescent population, the level of evidence for ACL prevention in those below the age of 12 years, is markedly lower [17] and therefore requires further research.…”

“…Cost effective prevention programs are now available for implementation at a national level [48]. Given the increasing trends reported in this paper, and the previously reported increasing trends in all forms of sports injury in children [27], it is perhaps now time to consider the application of more structural, political, and population-focused measures to this important public health issue.…”