Prevention of Anterior Cruciate Ligament Injuries in Competitive Adolescent Alpine Skiers

Westin, Maria; Harringe, Marita; Engström, Birgitta; Alricsson, Marie; Werner, Suzanne

doi:10.3389/fspor.2020.00011

Cited by 20 publications

(25 citation statements)

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“…Knowing that the effect of an intervention is presumed to decrease as testing moves from efficacy to effectiveness to dissemination and implementation research stages, the results of the current controlled experimental study that was conducted under unenforced real-world implementation conditions can be considered promising. Moreover, in addition to the recent study by Westin et al (2020) who reported a 45% reduction in the ACL injury incidence rate in U18 skiers, this is the first exercise-based prevention study focusing on younger skiers and different types of injuries. Notably, the IG differed from the CG in the average 2-weekly prevalence of traumatic knee injuries, knee overuse injuries, and lower back overuse injuries, three of the major injuryrelated hot spots in youth skiers (Westin et al, 2012;Müller et al, 2017;Fröhlich et al, 2020a,b;Peterhans et al, 2020;Schoeb et al, 2020).…”

Section: The Ispa Int Programme-promising Results Toward Effective In...mentioning

confidence: 91%

Section: Discussionmentioning

confidence: 91%

“…The benefits of exercise-based injury prevention programmes have been demonstrated in several competitive sports ( Junge et al, 2002 ; Mandelbaum et al, 2005 ; Michaelidis and Koumantakis, 2014 ; Riva et al, 2016 ; Soomro et al, 2016 ; Mehl et al, 2018 ; Petushek et al, 2018 ; Webster and Hewett, 2018 ; Huang et al, 2020 ; Pas et al, 2020 ). However, to the best of our knowledge, apart from a single study specifically focusing on anterior cruciate ligament (ACL) injuries ( Westin et al, 2020 ), evidence-based injury prevention programmes tailored to the specific injury patterns of U16 competitive alpine skiers are lacking.…”

Section: Introductionmentioning

confidence: 99%

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The ISPAInt Injury Prevention Programme for Youth Competitive Alpine Skiers: A Controlled 12-Month Experimental Study in a Real-World Training Setting

et al. 2022

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Evidence-based injury prevention programmes for youth competitive alpine skiers are widely absent. The aims of this controlled 12-month experimental study were to introduce a novel injury prevention programme targeted to the injury patterns of youth skiers, called ISPAInt, and to compare the differences in injury occurrence between an intervention group (IG) additionally performing the ISPAInt programme and an independent, historical control group (CG) following their regular training routines. None of the skiers of the CG were part of the IG and vice versa. The study was directly conducted within the real-world youth development structures of skiers competing at the under 16 years (U16) level in Switzerland. Seventy-one skiers (aged 14.4 ± 0.3 years) assigned to the IG were compared to 58 age- and gender-matched controls. The IG was offered the ISPAInt programme with the recommendation to perform it at least once per week. Skiers’ adherence to this recommendation was surveyed but not enforced. Injuries were recorded using the Oslo Sports Trauma Research Centre Questionnaire. Primary outcomes were the absolute injury rates (number of injuries/100 athletes per season) and epidemiological incidence proportion (number of injured athletes/100 athletes per season). The secondary outcome was the average 2-weekly prevalence of traumatic knee, knee overuse, and lower back overuse injuries. There were lower absolute rates of all traumatic injuries [rate/risk difference, RD: −57.1 (−98.1, −16.0); rate/risk ratio, RR: 0.665 (0.485, 0.884)] and overuse injuries [RD: −35.9 (−71.0, −0.7); RR: 0.699 (0.493, 0.989)] in the IG than in the CG. Likewise, the epidemiological incidence proportion for all overuse injuries was smaller in the IG [RD: −28.4 (−44.8, −12.0); RR: 0.598 (0.435, 0.822)], while the proportion of skiers suffering from traumatic injuries did not significantly differ between the groups. Notably, the IG particularity differed from the CG in the average 2-weekly prevalence of knee trauma, knee overuse, and lower back overuse complaints, three of the major injury-related hot spots in youth skiers. Based on these promising results, the ISPAInt programme may have great potential to prevent injuries in youth competitive alpine skiers, and the underlying exercises should be considered complementary training content at the U16 level.

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Section: The Ispa Int Programme-promising Results Toward Effective In...mentioning

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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The ISPAInt Injury Prevention Programme for Youth Competitive Alpine Skiers: A Controlled 12-Month Experimental Study in a Real-World Training Setting

et al. 2022

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“…In a study by Schoeb et al ( 35), an off-snow injury prevention program for Swiss aged under 16 years (U16) competitive skiers performed once a week, reduced the 2-weekly prevalence of knee trauma, knee overuse, and lower back overuse complaints. Another study by Westin et al (36) using a neuromuscular prevention program on-and off-snow, showed a reduction of first episode ACL injury in competitive alpine skiers between 16 and 20 years of age. Both these programs were carried out during the whole skiing season.…”

Section: Discussionmentioning

confidence: 95%

Side-to-side differences in knee laxity and side hop test may predispose an anterior cruciate ligament reinjury in competitive adolescent alpine skiers

Westin

Mirbach

Harringe

2022

Front. Sports Act. Living

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An anterior cruciate ligament (ACL) injury is a common, severe injury in alpine skiing, and anterior cruciate ligament reconstruction (ACLR) is frequently performed in competitive alpine skiers younger than 20 years old. To reduce the reinjury rate, both intrinsic and extrinsic risk factors should be examined. The aim of this study was to investigate possible intrinsic risk factors for an ACL reinjury in competitive alpine skiers. A cohort of 384 alpine skiers (191 males/193 females) from the Swedish ski high schools were prospectively followed during their high school years. The students were clinically examined and physically tested prior to each ski season. In addition, the RAND 36-Item health survey 1.0 (SF-36, Copyright 1994 Medical Outcome Trust, distributed by RAND Corporation) and injuries were prospectively registered. Thirty-one of the skiers (five males/26 females) had undergone an ACLR before entering the ski high school. This cohort was analyzed with respect to the occurrence of, and possible risk factors for an ACL reinjury (including ipsilateral and contralateral ACL injuries). Skiers who sustained an ACL reinjury were called the “ACL reinjury group,” and those who did not sustain an ACL reinjury were called the “ACL injury group.” Notably, 12 of the 31 students (39%), ten female and two male skiers, aged 16.5 (SD 0.5) years, sustained an ACL reinjury during the two first years at the ski high school. In addition, 10 of the 12 ACL reinjuries occurred within 10–23 months from the first injury [m 14.8 (SD4.7)] and two ACL reinjuries occurred at 29 and 47 months, respectively, from the first injury. It is noted that eight of the ACL reinjuries were to the ipsilateral knee and four to the contralateral knee. There were no differences between the groups with respect to muscle flexibility in the lower extremity, Beighton score, and one leg hop for distance or square hop test. Side-to-side differences were found with respect to knee joint laxity, >3 mm, measured with KT-1000 arthrometer (p = 0.02), and the side hop test (p = 0.04). RAND 36-Item health survey did not predict an ACL reinjury. In conclusion, a side-to-side difference in the side hop test and knee joint laxity (KT-1000) may predispose an ACL reinjury in competitive adolescent alpine skiers.

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“…Physical aspects are indeed known to be a key driver for injury risk in alpine ski racing. [23][24][25][26][27][28][29] Moreover, also in many sports other than alpine ski racing, the benefits of physical fitness-related injury prevention programmes have been demonstrated. [30][31][32] Concerning the 'ski, plate, binding, boot' category, several stakeholders suggested a less aggressive setup as one of the most promising approaches.…”

Section: Potential Change Of Perception Over the Last Decadementioning

confidence: 99%

Perceptions of experts on key injury risk factors in alpine ski racing as a function of stakeholder role and associated level of competition

Kiers

Kröll

Mitterbauer

et al. 2021

BMJ Open Sport Exerc Med

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Objectives(1) To update experts’ priorities of perceived key injury risk factors in alpine ski racing based on a framework and list derived 10 years ago, (2) to identify additionally emerging risk factors since then and (3) to compile a list with countermeasure suggestions.MethodsA sample of 532 expert stakeholders (athletes, coaches, team medical staff, Ski Racing Suppliers (SRS) and International Ski Federation (FIS) representatives) from the World Cup (WC), European Cup (EC) and FIS-race level participated in a cross-sectional online survey. Experts were asked to name those risk factors with the highest believed impact on injury risk and rank them according to their current priority from a predefined list. In addition, experts were encouraged to name additional (not listed) risk factors and to suggest countermeasures.ResultsRegardless of stakeholder role and competition level, snow-related factors appeared to have the highest perceived priority. However, WC athletes’ and coaches’ perceptions were also related to equipment, while at the EC and FIS-race level fatigue and physical fitness-related factors were considered important. Athletes’ perceptions were largely in agreement with SRS (ie, snow-related and equipment-related factors). At the same time, while coaches, team medical staff and FIS representatives additionally emphasised fatigue and physical fitness-related factors.ConclusionExperts’ perceptions on key injury risk factors in alpine ski racing depend on the stakeholder role and differ between the competition levels. Thus, to develop effective prevention measures and to successfully implement them, all relevant stakeholders should be given a voice, and prevention efforts should be targeted to the specific level.

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Prevention of Anterior Cruciate Ligament Injuries in Competitive Adolescent Alpine Skiers

Cited by 20 publications

References 32 publications

The ISPAInt Injury Prevention Programme for Youth Competitive Alpine Skiers: A Controlled 12-Month Experimental Study in a Real-World Training Setting

The ISPAInt Injury Prevention Programme for Youth Competitive Alpine Skiers: A Controlled 12-Month Experimental Study in a Real-World Training Setting

Side-to-side differences in knee laxity and side hop test may predispose an anterior cruciate ligament reinjury in competitive adolescent alpine skiers

Perceptions of experts on key injury risk factors in alpine ski racing as a function of stakeholder role and associated level of competition

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