The Effectiveness of Injury-Prevention Programs in Reducing the Incidence of Anterior Cruciate Ligament Sprains in Adolescent Athletes

Abstract

Clinical Scenario: There is a high incidence of anterior cruciate ligament (ACL) injury in adolescents participating in pivoting sports such as soccer, basketball, and handball. Most ACL injuries in athletes are noncontact injuries, with a mechanism of sudden deceleration, change in direction, or landing from a jump. These mechanisms coupled with an increase in contraction of the quadriceps have been shown as risk factors for ACL injuries. Injuries to the ACL may require surgery, a long rehabilitation, and the potential for reinjury. Studies have shown reductions in lower extremity injury rates using training protocols that focus on landing mechanics, balance training, strength training, and/or agility training. There has been some thought that starting preventive training programs with adolescent athletes may be the most effective approach to reducing adolescent ACL injuries. Focused Clinical Question: Can lower extremity injury-prevention programs effectively reduce ACL injury rates in adolescent athletes? Keywords: youth, preventive training program, knee injury Clinical ScenarioThere is a high incidence of anterior cruciate ligament (ACL) injury in adolescents participating in pivoting sports such as soccer, basketball, and handball. Most ACL injuries in athletes are noncontact injuries, with a mechanism of sudden deceleration, change in direction, or landing from a jump. These mechanisms coupled with an increase in contraction of the quadriceps have been shown as risk factors for ACL injuries. Injuries to the ACL may require surgery, a long rehabilitation, and the potential for reinjury. Studies have shown reductions in lower extremity injury rates using training protocols that focus on landing mechanics, balance training, strength training, and/or agility training. There has been some thought that starting preventive training programs with adolescent athletes may be the most effective approach to reducing adolescent ACL injuries. Focused Clinical QuestionCan lower extremity injury-prevention programs effectively reduce ACL injury rates in adolescent athletes?Summary of Search, "Best Evidence" Appraised, and Key Findings• The literature was searched for studies of level 2 evidence or higher that investigated the effect of injury-prevention training programs on knee-sprain incidence in adolescent athletes.• The literature search returned 10 possible studies related to the clinical question; 4 studies met the inclusion criteria and were included.• Two high-quality cluster randomized controlled trials and 2 prospective cohort studies were included.• Of the included studies, 2 demonstrated reductions of ACL injuries of the intervention group and 2 showed no statistical difference between the intervention group and control group. Clinical Bottom LineThere is moderate evidence to support the use of a supervised injury-prevention training program that focuses on developing neuromuscular control of the lower extremity through neuromuscular strengthening exercises, plyometrics, and proprioception exercises. The prog...

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