ACL INJURY PREVENTION PROGRAMS

Gregory M. Mathien, M.D. Knoxville Orthopaedic Clinic

ACL ANATOMY Ligament: Inner wall lateral femoral condyle to intercondylar eminence or tibia Two Bundles: Anteromedial and Posterolateral

ACL FUNCTION Primary restraint to anterior translation of tibia Restraint to rotational instability

MOST COMMON MECHANISM OF INJURY Non-Contact Deceleration Change of Direction

EPIDEMIC Approximately 250,000 ACL Injuries occur each year in individuals between 15 to 25 years old

Estimated 100,000 to 200,000+ ACL Reconstructions are done in the U.S. each year

ACL Reconstruction is the 6 th most common orthopaedic procedure in the U.S.

SINCE TITLE IX… Male participation – 3.8 million Female participation – 0.3 to 3 million Female athletes 4-6 times more likely to sustain an ACL tear than male athletes

AGAIN… ACL Injury is more common in female athletes 4-6 x males

Approximately 1 in 70 female athletes in high school will sustain an ACL Injury during any given year

WHY WOMEN? Multiple Factors: ◦Wider hips ◦Smaller joints ◦Increased joint laxity ◦Small ACL’s ◦Increased BMI ◦Different patterns of movement

SHORT TERM DISABILITY Pain Swelling Instability Prolonged absence from sport

LONG TERM DISABILITY Decreased function Premature osteoarthritis

SCREENING TOOLS?

LANDING ERROR SCORING SYSTEM Possible screening tool

Landing Error Scoring System “LESS”

“LESS”

Training may facilitate neuromuscular adaptations helping to protect the ACL

NEUROMUSCULAR TRAINING PROGRAMS Plyometrics Balance Technique Training Reduces the risk of injury

Dedicated program MAY reduce risk/incidence of injury

DO NO HARM!

LITERATURE REVIEW Recent literature review of 10 studies: 2 – significant decrease 4 – trended to reduced ACL Injuries 2 – studies increase

PEP PROGRAM PREVENT INJURY AND ENHANCE PERFORMANCE D1 Soccer ACL Injury – 88% less ACL Injuries 74%

Santa Monica PEP Program (Prevent Injury and Enhance Performance)

ACL Injury Prevention Exercises (PEP program)

PEP Program

FIFA - 11+

Running Warm Up -- Straight Ahead -- FIFA 11+ (1.0)

Running Warm Up -- Hip out Exercise -- FIFA 11+ (2.0)

Running Warm Up -- Hip In Exercise -- FIFA 11+ (3.0)

Running Warm Up -- Circling Partner -- FIFA 11+ (4.0)

Running Warm Up -- Shoulder Contact Exercise -- FIFA 11+ (5.0)

Running Warm Up -- Quick Forwards & Back -- FIFA 11+ (6.0)

Bench -- Static -- FIFA 11+ (7.1)

Bench -- Alternating Legs Exercise -- FIFA 11+ (7.2)

Bench -- One Leg Lift & Hold Exercise -- FIFA 11+ (7.3)

Sideways Bench Exercise -- Static -- FIFA 11+ (8.1)

Bench -- Raise & Lower Hip Exercise -- FIFA 11+ (8.2)

Sideways Bench -- With Leg Lift -- FIFA 11+ (8.3)

Hamstrings Exercise -- Beginner -- FIFA 11+ (9.0)

Single Leg Stance --Holding Ball -- FIFA 11+ (10.1)

Single Leg Stance -- Throwing Ball -- FIFA 11+ (10.2)

Single Leg Stance Exercise -- Test Your Partner -- FIFA 11+ (10.3)

Squats -- With Toe Raise -- FIFA 11+ (11.1)

Squats -- Walking Lunges -- FIFA 11+ (11.2)

Squats -- One-Leg Squats -- FIFA 11+ (11.3)

Jumping -- Vertical Jump Exercises -- FIFA 11+ (12.1)

Jumping Exercise -- Lateral Jumps -- FIFA 11+ (12.3)

Jumping -- Box Jumps Exercise -- FIFA 11+ (12.3)

Running Warm Up -- Across The Pitch -- FIFA 11+ (13.0)

Running Warm Up - Bounding -- FIFA 11+ (14.0)

Running Warm Up -- Plant & Cut -- FIFA 11+ (15.0)

Cincinnati SPORTSMETRICS

SPORTSMETRICS TECHNIQUE & TRAINING “Sportsmetrics™ Techniques and Training is the foundation upon which sports specific skills are built. Training builds from technique development to performance enhancement.” “This six week program was scientifically proven to significantly reduce the risk of serious knee injuries in female athletes, while improving hamstrings to quadriceps strength ratio and jumping height. It combines a dynamic warm up, plyometrics, strength training and flexibility.”

SPORTSMETRICS TECHNIQUE & TRAINING Dynamic Warm-up Plyometrics/Jump Training High Intensity Strength Training Flexibility Training

Dynamic Warm-up: (5 minutes) Prepares the body with functional based activities that use sport specific motions. It raises core body temperature, increases blood flow to the muscles and improves flexibility, balance and coordination.

Plyometrics/Jump Training: (30 minutes) Plyometrics, the core of the Sportsmetrics™ program, are used to focus on correct jumping technique and are divided into three two week phases. Each phase has a different training focus and the exercises change accordingly. Plyometrics develops muscle control and strength that are critical for reducing the risk of knee injury and increasing jump height.

High Intensity Strength Training: (30 minutes) With emphasis on body alignment and form. Sportsmetrics™ provides structured (yet adaptable) strength training guidance. This section focuses on development of core strength and improving overall muscular efficiency. This can be done with or without equipment or free weights.

Flexibility Training: (10 minutes) Stretching is essential to achieve maximum muscle length, allowing muscles to work with power through complete range of motion. This is important for decreasing injury and post-training muscle soreness.

COMPONENTS IN MOST PROGRAMS Plyometrics Biomechanics Technique Feedback Balance Core Stability Strength Training

Plyometrics should be included

Balance training alone not as effective

Majority of studies suggest a trend toward a reduction in ACL Injuries in female athletes using a Neuromuscular Training Program

Moderate evidence that multi-faceted Neuromuscular Programs involving preseason conditioning, including Plyometrics, may reduce the risk of injuries in female athletes

Moderate evidence that programs that utilize only in-season conditioning do not reduce ACL Injuries in female athletes

Moderate evidence that programs that only use Proprioception or Plyometrics do NOT reduce ACL Injuries in female athletes

Definitive conclusion on program success cannot be made regarding effectiveness of prevention programs in reducing ACL Injuries in female athletes

CONCLUSION In my opinion… there is strong evidence in support of effect of ACL Injury Prevention Programs.