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Dr. Peter Ove discusses anterior cruciate ligament (ACL) injuries and how to prevent them at Anne Arundel Medical Center's Preventing Injuries in Young Athletes program.
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Preventing ACL Injuries
Peter N Ove, MDSports Medicine, Arthroscopic Knee and
Shoulder SurgeryOrthopaedics and Sports Medicine
What is the ACL?
ACL Injuries
ACL injuries
ACL Injuries
ACL injury can be career ending Even if get back, risk for further
surgery, re-injury, arthritis Focus on preventable ACL injuries
Valgus, slight flexion, and rotation
Landing differences
Some proposed risk factors for ACL tear
Bracing: no conclusive evidence Footwear: increased friction
coefficient more risky Playing surface: lower friction
(wooden vs artificial, turf vs. grass?, even vs uneven surface) better
Environmental conditions: outdoor turf, grass cold better than hot weather
Epidemiology
ACL tears 4-6x more common in girls than boys
Why? Anatomy & Physiology Hormonal, ligament/house size,
biomechanics Technique Environment, other factors’
contribution notwithstanding
ACL Injuries-non contact injuries
ACL Injuries in Girls
38,000 estimated female ACL injuries each year
Estimated 2,200 at the collegiate level
May be 4 times as high at HS level (8000-9000!!)
ACL Injuries in Girls
Increased Participation in sports (Title IX) Female basketball
players are 2x more likely to suffer an ACL tear than their male counterparts
Female soccer players are 4x more likely to suffer an ACL tear than their male counterparts
Why?Theories To Explain Gender Differences
Anatomical Differences
Biomechanical Factors
Hormonal Influences
Neuromuscular Differences
Anatomic Differences
Women tend to have a more “knock-kneed” leg alignment
The femoral notch, in women tends to be narrower
Biomechanical Differences Compared with men,
women: Have less muscle mass Are slower at the rate of
muscle force development (ms)
Have a stronger, quicker reacting quadriceps relative to hamstrings
Tend to be more upright when landing
Tend to be “quad dominant”
Neuromuscular Differences Ligament Dominance
Knee ligaments rather than knee muscles absorb the landing forces during sports maneuvers
Quadriceps Dominance Quads react more quickly to forces than the
hamstrings Leg Dominance
The non-dominant knee is at greater risk because it’s weaker
How Can The Incidence of ACL Injuries Be Reduced?
ACL injury prevention programs have demonstrated a reduction in the rate of ACL injuries in 14-18 year old girls by 74-83%!! Helping to change the position of the knee
when landing or cutting and pivoting Decreasing landing forces on the knee
when landing from a jump
ACL Injuries
Landing Differences
Strategies to Avoid Injury
• Avoid vulnerable positions
• Increase flexibility • Increase strength• Increase balance
through agility training
• Include sports specific exercises into the training program
Research-proven ACL injury prevention programs:
-Preseason
-In-season
-Multi-year
Randomized Trials in high school, college, and professional athletes; female and male
Examples: Sportsmetrics, PEP, Frappier, BAPS
Prevent ACL
• Technique changes– Landing properly– Accelerated round turns, multi-step stop
deceleration• Balance, proprioceptive training• Neuromuscular training
– Correct imbalances (leg, muscle groups)– Improve strength, flexibility via
plyometrics, weight training with proper alignment and technique
Successful
Reduction in ACL injuries by 5X in many studies
Usually most impressive statistics when you separate out non-contact injuries
Improvement in performance (vertical jump)
Conclusion
The research and development of training programs to prevent ACL injuries is evolving rapidly
More attention needs to be placed on implementing these programs to younger athletes during their developmental years
Thank you