Letha Y. Griffin

Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies.

An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports. With an estimated cost for these injuries of almost a billion dollars per year, the ability to identify risk factors and develop prevention strategies has widespread health and fiscal importance. Seventy percent of ACL injuries occur in noncontact situations. The risk factors for non-contact ACL injuries fall into four distinct categories: environmental, anatomic, hormonal, and biomechanical. Early data on existing neuromuscular training programs suggest that enhancing body control may decrease ACL injuries in women. Further investigation is needed prior to instituting prevention programs related to the other risk factors.

Understanding and Preventing Noncontact Anterior Cruciate Ligament Injuries A Review of the Hunt Valley II Meeting, January 2005

The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.

A Randomized Controlled Trial to Prevent Noncontact Anterior Cruciate Ligament Injury in Female Collegiate Soccer Players

Background Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large. Hypothesis A simple on-field alternative warm-up program can reduce noncontact ACL injuries. Study Design Randomized controlled trial (clustered); Level of evidence, 1. Methods Participating National Collegiate Athletic Association Division I womens soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes’ participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons. Results Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41 % decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries). Conclusion This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.

Etiology and Prevention of Noncontact ACL Injury

IN BRIEF: An understanding of the etiology and prevention of noncontact ACL injuries has lagged behind diagnosis and treatment. However, a growing research implicates hormonal, anatomic, environmental, and neuromuscular factors that may predispose athletes, particularly women, to these injuries. Specific factors may include estrogen levels, the shape of the intercondylar notch, playing style, and neuromuscular control of the quadriceps and hamstring muscles. Prevention programs that involve proprioception, plyometrics, strength training, and improved jumping, stopping, and turning techniques show promising results.

The Female Athlete

Mary Lloyd Ireland and Aurelia Nattiv, editors. Philadelphia: Saunders; 2002. 832 pages.

Bull's Handbook of Sports Injuries. 2nd ed.

64.95. The Female Athlete is a comprehensive, 832-page text edited by Mary Lloyd Ireland, an orthopaedist, and Aurelia Nattiv, a family practitioner. Both editors are respected for their expertise in the evaluation and management of illnesses and injuries in the female athlete. The two have assembled a superb group of …

Review of Sports Medicine and Arthroscopy. 2nd ed.

William O. Roberts, editor. New York: McGraw-Hill; 2004. 834 pages.

Understanding and preventing noncontact ACL injuries

64.95. The second edition of Bulls Handbook of Sports Injuries, edited by William O. Roberts, MD, an associate professor of family medicine at the University of Minnesota, is, like the first edition, a small paperback text, which, as Dr. Roberts indicates, is a “mix of evidence-based and expert opinion... of the authors.” The book is heavy on text, but the information is nicely subtitled in each chapter for easy reading and reference. The text is a blend of overview and detail. The size of this book does not permit an in-depth discussion of …

Sports injuries in women: sex- and gender-based differences in etiology and prevention.

Mark D. Miller, Daniel E. Cooper, and Jon J.P. Warner, editors. Philadelphia: W.B. Saunders; 2002. 302 pages.

Emergency preparedness : Things to consider before the game starts

64.00. This update of the original 1995 text (which was also edited by Miller, Cooper, and Warner) is another outstanding contribution by these sports-medicine scholars. Written in outline form for easy scanning and …