ACL INJURIES PART 7

IOC

Summary of prevention programmes

Based on these studies, we know that there can be a quantifiable reduction in the risk of ACL for athletes, particularly women, who complete a well-designed injury prevention programme.

Most of these programmes attempt to alter dynamic loading of the tibiofemoral joint through neuromuscular and proprioceptive training.

An emphasis is placed on proper landing technique; landing softly on the forefoot and rolling back to the rearfoot, engaging knee and hip flexion upon landing. Two-feet landing is encouraged where possible.133

When cutting manoeuvres, athletes should avoid excessive dynamic valgus of the knee upon landing and squatting; they should aim to achieve the ‘‘knee over toe position’’ (fig 3).

Intervention programmes have focused on increasing hamstring, gluteus medius and hip abductor strength, and addressing proper deceleration techniques.

Successful implementation of these programmes requires the collaboration of governing bodies, sports scientists, physicians, coaches, parents and athletes.

Important factors for a successful prevention programme

The programme should include
strength and power exercises, neuromuscular training, plyometrics and agility
exercises.

Design as a regular warm-up programme increases adherence.

Focus should be on performance of the hip-knee-foot line and ‘‘kissing knees’’ should be avoided (excessive valgus strain).

Figure 4 Drop vertical jump test.

To identify athletes at risk of severe knee injuries, the drop vertical jump test as described by Hewett et al148 should be used. The athlete is instructed to ‘‘drop off the box and immediately jump as high as you possibly can’’. Athletes who land with good valgus knee motion should perform neuromuscular training before sports participation. Training which emphasises the ‘‘hip-knee-toe line’’position when landing (avoid ‘‘kissing knees’’) could prevent future ACL injuries.

408 Br J Sports Med 2008;42:394–412. doi:10.1136/bjsm.2008.048934

Maintenance and compliance of prevention programmes before, during and after the sports participation season are essential to minimise injuries.

The drop vertical jump test should be used to identify players at risk (fig 4).

The programme must be well received by coaches and players to be successful.

Evaluation of success or failure of a prevention programme requires large numbers of athletes and injuries.

SEE INTERNATIONAL OLYMPIC COMMITTEE POSITION STATEMENT ON ACL INJURIES