A Secondary Injury Prevention Program May Decrease Contralateral Anterior Cruciate Ligament Injuries in Female Athletes: 2-Year Injury Rates in the ACL-SPORTS Randomized Controlled Trial.
Ontology highlight
ABSTRACT: Objective
To determine whether the addition of perturbation training to a secondary injury prevention program reduces the rate of second anterior cruciate ligament (ACL) injury compared to the prevention program alone.Design
Single-blinded randomized controlled trial.Methods
Thirty-nine female athletes who intended to return to cutting/pivoting sports were enrolled 3 to 9 months after primary anterior cruciate ligament reconstruction (ACLR). Athletes were randomized to receive a training program of either progressive strengthening, agility, plyometrics, and prevention (SAPP) (n = 20) or SAPP plus perturbation training (n = 19); each had 10 sessions over 5 weeks. Occurrence and side of second ACL injury were recorded for 2 years after primary ACLR.Results
There were 9 second ACL injuries in the 2 years after ACLR. There was no statistically significant difference in rate or side of second ACL injury between the SAPP-plus-perturbation training and SAPP groups.Conclusion
Adding perturbation training to a secondary ACL injury prevention program did not affect the rate of second ACL injury in female athletes. J Orthop Sports Phys Ther 2020;50(9):523-530. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9407.
SUBMITTER: Johnson JL
PROVIDER: S-EPMC7484246 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BackgroundAthletes are twice as likely to rupture the anterior cruciate ligament (ACL) on their healthy contralateral knee than the reconstructed graft after ACL reconstruction (ACLR). Although physical testing is commonly used after ACLR to assess injury risk to the operated knee, strength, jump, and change-of-direction performance and biomechanical measures have not been examined in those who go on to experience a contralateral ACL injury, to identify factors that may be associated with injury risk.PurposeTo prospectively examine differences in biomechanical and clinical performance measures in male athletes 9 months after ACLR between those who ruptured their previously uninjured contralateral ACL and those who did not at 2-year follow-up and to examine the ability of these differences to predict contralateral ACL injury.Study designCase-control study; Level of evidence, 3.MethodsA cohort of male athletes returning to level 1 sports after ACLR (N = 1045) underwent isokinetic strength testing and 3-dimensional biomechanical analysis of jump and change-of-direction tests 9 months after surgery. Participants were followed up at 2 years regarding return to play or at second ACL injury. Between-group differences were analyzed in patient-reported outcomes, performance measures, and 3-dimensional biomechanics for the contralateral limb and asymmetry. Logistic regression was applied to determine the ability of identified differences to predict contralateral ACL injury.ResultsOf the cohort, 993 had follow-up at 2 years (95%), with 67 experiencing a contralateral ACL injury and 38 an ipsilateral injury. Male athletes who had a contralateral ACL injury had lower quadriceps strength and biomechanical differences on the contralateral limb during double- and single-leg drop jump tests as compared with those who did not experience an injury. Differences were related primarily to deficits in sagittal plane mechanics and plyometric ability on the contralateral side. These variables could explain group membership with fair to good ability (area under the curve, 0.74-0.80). Patient-reported outcomes, limb symmetry of clinical performance measures, and biomechanical measures in change-of-direction tasks did not differentiate those at risk for contralateral injury.ConclusionThis study highlights the importance of sagittal plane control during drop jump tasks and the limited utility of limb symmetry in performance and biomechanical measures when assessing future contralateral ACL injury risk in male athletes. Targeting the identified differences in quadriceps strength and plyometric ability during late-stage rehabilitation and testing may reduce ACL injury risk in healthy limbs in male athletes playing level 1 sports.Clinical relevanceThis study highlights the importance of assessing the contralateral limb after ACLR and identifies biomechanical differences, particularly in the sagittal plane in drop jump tasks, that may be associated with injury to this limb. These factors could be targeted during assessment and rehabilitation with additional quadriceps strengthening and plyometric exercises after ACLR to potentially reduce the high risk of injury to the previously healthy knee.RegistrationNCT02771548 (ClinicalTrials.gov identifier).
| S-EPMC9938948 | biostudies-literature
Project description:To address the increasing rates of anterior cruciate ligament (ACL) injury among young sports participants, the Hospital for Special Surgery (HSS) and the Aspen Institute convened a meeting of a new national coalition to make ACL injury prevention a fundamental aspect of youth sports. This executive summary outlines the National ACL Injury Coalition's goals as defined at its inaugural meeting held at HSS on March 27, 2023. Using a theory of change called "collective impact" designed to support collaboration and drive systems-level change, the coalition focused on 4 strategic priorities intended to reduce ACL injury rates in high school sports participants: widespread implementation of interventions (ensuring that student athletes are adequately trained), high-quality education (raising awareness among many stakeholders), equitable access (ensuring that all high school sports participants, regardless of the resources available at their schools, have access to injury prevention resources), and aligning stakeholders (uniting disparate entities-schools, sports clubs, parents, coaches, and others in these efforts). The group outlined short-range, medium-range, and long-range goals over a 3-year period, including the launch of an ACL injury prevention toolkit for use by adolescent sports participants and teams, athletic trainers, coaches, and other key stakeholders.
| S-EPMC11299321 | biostudies-literature
Project description:Anterior cruciate ligament reconstruction (ACLR) is standard practice for athletes that wish to return to high-level activities; however functional outcomes after ACLR are poor. Quadriceps strength weakness, abnormal movement patterns and below normal knee function is reported in the months and years after ACLR. Second ACL injuries are common with even worse outcomes than primary ACLR. Modifiable limb-to-limb asymmetries have been identified in individuals who re-injure after primary ACLR, suggesting a neuromuscular training program is needed to improve post-operative outcomes. Pre-operative perturbation training, a neuromuscular training program, has been successful at improving limb symmetry prior to surgery, though benefits are not lasting after surgery. Implementing perturbation training after surgery may be successful in addressing post-operative deficits that contribute to poor functional outcomes and second ACL injury risk.80 athletes that have undergone a unilateral ACLR and wish to return to level 1 or 2 activities will be recruited for this study and randomized to one of two treatment groups. A standard care group will receive prevention exercises, quadriceps strengthening and agility exercises, while the perturbation group will receive the same exercise program with the addition of perturbation training. The primary outcomes measures will include gait biomechanics, clinical and functional measures, and knee joint loading. Return to sport rates, return to pre-injury level of activity rates, and second injury rates will be secondary measures.The results of this ACL-Specialized Post-Operative Return To Sports (ACL-SPORTS) Training program will help clinicians to better determine an effective post-operative treatment program that will improve modifiable impairments that influence outcomes after ACLR.Randomized Control Trial NIH 5R01AR048212-07. ClinicalTrials.gov: NCT01773317.
| S-EPMC3617067 | biostudies-literature
Project description:BackgroundReturn to play after anterior cruciate ligament (ACL) reconstruction can increase risk for both ipsilateral graft rupture and contralateral ACL rupture. The risk for injury of the contralateral knee after ACL reconstruction could be nearly double that of ipsilateral graft rupture.Questions/purposesWe sought to identify independent, patient-related risk factors for contralateral ACL rupture following primary ACL reconstruction.MethodsA national database was queried for patients who underwent primary ACL reconstruction from 2007 to 2015 with a minimum of 2 years of post-operative follow-up (n = 12,044). Patients who underwent subsequent primary ACL reconstruction on the contralateral extremity were then identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for contralateral ACL rupture, including demographic and comorbidity variables. Adjusted odds ratios and 95% confidence intervals were calculated for each risk factor.ResultsOf the 3707 patients who had a minimum of 2 years of database activity and comprised the study group, 204 (5.5%) experienced a contralateral ACL rupture requiring reconstruction. Independent risk factors for contralateral ACL rupture included age less than 20 years, female gender, tobacco use, and depression. Obesity, morbid obesity, type 1 diabetes, type 2 diabetes, and a history of anxiety were not significant predictors of contralateral injury.ConclusionWe were able to adequately power an analysis to identify several significant patient-related risk factors for contralateral ACL rupture after primary ACL reconstruction, including younger age, female gender, tobacco use, and depression. This information can be used to counsel patients on the risk of injury to the contralateral knee.
| S-EPMC7749876 | biostudies-literature
Project description:BACKGROUND:Hamstring strain and anterior cruciate ligament injuries are, respectively, the most prevalent and serious non-contact occurring injuries in team sports. Specific biomechanical and neuromuscular variables have been used to estimate the risk of incurring a non-contact injury in athletes. OBJECTIVE:The aim of this study was to systematically review the evidences for the effectiveness of injury prevention protocols to modify biomechanical and neuromuscular anterior cruciate and/or hamstring injuries associated risk factors in uninjured team sport athletes. DATA SOURCES:PubMed, Science Direct, Web of Science, Cochrane Libraries, U.S. National Institutes of Health clinicaltrials.gov, Sport Discuss and Google Scholar databases were searched for relevant journal articles published until March 2015. A manual review of relevant articles, authors, and journals, including bibliographies was performed from identified articles. MAIN RESULTS:Nineteen studies were included in this review. Four assessment categories: i) landing, ii) side cutting, iii) stop-jump, and iv) muscle strength outcomes, were used to analyze the effectiveness of the preventive protocols. Eight studies using multifaceted interventions supported by video and/or technical feedback showed improvement in landing and/or stop-jump biomechanics, while no effects were observed on side-cutting maneuver. Additionally, multifaceted programs including hamstring eccentric exercises increased hamstring strength, hamstring to quadriceps functional ratio and/or promoted a shift of optimal knee flexion peak torque toward a more open angle position. CONCLUSIONS:Multifaceted programs, supported by proper video and/or technical feedback, including eccentric hamstring exercises would positively modify the biomechanical and or neuromuscular anterior cruciate and/or hamstring injury risk factors.
| S-EPMC4865209 | biostudies-literature
Project description:PurposeA stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed.MethodsTo establish a standardized approach to assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA; USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method.ResultsIn general, outcomes after ACL treatment can be divided into four robust categories-early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific PROs and Health-Related Quality of Life questionnaires. In the mid- to long-term follow-up, the presence of osteoarthritis should be evaluated.ConclusionThis consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment.Level of evidenceV.
| S-EPMC7429530 | biostudies-literature
Project description:BackgroundHigher scores (closer to 100) on the Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI) scale indicate better psychological readiness to return to sport after anterior cruciate ligament reconstruction (ACLR).ObjectivesTo verify the validity and reliability of the ACL-RSI-short version (ACL-RSI-SV) in Brazilian Portuguese in individuals who underwent ACLR.MethodsParticipants (n=168) answered the Brazilian versions of ACL-RSI, Tampa Scale for Kinesiophobia (TSK-17), and International Knee Documentation Committee (IKDC) to assess the convergent validity of the short version. Internal consistency was also verified through correlation between items. Scores of participants who did not return to sport, who returned at a lower level, and at the pre-injury level were compared to verify divergent validity. ACL-RSI was answered again after 5-8 days to verify test-retest reliability.ResultsACL-RSI-SV in Brazilian Portuguese showed good test-retest reliability (ICC2.1 = 0.85, 95% CI: 0.76, 0.90) and acceptable internal consistency (Cronbach's alpha = 0.78). Standard error of measurement (SEM) and smallest detectable change (SDC) were 4.98 and 13.82. High positive correlation was found with the full version of the ACL-RSI (r=0.93, 95% CI: 0.91, 0.95), moderate positive correlation with the IKDC (r=0.52, 95% CI: 0.40, 0.62), and weak negative correlation with the TSK-17 (r = -0.45, 95% CI: -0.60, -0.28). It also presented good divergent validity to identify individuals who returned to sport.ConclusionACL-RSI-SV in Brazilian Portuguese is a consistent, valid, and reliable instrument to assess patients who have undergone ACLR, with good ability to identify those who return to sport.
| S-EPMC9193860 | biostudies-literature
Project description:BackgroundAnterior cruciate ligament (ACL) injuries are common among young athletes. Biomechanical studies have led to the development of training programs to improve neuromuscular control and reduce ACL injury rates as well as screening tools to identify athletes at higher risk for ACL injury. The purpose of this study was to evaluate the cost-effectiveness of these training methods and screening strategies for preventing ACL injuries.MethodsA decision-analysis model was created to evaluate three strategies for a population of young athletes participating in organized sports: (1) no training or screening, (2) universal neuromuscular training, and (3) universal screening, with neuromuscular training for identified high-risk athletes only. Risk of injury, risk reduction from training, and sensitivity and specificity of screening were based on published data from clinical trials. Costs of training and screening programs were estimated on the basis of the literature. Sensitivity analyses were performed on key model parameters to evaluate their effect on base case conclusions.ResultsUniversal neuromuscular training of all athletes was the dominant strategy, with better outcomes and lower costs compared with screening. On average, the implementation of a universal training program would save $100 per player per season, and would reduce the incidence of ACL injury from 3% to 1.1% per season. Screening was not cost-effective within the range of reported sensitivity and specificity values.Conclusions and clinical relevanceGiven its low cost and ease of implementation, neuromuscular training of all young athletes represents a cost-effective strategy for reducing costs and morbidity from ACL injuries. While continued innovations on inexpensive and accurate screening methods to identify high-risk athletes remain of interest, improving existing training protocols and implementing neuromuscular training into routine training for all young athletes is warranted.
| S-EPMC4001460 | biostudies-literature
Project description:This meta-analysis aimed to investigate the association between genetic polymorphisms in Collagen type 1 alpha-1 (COL1A1), Collagen type 3 alpha-1 (COL3A1), Collagen type 5 alpha-1 (COL5A1), and Collagen type 12 alpha-1 (COL12A1) genes and anterior cruciate ligament (ACL) injuries in athletes. A systematic search was diligently conducted on the PubMed and Web of Science databases to identify relevant studies on 5-9 September 2023. Only case-control studies were included in the meta-analysis. A total of 19 studies were reviewed, involving the analysis of 3522 cases and 6399 control subjects. Data relevant to the study objectives were extracted from these chosen studies and subsequently analyzed using either a random-effects or fixed-effects model. It indicates that individuals carrying the G allele in the COL1A1 (rs1107946) gene have a decreased risk of anterior cruciate ligament injuries (OR: -0.27, 95% CI: -0.42 to -0.12, p < 0.001). A similar relationship was observed in the dominant model, but this relationship was reversed in the recessive model (OR: 0.69, 95% CI: 0.33 to 1.05, p < 0.001). However, no significant associations were found in the COL3A1 (rs1800255) and COL5A1 (rs12722) genes. In the COL12A1 (rs970547) gene, the A allele was associated with an increased risk of anterior cruciate ligament injuries (OR: 0.18, 95% CI: 0.01 to 0.36, p = 0.041). This meta-analysis suggests that genetic variants in COL1A1 (rs1107946) and COL12A1 (rs970547) may be associated with ACL injuries in athletes. However, COL3A1 rs1800255 and COL5A1 rs12722 gene variants do not appear to have a significant association with these injuries.
| S-EPMC10740817 | biostudies-literature
Project description:Background/objectiveInjury-related fear during sport activities are major psychological factors inhibiting a person's return to sports (RTS) following anterior cruciate ligament reconstruction (ACLR). Currently, there are no studies that quantitatively analyse the open-ended questionnaire for knee injury-related fear in post-ACLR athletes.The purpose of this study was to identify knee injury-related fear in athletes who return to ball-centric sports via the use of an open-ended questionnaire. We aimed to determine the main concepts of injury-related fear according to sex, type of sport, and participation level.MethodsIn this study, a quantitative analysis of an open-ended questionnaire was used to examine the type of fear athletes experience after returning to ball-centric sports. The RTS and fear questionnaire collected open-ended questionnaire to knee injury-related fear during sport activities; this questionnaire was completed at the outpatient visit post-RTS. Quantitative content analysis was performed to extract frequently occurring words from the responses to the questionnaire to create a co-occurrence network. The resulting co-occurrence network and extracted words were used to create concepts regarding knee injury-related fear. The relationship between each concept and subject demographics (sex, returned sports events, and participation level) were analysed using the chi-squared test.ResultsFifty-four athletes (30 females and 24 males) aged 16-45 [median age: 21.2; interquartile range (IQR): 11.0] years with an average RTS of 8.0 (IQR: 3.3) months from ACLR participated in the study. A total of 79 responses were included in the analysis. The knee injury-related fear can be summarized as follows: (1) Quick response to the opponent; (2) Ball-related play; (3) Jump-landing; (4) Contact; (5) Loss of balance; and (6) Athletic movement. Chi-squared tests showed that athletes participating in sport events with potential contact with an opponent (soccer, futsal, basketball, handball, lacrosse, and ultimate (frisbee)) were more likely to experience fear in quick response to the opponent (P < 0.01, adjusted residual = 2.943, ϕ = 0.301).ConclusionThe knee injury-related fear can be summarized into six concepts. Post-ACLR athletes participating in ball-centric sports need to assess fear in situations such as quick responses to the opponent's movements and ball-related play, in addition to simple movements such as jumping, cutting, and contact.
| S-EPMC8058518 | biostudies-literature