The 2012 ABJS Nicolas Andry Award: The Sequence of Prevention: A Systematic Approach to Prevent Anterior Cruciate Ligament Injury
ABSTRACT ACL injuries are common, often devastating injuries that lead to short-term disability and long-term sequelae, many of which lack effective treatment, such as osteoarthritis. Therefore, prevention of ACL injury is currently the only effective intervention for these life-altering sequelae, while much of the literature has a rehabilitative focus.
The primary long-term purpose of our multidisciplinary collaborative research team has been to develop ACL injury prevention programs by determining which factors related to ACL injury should be altered, followed by how and when they should be altered.
Our primary study objectives were to determine: (1) modifiable risk factors; (2) how these factors can best be modified; and (3) when is the best time to diminish these risk factors. Throughout the course of various studies, we determined the modifiable factors related to increased ACL injury risk. Our research team then focused on exploring numerous ways to augment these factors to maximize prevention efforts. We developed a sequence of prevention models that provide a framework to monitor progress toward the ultimate goal of preventing ACL injuries.
The modifiable factors shown in our work include biomechanical and neuromuscular functionality. When targeted in physical training, we have determined that these factors can be enhanced to effectively aid in the prevention of ACL injuries. Preliminary data have shown that childhood and early adolescence may be valuable periods to implement such training.
Current evidence has led to the evolution of clinical assessment tools for high-risk athletes and interventions for large populations and specific high-risk individuals. Targeted intervention implemented at the specified developmental stage of highest risk may be the final step toward the maximal reduction of ACL injury risk in young athletes.
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ABSTRACT: Growing numbers of youth participating in competitive, organized physical activity have led to a concern for the risk of sports-related injuries during important periods of human development. Recent studies have demonstrated the ability of integrative neuromuscular training (INT) to enhance athletic performance and reduce the risk of sports-related injuries in youth. Successful implementation of INT necessitates instruction from knowledgeable and qualified instructors who understand the unique physical, cognitive, and psychosocial characteristics of the youth to provide appropriate training instruction and feedback. Principles of a classical theory of cognitive development provide a useful context for discussion of developmentally appropriate methods and strategies for INT instruction of youth. INT programs that consider these developmentally appropriate approaches will provide a controlled efficacious environment for youth to improve athletic performance and reduce risk of sports-related injury, thus promoting a healthy active lifestyle beyond an individual's formative years.Current Sports Medicine Reports 05/2015; 14(3):235-43. DOI:10.1249/JSR.0000000000000150 · 1.60 Impact Factor
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ABSTRACT: Background Psychological perceptions are increasingly being recognized as important to recovery and rehabilitation post-surgery. This research longitudinally examined perceptions of the personal importance of exercise and fears of re-injury over a three-year period post anterior cruciate ligament (ACL) reconstruction. Stability and change in psychological perceptions was examined, as well as the association of perceptions with time spent in different types of physical activity, including walking, household activities, and lower and higher risk for knee injury activities. Methods Participants were athletes, 18–40 years old, who underwent ACL reconstruction for first-time ACL injuries. They were recruited from a tertiary care centre in Toronto, Canada. Participants completed interviewer-administered questionnaires pre-surgery and at years one, two and three, postoperatively. Questions assessed demographics, pain, functional limitations, perceived personal importance of exercise, fear of re-injury and physical activities (i.e., walking; household activities; lower risk for knee injury activities; higher risk for knee injury activities). Analyses included fixed-effect longitudinal modeling to examine the association of a fear of re-injury and perceived personal importance of exercise and changes in these perceptions with the total hours spent in the different categories of physical activities, controlling for other factors. Results Baseline participants were 77 men and 44 women (mean age = 27.6 years; SD = 6.2). At year three, 78.5% of participants remained in the study with complete data. Fears of re-injury decreased over time while personal importance of exercise remained relatively stable. Time spent in walking and household activities did not significantly change with ACL injury or surgery. Time spent in lower and higher risk of knee injury physical activity did not return to pre-injury levels at three years, post-surgery. Greater time spent in higher risk of knee injury activities was predicted by decreases in fears of re-injury and by greater personal importance of exercise. Conclusions This study highlights not only fears of re-injury, which has been documented in previous studies, but also the perceived personal importance of exercise in predicting activity levels following ACL reconstructive surgery. The findings can help in developing interventions to aid individuals make decisions about physical activities post knee injury and surgery.01/2015; 7. DOI:10.1186/2052-1847-7-4
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ABSTRACT: The goal of this study was to evaluate postural stability during the transition from double-leg stance (DLS) to single-leg stance (SLS) in anterior cruciate ligament reconstructed (ACLR) (n=20) and non-injured control subjects (n=20). All ACLR subjects had fully returned to their pre-injury sport participation. Both groups were similar for age, gender, height, weight, body mass index and activity level. Spatiotemporal center of pressure outcomes of both legs of each subject were measured during the transition from DLS to SLS in eyes open and eyes closed conditions. Movement speed was standardized. The center of pressure displacement after a new stability point was reached during the SLS phase was significantly increased in the ACLR group compared to the control group in the eyes closed condition (P=.001). No significant different postural stability outcomes were found between the operated and non-operated legs. In conclusion, the ACLR group showed postural stability deficits, indicating that these persons may have a decreased ability to stabilize their body after the internal postural perturbation created by the transition from DLS to SLS. The non-operated leg may not be the best reference when evaluating postural stability of the operated leg after ACLR, as no differences were found between legs. Copyright © 2015 Elsevier B.V. All rights reserved.Human Movement Science 02/2015; 41C. DOI:10.1016/j.humov.2015.02.001 · 2.03 Impact Factor