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: Objective: Medical expenses for collegiate athletics include providing a training room with its supplies, equipment, personnel costs, and insurance coverage. Additional expenses beyond the training room include imaging, diagnostic testing, specialty consultations, and surgeries. We hypothesized that there would be no difference in average expenses or number of claims between male and female athletes over a 5-year period. Design: Prospective patient cohort. Setting: A sports medicine center serving athletes in Big 10 Conference intercollegiate sports. Assessment of Risk Factors: All medical claims and charges for 36 varsity teams were analyzed from 2005 to 2010. The teams were categorized into 3 groups: female-only teams, male-only teams, and coed teams. Analysis of sports with corresponding male and female teams was also performed. Main Outcome Measurements: Claims and charges for medical care for 36 intercollegiate athletic teams over 5 years. Results: Individual team claims and charges were stable over the study period. In 11 of the 14 sex-matched sports, the female teams had higher average annual charges. After normalizing for roster size in the sex-matched sports, females had 0.97 more average annual claims (P < 0.01) and $1459 higher annual charges (P = 0.001) than their male counterparts. The charges per claim were similar between the sexes. The 5 teams with the highest average annual charges were football, wrestling, softball, women's crew, and men's lacrosse. When normalized for roster size, the 5 sports with the highest average annual charges per athlete were softball, women's diving, men's basketball, wrestling, and men's gymnastics. Conclusion: Charges per claim were similar between the sex-matched sports, but the female sports had a higher number of annual claims per athlete and thus higher total charges per athlete/year. Football had the highest average annual total charges as a team, but when normalized for roster size football charges per athlete/year were similar to those of other sports.The Physician and sportsmedicine 09/2014; 42(3):71-77. DOI:10.3810/psm.2014.09.2078 · 1.49 Impact Factor
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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