Understanding and preventing noncontact anterior cruciate ligament injuries: A review of the Hunt Valley II Meeting, January 2005

Peachtree Orthopaedic Clinic, Atlanta, GA 30309, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 10/2006; 34(9):1512-32. DOI: 10.1177/0363546506286866
Source: PubMed


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.

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Available from: Frank Noyes, M.D.,
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    • "La rupture du ligament croisé antérieur (LCA) se produit généralement lors d'une réception de saut ou au cours d'un pivot rotatoire [1] [2]. Le risque lésionnel peut être augmenté par des facteurs intrinsèques ou extrinsèques [3]. Si les facteurs extrinsèques peuvent être modifiés par des programmes de prévention comme l'amélioration de la force des ischio-jambiers [4] [5], la proprioception [6] et le contrôle neuromusculaire [7] [8], les facteurs intrinsèques comme les structures ligamentaires [9] [10] et l'anatomie du genou ne peuvent être modifiés [11] [12]. "

    Journal de Traumatologie du Sport 12/2013; 31(1). DOI:10.1016/j.jts.2013.12.004
    • "Several factors have been proposed to explain the movement behavior and higher ACL injury rates in females (e.g. hormonal, anatomical, environmental, neuromuscular) (Griffin et al., 2006). However, literature suggests that lower limb strength and anthropometry do not fully explain the sex disparity in movement behavior or injury rates (Beutler et al., 2009; Herman et al., 2008; Mizner et al., 2008; Shultz et al., 2009). "
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    ABSTRACT: Controlling dynamic interactions between the lower limb and ground is important for skilled locomotion and may influence injury risk in athletes. It is well known that female athletes sustain anterior cruciate ligament (ACL) tears at higher rates than male athletes, and exhibit lower extremity biomechanics thought to increase injury risk during sport maneuvers. The purpose of this study was to examine whether lower extremity dexterity (LED) - the ability to dynamically control endpoint force magnitude and direction as quantified by compressing an unstable spring with the lower limb at submaximal forces - is a potential contributing factor to the "at-risk" movement behavior exhibited by female athletes. We tested this hypothesis by comparing LED-test performance and single-limb drop jump biomechanics between 14 female and 14 male high school soccer players. We found that female athletes exhibited reduced LED-test performance (p=0.001) and higher limb stiffness during landing (p=0.008) calculated on average within 51ms of foot contact. Females also exhibited higher coactivation at the ankle (p=0.001) and knee (p=0.02) before landing. No sex differences in sagittal plane joint angles and center of mass velocity at foot contact were observed. Collectively, our results raise the possibility that the higher leg stiffness observed in females during landing is an anticipatory behavior due in part to reduced lower extremity dexterity. The reduced lower extremity dexterity and compensatory stiffening strategy may contribute to the heightened risk of ACL injury in this population.
    Journal of Biomechanics 11/2013; 47(2). DOI:10.1016/j.jbiomech.2013.10.038 · 2.75 Impact Factor
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    • "Specifically, for females the injury rate-reported in number of injuries/1000 athlete-exposures (1 exposure ¼ 1 game or practice) was 0.28 for soccer, 0.23 for basketball, relatively smaller for volleyball (0.09) and the highest for gymnastics (0.33) (Hootman et al., 2007). Scientific studies support that females are at increased risk for an ACL injury due to sex specific anatomical and hormonal differences as well as sex disparities in neuromuscular (NM) factors (Alentorn-Geli et al., 2009; Griffin et al., 2006; Hewett, Myer, & Ford, 2006). Studies examining the relation of female hormones and increased risk of ACL injury in females have not yet concluded on the relative importance of this factor (Beynnon, 2008; Hewett, Zazulak, & Myer, 2007). "
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    ABSTRACT: Background Anterior Cruciate Ligament (ACL) injury is frequently encountered in sports. Purpose To analyze the effects of ACL injury prevention programs, on injury rates in female athletes between different sports. Methods A comprehensive literature search was performed in September 2012 using Pubmed Central, Science Direct, CINAHL, PEDro, Cochrane Library, SCOPUS, SPORTDiscus. The key words used were: ‘anterior cruciate ligament’, ‘ACL’, ‘knee joint’, ‘knee injuries’, ‘female’, ‘athletes’, ‘neuromuscular’, ‘training’, ‘prevention’. The inclusion criteria applied were: (1) ACL injury prevention training programs for female athletes; (2) Athlete–exposure data reporting; (3) Effect of training on ACL incidence rates for female athletes. Results 13 studies met the inclusion criteria. Three training programs in soccer and one in handball led to reduced ACL injury incidence. In basketball no effective training intervention was found. In season training was more effective than preseason in ACL injury prevention. A combination of strength training, plyometrics, balance training, technique monitoring with feedback, produced the most favorable results. Conclusion Comparing the main components of ACL injury prevention programs for female athletes, some sports-dependent training specificity issues may need addressing in future studies, related primarily to the individual biomechanics of each sport but also their most effective method of delivery.
    Physical Therapy in Sport 01/2013; 15(3). DOI:10.1016/j.ptsp.2013.12.002 · 1.37 Impact Factor
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