The 2012 ABJS Nicolas Andry Award: The Sequence of Prevention: A Systematic Approach to Prevent Anterior Cruciate Ligament Injury

Departments of Physiology & Cell Biology and Orthopaedic Surgery, The Ohio State University Sports Medicine Sports Health & Performance Institute, 2050 Kenny Road, Suite 3100, Columbus, OH, 43221-3502, USA, .
Clinical Orthopaedics and Related Research (Impact Factor: 2.77). 06/2012; 470(10):2930-40. DOI: 10.1007/s11999-012-2440-2
Source: PubMed


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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    • "A concern with these efforts, however, is the often extended time between data collection and the resultant injury. This time lapse between testing and injury may compromise outcome efficacies, due to additional factors such as ongoing training regimes having the ability to induce changes in neuromuscular control [2] [9]. Neuromuscular abnormalities that evolve during this period may therefore precipitate injury rather than the originally recorded parameters. "
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    ABSTRACT: This case report examined the neuromuscular function of a competitive female netball player six days prior to an incident where she sustained an acute anterior cruciate ligament injury during normal sports activity. Electromyography was used to examine activation onsets of four lower limb muscles (rectus femoris, biceps femoris, medial hamstrings and gluteus medius) relative to initial contact (IC) during netball-specific landings of varying complexity. The results of the injured participant were compared to the remaining participants in the study (n = 8), and the injured participant’s injured limb was compared to the contralateral limb. The injured participant was the only player to record delayed pre-injury muscle onsets after IC for all muscles tested in the injured limb, while her non-injured limb was comparable to the other participants tested. Furthermore, delayed muscle onset after IC occurred more frequently as landing complexity increased. This case report suggests that delayed muscle activity onset after IC during landing may be an important risk factor for ACL injury.
    No preview · Article · Jan 2014 · The Knee
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    • "Other movements evaluated were whether the lumbar spine flexed, extended, and/or laterally bent during jumping or landing and if the hip/leg musculature was able to keep the front knee in midline throughout the test. This was of interest because hip stability has been correlated with injuries to the anterior cruciate ligament of the knee [20]. "
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    ABSTRACT: Background. Momentary lapses in concentration contribute to workplace accidents. Given that blood glucose (BG) and hydration levels have been shown to affect vigilance, this study proposed to investigate these parameters and functional movement patterns of ski-resort workers and to determine whether an educational program to stabilize BG and hydration and encourage joint stability had an effect in decreasing occupational injuries. Methods. Seventy-five instructors, patrollers and, lift-operators at five snowsport resorts were evaluated for BG, vigilance, workload, dietary/hydration practices, and functional-movement patterns. Injury rates were tabulated before and after an educational program for nutrition and functional-movement awareness and compared to other resorts. Results. Workers showed poor stability at the lumbar spine, knee, and shoulder. BG levels were normal but variable (%CV = 14 ± 6). Diets were high in sugar and fat and low in water and many nutrients. Medical Aid and Lost Time claims declined significantly by 65.1 ± 20.0% (confidence interval −90.0% ≤μ ≤ −40.2%) in resorts that used the educational program whereas four control resorts not using the program experienced increases of 33.4 ± 42.9% (confidence interval −19.7% ≤μ ≤ −86.7%; F[2,12] = 21.35, P < 0.0001 ) over the same season. Conclusion. Provision of snowsport resort workers with educational programs encouraging hydration, diet to stabilize BG, and functional-movement awareness was effective in reducing worksite injuries in this population.
    Full-text · Article · Jul 2013
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    • "Next to their role in controlling trunk motion, hip muscles are also important to eccentrically control lower extremity alignment during unipodal tests (Powers, 2010; Reiman, Bolgla, & Lorenz, 2009). Neuromuscular training programs including movement re-education and feedback, core motor control and strengthening, plyometrics and balance training have been shown to be successful in improving movement patterns and decreasing knee injury risk (Baldon, Lobato, Carvalho, Wun, Santiago & Serrao, 2012; Hewett, Myer, Ford, Paterno & Quatman, 2012; Sugimoto, Myer, McKeon & Hewett, 2012). Future studies should examine whether specific neuromuscular interventions can improve the LTM and KVLTM parameters. "
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    ABSTRACT: To investigate the reliability and validity of the measurement of lateral trunk motion (LTM) in two-dimensional (2D) video analysis of unipodal functional screening tests. Observational study. Research laboratory. Forty-three injury-free female athletes. Knee valgus (KV) and lateral trunk motion (LTM) angles were measured with a standard digital camera during the single leg squat and the single leg drop vertical jump (SLDVJ). Three-dimensional motion analysis was used during the SLDVJ to measure peak external knee abduction moment (pKAM). Intraclass correlation coefficients were calculated to assess the intra- and intertester reliability of the LTM angle. Correlations between 2D angles and pKAM were calculated for the SLDVJ. Excellent intraclass correlation coefficients for the LTM angle were found within (0.99-1.00) and between testers (0.98-0.99). The sum of KV and LTM was significantly correlated with the pKAM during the SLDVJ for the dominant (r = -0.36; p = 0.017) and non-dominant leg (r = -0.32; p = 0.034), while either angle alone was not. LTM can be measured with excellent intra- and intertester reliability. The combination of KV and LTM was moderately associated with pKAM and thus including LTM may aid assessment of movement quality and injury risk.
    Full-text · Article · Jul 2013 · Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine
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