ACL Prevention Programs: Can We Do More to Prevent this Catastrophic Injury?
Image 1. Robert Griffin III at the NFL combine (courtesy of stack.com)
There is a growing body of evidence with ACL prevention programs and most of the studies have shown positive results in regards to overall prevention. There is a lack of high quality studies despite more than 36 intervention programs described since 1995. A recent presentation at the American Academy of Orthopedic Surgeons showed that only programs were shown to have a significant impact on improving neuromuscular patterns and significantly reducing non-contact ACL injuries (9).
Image 2. Sportsmetrics current research studies
Image 3. Before and after demonstration of a succesful ACL injury prevention program (courtesy of strideseattle.com)
No evidence suggests that a single optimal preventive training program exists. Instead, general guidelines should be considered when developing or implementing an injury prevention training program. The National Athletic Training Association provided an excellent review in regards to current evidence in regards to specifics such as implementation and timing of programs (17). It is generally accepted that programs should begin at or close to puberty and have multiple components including plyometrics, neuromuscular training, and strengthening.
Summary. In summary, anterior cruciate ligament injuries occur in both the general and athletic population and can lead to immediate and long-term sequelae. There is a psychological and financial burden associated with these injuries in the short term, as well as an increased long term risk of osteoarthritis and re-injury. Many ACL programs have been proposed and studied over the past 25 years and most have shown an overall decrease in ACL incidence, which is why an ACL prevention program is generally recommended for at risk athletes. Only two programs have been shown to have a significant improvement of neuromuscular patterns and a significant reduction of non-contact ACL injuries, both of which are available to the public. While there is not a current optimal program and more research is needed, many guidelines exist on specifics when implementing an ACL prevention program.
1. Nessler T, Denney L, Sampley J. ACL Injury Prevention: What Does Research Tell Us?. Curr Rev Musculoskelet Med. ;10(3):281–288. doi:10.1007/s12178-017-9416-5