Prevention of Anterior Cruciate Ligament Injury in Athletes

Written by admin on June 9, 2013 – 7:16 pm -

A Review
Thomas Trojian, MD, Lindsay DiStefano, PhD, ATCDisclosures

Clin J Sport Med. 2013;23(2):120-121.

Abstract and Introduction

Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94:769–776.

Objective: To investigate whether anterior cruciate ligament (ACL) prevention programs reduce risk of injury in athletes, and which prevention program is most effective, by means of a review of the literature and meta-analysis of the results.

Data Sources: PubMed, MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched online using the terms anterior cruciate ligament, knee, injury, prevention, and control. The reference lists of relevant studies were searched for further trials.

Study Selection: Prospective controlled studies of humans, in any language, that reported on proprioceptive neuromuscular training techniques for ACL injury prevention compared with usual training programs were selected if they reported clinical outcomes and had an attrition rate of <20%. Three independent reviewers selected the studies and resolved differences by consensus. After duplicates were eliminated, the search identified 723 reports. Eight studies met the selection criteria.

Data Extraction: Details of the study design, participant characteristics, the intervention, the number of ACL injuries at follow-up, the duration of follow-up, and the sport played were extracted. Study quality was scored 0 to 3, according to use of randomization and blinding and adequacy of follow-up of participants. Pooled risk ratios (RRs) were calculated in random-effects models.

Main Results: Participants in the studies were predominantly women or girls who played soccer, basketball, or volleyball. The interventions included proprioceptive neuromuscular training and agility skills as well as strength, flexibility, and cardiovascular training, done either preseason or for 30 days to 12 weeks during the season. With 1 exception, the results of the interventions were positive, with the number needed to treat to prevent 1 ACL injury varying from 5 to 187 in those 7 studies. The pooled RR favoring the interventions was 0.38 (95% confidence interval [CI], 0.20–0.72). This included 34 ACL injuries among the 3905 intervention participants and 181 ACL injuries among the 6703 control participants. The pooled RR among female athletes was 0.48 (95% CI, 0.26–0.89) and among male athletes was 0.15 (95% CI, 0.08–0.28). The mean quality score for the studies was poor (mean, 1 point; 95% CI, 0.43–1.57 points). No variable such as type of intervention, timing of the program, or length of the program was clearly related to effectiveness.

Conclusions: Neuromuscular-focused exercise training programs to prevent ACL injuries were effective among both female and male athletes. Despite the poor methodological quality of the studies, the results were consistent.

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