ACL Injury Prevention

Stephanie Arlis-Mayor, MDRowland Mayor, MD

Center for Orthopaedics, P.C.

The scope of the problem

ACL injuries were known to be a problem for male athletes. Title XI resulted in an explosion of female athletic participation

Since the passage of Title IX of The Educational Assistance Act, male participation at the high school level has increased less than 3 percent (from 3.7 to 3.8 million), while female participation has increased 800 percent, roughly doubling every 10 years (from 0.3 to 2.7 million)

Suddenly, we noticed that female athletes were injuring themselves just like the boysThen we noticed that there were differences in the injury patternsThe girls were tearing their ACLs at a furious rate

The Risk of ACL Injury

Over 250,000 ACL injuries occur each year in the US Studies have shown that the risk of ACl injury in women athletes ranges from 4 to 8 times the risk for men and boys in similar sports.Prior to puberty, the injury risk is about the same. In high school girls soccer, there was one ACL injury for each 6500 exposures

ACL Anatomy

ACL Function

Stops the tibia (shin bone) from sliding forward and rotating under the femur (thigh bone).Rarely sees strain under everday activities.Mostly used when planting and cutting and when landing from a jump.Most ACL injuries are non-contact.

ACL Injury Treatment

Occasionally, an ACL tear can be treated without surgery.

This is rarely the case in a adolescent or young adult athlete.

ACL surgery is performed primarily via an arthroscope, with minimal incisionsAbout 60-70 percent of athletes are able to return to their prior level of play

Only about 5 percent do not return because of their knee symptoms.

ACL Injury Treatment

For most athletes, return to sport is possible 4-8 months after surgery.

Surgery is usually performed 1-2 months after the injury.

However, most athletes are not back to their previous level of play until 18 months after the surgery.

What's up with the girls?

Injury risk factors seem to beAnatomicHormonalEnvironmentalBiomechanical/Neuromuscular

Anatomic Factors

Intercondylar notch sizeACL ligament sizeIncreased knee valgus (knock knee)

Hormonal Factors

PubertyMenstrual Cycle

Biomechanical and Neuromucular Factors

Quadriceps DominanceWomen athletes increase their quadriceps strength, but their hamstring strength lags.Male athletes increase both quad and hamstring strength.

Less knee flexion when landing and cuttingGirl athletes tend to land and cut with less hip and knee flexion than boys.

Dynamic valgus when landing and cuttingHip internal rotation and flexion producing knee valgus

Prevention: Modifying Risk Factors

AnatomyGender / HormonesEnvironmentBiomechanical / Neuromuscular

Programs

Santa Monica PEP ProgramFIFA 11+ONS Foundation ACL Injury Prevention ProgramGirlsCanJumpSportmetrics

Santa Monica PEP Program:Prevent Injury Enhance

PerformanceAvoidance of InjuryFlexibilityStrengtheningProprioception/ PlyometricsAgility

Implementation

Ages 12 through adult2 to 3 times per week15 to 18 minutes

Avoid InjuryJoggingShuttle RunBackward Run

FlexibilityCalf StretchQuadraceps StretchHamstring StretchInner Thigh StretchHip Flexor Stretch

StrengthWalking LungesToe RaisesRussian Hamstring

PlyometricsSide HoppingBackward and Forward HopsSingle Leg HopsVertical HeadersScissor Jumps

AgilityShuttle RunDiagonal RunBounding Run

Cool DownBridgingAbdominal CrunchesFigure FourButterfly