ACL injury prevention: Where have we come from and where are we going?

Abstract

Anterior cruciate ligament (ACL) injuries are one of the most common and severe knee injuries across sports. As such, ACL injury prevention has been a focus of research and sports medicine practice for the past three-plus decades. Examining the current research and identifying both clinical strategies and research gaps, the aim of this review is to empower clinicians and researchers with knowledge of where the ACL injury prevention literature is currently and where it is going in the future. This paper examines the mechanism of ACL injury prevention, screening, implementation, compliance, adherence, coronavirus, and areas of future research.Clinical significance: The time lag between research and practical implementation in general healthcare settings can be as long as 17 years; however, athletes playing sports today are unable to wait that long. With effective programs already established, implementation and adherence to these programs is essential. Strategies such as coaching education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaboration are just a few ways that could help improve both ACL injury prevention implementation and adherence.

Preliminary Report on the Train the Brain Project, Part II: Neuroplasticity of Augmented Neuromuscular Training and Improved Injury-Risk Biomechanics

“…13 While recent data indicates that knee abduction mechanics may not predict injury risk in all populations, 45 associated knee valgus motion is commonly identified during non-contact ACL injury 1 and is a common intervention target to reduce ACL injury risk. 8 Thus, despite the need for future O n l i n e F i r s t research with complementary biomechanical assessments (e.g., global movement profiles), these preliminary data provide initial support for the ability of aNMT to improve neuromuscular, potentially by promoting adaptive neuroplasticity. The aNMT stimulus is a real-time, interactive biofeedback stimulus responsive to and driven by select biomechanical variables identified in prior research as contributing to injury risk.…”

“…Further, ACL injury incidence has remained unchanged, or is even increasing in female athletes. 7 This is due in part to lack of program adherence, education, and instruction, 8 compounded by the efficacy of NMT for ACL injury prevention not advancing for nearly a decade, 9 remaining at ~100 athletes required to be treated to prevent 1 ACL injury. Although NMT incorporates a series of progressive exercises (including balance, strength, and plyometric activities) that have positive effects on physical and mental preparation for sport, 8 the injury prevention focus of traditional NMT is limited to improving body mechanics associated with injury risk.…”

“…7 This is due in part to lack of program adherence, education, and instruction, 8 compounded by the efficacy of NMT for ACL injury prevention not advancing for nearly a decade, 9 remaining at ~100 athletes required to be treated to prevent 1 ACL injury. Although NMT incorporates a series of progressive exercises (including balance, strength, and plyometric activities) that have positive effects on physical and mental preparation for sport, 8 the injury prevention focus of traditional NMT is limited to improving body mechanics associated with injury risk. These mechanics are typically evaluated O n l i n e F i r s t using standardized biomechanics laboratory testing 10 which neglects critical aspects of neural function that may contribute to injury risk and the neuroplasticity associated with acquisition injury-resistant movement patterns.…”

Raising the Young Athlete: Training and Injury Prevention Strategies

“…), external cues, video, or real-time feedback as parts of effective ACL IPPs. 58 Additionally, for prevention of Achilles tendinopathic injuries, programming is optimized with 85-90% maximum voluntary contractions maintained for 3 seconds [59][60][61] in which the mode of contraction (concentric vs. eccentric) does not appear to play a significant role. 62 Ultimately, we recommend initiating an IPP best suited to the individual needs of the young athlete, and emphasize that adherence to a prevention program is necessary for optimal injury prevention.…”

ACL special issue, editors

“…[1][2][3] The review emphasizes that strategies like coach education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaboration could help improve both the implementation of and adherence to ACL injury prevention programs which could ultimately decrease the incidence of ACL injury. 4 Orthopedic surgeon scientists, Martha Murray, Constance Chu, and Elizaveta Kon all approach the conundrum of ACL reconstruction and graft healing from their own scientific perspectives. Dr. Murray describes and discusses her group's work using a tissue engineering strategy to solve one of the most vexing problems, that the ACL does not heal.…”