Implementing ACL Injury Prevention in Daily Sports Practice—It’s Not Just the Program: Let’s Build Together, Involve the Context, and Improve the Content

Abstract

Although the benefits of current anterior cruciate ligament (ACL) injury prevention programmes have been demonstrated in efficacy studies, they, unfortunately, have had limited public health impact to date. For example, the incidence of ACL injuries continues to rise in adolescent athletes. Raising awareness and educating coaches and athletes is not enough to facilitate the widespread, sustained use of these programmes in the real-world setting. Considering the profound burden of ACL injuries, it is necessary to continue to improve the current ACL injury prevention programmes through co-creation. First, the uptake of the programmes should be optimized by a better appreciation and understanding of the individual, socio-cultural and environmental context (i.e., community). Second, the content of the programmes should be optimized to better reflect the demands of the sport by creating more ownership and increasing motivation (incorporating challenging, sport-specific and fun elements) with the end-users. In addition, implicit motor learning, random practice and differential learning are concepts that should be integrated when practising to obtain the most optimal results when learning or finetuning skills.

Barriers and facilitators to the adoption and implementation of evidence-based injury prevention training programmes: a narrative review

“…Drawing from key ideas within the implementation and dissemination science realm, the use of systematic evaluation of the social, cultural and environmental context is necessary to encourage the spread, scalability and sustained use of evidence-based injury prevention programmes. 60 …”

Hybrid effectiveness-implementation study designs in sports injury prevention research

“…Sport-related injury prevention research typically follows the staged scientific paradigm described above, where interventions are tested in ideal, controlled circumstances, then realworld circumstances, and finally implementation strategies are assessed for public health impact. Unfortunately, a replication crisis exists at the effectiveness level of science (Peterson, 2021) where outcomes are progressively more diluted as evidence-based interventions are applied to varying populations and contexts (Benjaminse and Verhagen, 2021). However, an improvement in dissemination and implementation science methods (Curran et al, 2012;Brown et al, 2017;Landes et al, 2019) can be applied to lower extremity prevention training programs to enhance real-world impact.…”

“…While the freedom to modify PTPs can be a strength that allows for a range of population types, sports, and levels of competition to tailor programs for their needs, this leads to exponential intervention and implementation variability, making replicability of positive benefits less predictable. While it is established that PTPs can reduce injury risk and injury rate, implementation strategies that lead to successful maintenance and sustainability are not well understood (Benjaminse and Verhagen, 2021 ). For example, a stakeholder education strategy to train-the-trainer that is successful in a military or professional soccer organization may not lead to long-term implementation behaviors in a youth basketball organization.…”

“…However preventive training programs are not a part of routine sport practices across multiple populations (Joy et al, 2013 ; Norcross et al, 2016 ; Donaldson et al, 2018 ; Dix et al, 2021 ). More systematic evaluations of context and end-user behaviors are needed to address this critical gap between demonstrated efficacy and real-world implementation and sustainability (Benjaminse and Verhagen, 2021 ).…”

Evaluation of an injury prevention programme (Prep-to-Play) in women and girls playing Australian Football: design of a pragmatic, type III, hybrid implementation-effectiveness, stepped-wedge, cluster randomised controlled trial

“… 29 The football skills include unique Australian Football activities (eg, tackling) and aim to reduce the risk of ACL injuries and concussion. Sport-specific skills and education can enhance programme uptake 30 potentially reducing concussion, 20 31 particularly where participation is new for women and girls.…”