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From the American Orthopaedic Society for Sports Medicine

Female ACL Injury Prevention Programs Work Despite Questions

Study says effectiveness not statistically proven, urges continued use and study

ACL injury prevention programs for female athletes work and should be used, despite  questions raised in a new study, which called for more research.

According to a study presented to the 2010 American Orthopaedic Society for Sports Medicine annual meeting, while "[t]here is evidence that injury prevention programs may reduce the risk of some knee injuries, ... additional research in necessary," said Kevin G. Shea, M.D., Intermountain Orthopaedics, Boise, Idaho.

"Questions about the efficacy of some programs exist and additional well-designed research studies need to be conducted before we can definitively prove the value of these programs for ACL and other knee injury," he said.

Female athletes at particular risk of ACL injuries

An estimated 200,000 ACL injuries occur annually in the U.S, according to the American Journal of Sports Medicine. Approximately 15 percent of all sports injuries involve the knee. Fifty percent of those injuries result in a doctor or hospital visit. 

Female athletes playing sports that involve jumping and pivoting (basketball, soccer, volleyball, lacrosse) are at significantly greater risk of knee injuries, particularly to the anterior cruciate ligament (ACL), than male athletes.

  • Recent studies reveal that young female athletes are up to eight times more likely than boys to tear their ACLs and are more prone to non-contact ACL injuries.

  • ACL injuries often require surgery to repair, months of rehab, increased risk of degenerative arthritis and other long-term impairments, and exact a high physical, mental, emotional and economic cost.
  • According to the Centers for Disease Control and Prevention more than 46,000 female athletes age 19 and younger experienced a sprain or strain of the ACL in 2006.

  • Nearly 30,000 of the injuries required reconstructive surgery.

Exercise programs still recommended

"At this time, we do not have the highest quality research designs showing us that preventive training programs can reduce knee/ACL injuries," said Shea. "[But] that doesn't mean that these training programs [such as the Prevent Injury and Enhance Performance (PEP) program] do not help - I encourage my own children and my patients to be do these exercises, as the existing evidence suggests some benefit to these training programs.

But, we need better research evidence that confirms the effectiveness of injury prevention programs. These types of studies are difficult to conduct, and require significant resources to produce the research. The sports medicine community should continue research in this area, including NIH funded studies to conduct the high quality clinical trials. "

Holly Silvers, MPT, Director of Research and physical therapist for the US Soccer Federation Medical Team and Major League Soccer's CD Chivas USA and LA Galaxy and the non-profit Santa Monica Orthopedic and Sports Medicine Research Foundation, agreed that more study was needed but urged continued use of PEP. 

A co-author of two of the studies criticized in Shea's study, Silvers told MomsTeam that, "if we can reduce [ACL] injury by 72%, I'm okay with that " - even if we fell just short of the 95% level considered the gold standard for statistical significance researchers strive for. 

"When you [look at] data for [just] the second half of the season [studied], our stastics were stellar.  We had no ACL injuries, contact or non-contact, in games or practices in the last 6 weeks of the 2002 collegiate season."

Created July 18, 2010