Special thanks to star physical therapist Leah Versteegen, DPT, of Alpine Physical Therapy for providing this write up on a recent article from the Journal of Bone and Joint Surgery.
Anterior cruciate ligament injuries are one of the more common injuries impacting young athletes. The impacts are not only physical in nature but have psychological components and add financial stress as well. As the prevalence of youth participating in sports has increased, ACL injuries have also increased. Some research estimates that return to sport after ACL rupture and repair is as low as fifty percent in young athletes, while epidemiological studies estimate that females are four to six times more likely to suffer an ACL injury compared to their male counterparts. For these reasons, a considerable amount of attention has been given to programs aimed to decrease ACL injury rate, particularly in the female athlete.
Research supports the effectiveness of many ACL injury prevention programs that have been developed in the past decade. These programs typically involve an altered warm up and inclusion of certain fitness drills in practice that include core work, stretches, plyometrics, strengthening and sport-specific agility drills. The end goal is to optimize muscle balance and improve the athletes biomechanics, particularly with jumping and cutting type movements that typically stress the ACL.
Aside from these ACL injury prevention programs, more recently certain researchers have recommended screening programs to identify the young athletes that may be at higher risk for ACL injury. Medical screening tools ideally are desigend to be sensitive enough to identify only the high risk individuals so that interventions can target this population rather than those who do not need the intervention, thus saving money. With an effective ACL injury screening tool, the athletes that are at highest risk can then participate in an injury prevention program, rather than having all of the athletes in the program, again with a goal of saving time and money.
As finances for youth and college sports can be limited and injury rates continue to rise with increased sport participation, it is important to find the most cost-effective program to implement that also provides the best results. It necessary to take into consideration the cost and accuracy of a screening tool, as the purpose of the screen is to identify those at risk. Similarly it is important to make sure that the intervention is targeting the correct population and is effective in making the modifications desired. Though research supports the sensitivity of screening tools as being effective in predicting ACL injury risk, these screening tests require extensive set-up, expensive motion analysis video equipment, and a skilled tester. Typically the athlete will run through a battery of jump and landing tests to determine the knee abduction moment. Even if a coach is educated on what to look for with a screening test and is able to use a simple camera, the time and cost required to conduct the testing exceeds the benefit.
The incidence of ACL injuries in youth is high enough that a screening tool is just not warranted. The high incidence rate equates to the fact that most athletes will benefit from an ACL injury prevention program, which are very inexpensive and highly effective as supported by research. On average, such programs decrease the incidence of ACL injury from three per cent to one pecent in a single season, saving on average $100 pre player per season in expenses related to such injuries. Universal ACL injury prevention programs for young athletes, male and female, are a cost effective strategy for reducing the physical, psychological and financial burden of ACL pathology.
Eric Swart MD, et al. Prevention and Screening Programs for Anterior Cruciate Ligament Injuries in Young Athletes. In the Journal of Bone and Joint Surgery. May 7, 2014. Volume 96A. Number 9. Pp 705 -711.
For more information on ACL injuries, visit our clinic resource page by clicking here.
Brent Dodge is the founding owner of Alpine Physical Therapy and is a board certified orthopedic specialist. He holds additional certifications in Functional Dry Needling, Manual Physical Therapy, and Strength and Conditioning.
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