ACL knee injuries in young athletes can be reduced with training

Teaching athletes to jump and land correctly key to preventing injuries.

A knee tear injury is on the rise among children and teens, particularly girls, who play sports, say pediatricians who recommend extra training before hitting the soccer field, gymnastics studio or basketball court.

Lasses competing in Scottish dance, Canmore Highland Games

CBC News April 28, 2014

Injuries to the anterior cruciate ligament, or ACL, in athletes age 18 and younger have increased over the last 20 years. A report in Monday’s issue of the journal Pediatrics offers information for parents, young athletes and clinicians on preventing, diagnosing and treating the injury before and after puberty

The ACL is one of four major ligaments that hold the bones of the knee together. The ligaments also work to stabilize the knee during movement. It can tear when athletes quickly change direction, land from a jump incorrectly, or slow down or stop suddenly.

ACL injury rates increase sharply during puberty, especially for girls, who have higher rates than boys when playing similar sports.

Aliya Mustafina of Russia gets assistance after suffering from an injury at the vault during the women’s individual all-around gymnastics final in 2011. Mustafina had surgery for an ACL injury, Gero Breloer, Associated Press

“After puberty, girls have a machine motor mismatch,” study author Timothy Hewett of the Council on Sports Medicine and Fitness said, in a release. “In contrast, boys get even more powerful relative to their body size after their growth spurt. The good news is that we’ve shown that with neuromuscular training, we can boost the power of girls’ neuromuscular engine, and reduce their risk of ACL injuries.”

Neuromuscular training programs work to strengthen muscles in the lower extremities, improve core stability and show athletes how to avoid jumping and landing improperly.

A few other factors are thought to be behind the increasing ACL injury rates, including the growing number of kids and teens participating in organized sports, more intense training at younger ages and greater rate of diagnosis thanks to increased awareness and advanced imaging.

Female athletes between 15 and 20 years old accounted for the largest number of ACL injuries.

At the high school level in the U.S., girl’s soccer has the most ACL injuries, followed by boy’s football, girl’s basketball, girl’s gymnastics, and lacrosse for both.

At the college level, U.S. data suggested ACL injury rates were highest in men’s spring football and women’s gymnastics.

Bethany Jewell wears a metal knee brace after her second ACL tear. CREDIT JEFF ST.CLAIR

Bethany Jewell wears a metal knee brace after her second ACL tear. Credit Jeff St. Clair, Kent State University

The study’s authors called the treatment of ACL in young athletes “challenging and controversial,” but that the tear is not a surgical emergency.

Ideally, surgical treatment would be postponed until the athlete’s skeletal structure is fully mature. Now, less invasive surgical techniques can be used and ACL surgery is about 90 per cent successful in restoring knee stability and patient satisfaction, they said.

Regardless of treatment, athletes with ACL tears are up to 10 times more likely to develop early-onset degenerative knee osteoarthritis that can lead to chronic pain and disability.

The authors suggested that pediatricians and orthopedic surgeons direct patients at highest risk of ACL injuries, such as adolescent female athletes or those with a family history, to resources such as the Pediatric Academy’s Council on Sports Medicine and Fitness.

It’s estimated that at least 70 per cent of ACL injuries are non-contact in nature.

Source CBC News

Canadian Academy of Sport and Exercise Medicine position statement: Neuromuscular training programs can decrease anterior cruciate ligament injuries in youth soccer players, Campbell CJ, Carson JD, Diaconescu ED, Celebrini R, Rizzardo MR, Godbout V, Fletcher JA, McCormack R, Outerbridge R, Taylor T, Constantini N, Cote M; Canadian Academy of Sport and Exercise Medicine. Clin J Sport Med. 2014 May;24(3):263-7. doi: 10.1097/JSM.0000000000000068.

Also see
A Wearable Neuromuscular Device Reduces ACL Injury Risk in Female Soccer Athletes in Orthopaedic Journal of Sports Medicine, July 2016 vol. 4 no. 7
Universal neuromuscular training an inexpensive, effective way to reduce ACL injuries in athletes in Science Daily
Neuromuscular Training Reduces ACL Injury Risk By Half in Moms Team
Female Teen Soccer Players In Neuromuscular Training Program Cut ACL Injury Risk By Two-Thirds in Moms Team
Promoting exercise and preventing injury in Canadian Family Physician
Training Program Can Reduce Female ACL Injury Risk, Improve Athletic Performance in Moms Team
PEP Exercise Program Reduces ACL Injuries in Female Soccer Players in Moms Team
How a Warm-Up Routine Can Save Your Knees in The New York Times
Sports Training Can Stem the Epidemic of Knee Injuries in Girls in Kent State University

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