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Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial
  1. Mette K Zebis1,2,
  2. Lars L Andersen3,4,
  3. Mikkel Brandt3,
  4. Grethe Myklebust5,
  5. Jesper Bencke2,
  6. Hanne Bloch Lauridsen2,
  7. Thomas Bandholm6,7,
  8. Kristian Thorborg8,
  9. Per Hölmich8,
  10. Per Aagaard9
  1. 1Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark
  2. 2Gait Analysis Laboratory, Department of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  3. 3National Research Centre for the Working Environment, Copenhagen, Denmark
  4. 4Human Performance group, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
  5. 5Oslo Sport Trauma Research Centre, Norwegian School of Sports Sciences, Norway Physical Activity, Oslo, Norway
  6. 6Clinical Research Centre, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  7. 7Department of Orthopaedic Surgery and Physical Therapy, Physical Medicine & Rehabilitation Research—Copenhagen (PMR-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark
  8. 8Sports Orthopaedic Research Centre—Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Amager-Hvidovre, Denmark
  9. 9Institute of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Dr Mette K Zebis, Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Sigurdsgade 26, Copenhagen 2200, Denmark; mettezebis{at}hotmail.com

Abstract

Background Adolescent female football and handball players are among the athletes with the highest risk of sustaining anterior cruciate ligament (ACL) injuries.

Aim This study evaluated the effects of evidence-based lower extremity injury prevention training on neuromuscular and biomechanical risk factors for non-contact ACL injury.

Methods 40 adolescent female football and handball players (15–16 years) were randomly allocated to a control group (CON, n=20) or neuromuscular training group (NMT, n=20). The NMT group performed an injury prevention programme as a warm-up before their usual training 3 times weekly for 12 weeks. The CON group completed their regular warm-up exercise programme before training. Players were tested while performing a side cutting movement at baseline and 12-week follow-up, using surface electromyography (EMG) and three-dimensional movement analysis. We calculated: (1) EMG amplitude from vastus lateralis (VL), semitendinosus (ST) and biceps femoris 10 ms prior to initial contact (IC) normalised to peak EMG amplitude recorded during maximal voluntary isometric contraction and (2) VL-ST EMG preactivity difference during the 10 ms prior to foot contact (primary outcome). We measured maximal knee joint valgus moment and knee valgus angle at IC.

Results There was a difference between groups at follow-up in VL-ST preactivity (43% between-group difference; 95% CI 32% to 55%). No between-group differences were observed for kinematic and kinetic variables.

Conclusions A 12-week injury prevention programme in addition to training and match play in adolescent females altered the pattern of agonist-antagonist muscle preactivity during side cutting. This may represent a more ACL-protective motor strategy.

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