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ACL injury incidence in female handball 10 years after the Norwegian ACL prevention study: important lessons learned
  1. Grethe Myklebust1,
  2. Arnhild Skjølberg1,2,
  3. Roald Bahr1
  1. 1Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo, Norway
  2. 2Orkanger Physiotherapy and Osteopathy, Orkanger, Norway
  1. Correspondence to Grethe Myklebust, Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, PO Box 4014 Ullevål Stadion, Oslo 0806, Norway; grethe.myklebust{at}

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Success in injury prevention in the short run is possible. Several studies have documented that injuries can be prevented if programme compliance is sufficient.1–6 However, the efficacy of an intervention is in a controlled trial does not mean that it will be widely adopted and sustained and have an impact on public health.7–9 Finch9 outlined the Translating Research into Injury Prevention Practice framework, emphasising that only research that can and will be adopted by the participants, the coaches and sporting bodies will succeed in the long run.

Anterior cruciate ligament (ACL) injuries is an example where there are controlled studies showing promising efficacy (that the intervention is capable of producing the desired effect);5 ,10–13 however, their efficiency (whether the desired effect occurs under real-life conditions) is not known. We wanted to know ‘Have ACL injury prevention initiatives taken in Norway during the last decade been successful in the long run?’ We report our experience with Norwegian handball as an example, as this is an area where several initiatives (table 1) building on prevention trials have coincided with an ongoing surveillance programme.

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Table 1

Prevention initiatives from 1998 through 2011

Norwegian female handball experience: a 13-year and ongoing story

ACL Injury Prevention Study

The 1998–1999 season served as the baseline for the ACL Injury Prevention Study; during the 1999–2000 season, an injury prevention programme was introduced in the top three divisions in female handball in Norway.10 The intervention consisted of a neuromuscular training programme with exercises on a wobble board, a balance mat and handball-specific exercises. In the first season (1999–2000), the intervention was based on coaches delivering the programme after being instructed by the investigators. However, as compliance was low, physical therapists were engaged to take charge of delivery of the programme during the second intervention season (2000–2001). Compared with a baseline rate of 0.48 ACL injuries per team, …

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  • Contributors All three authors were involved in planning the project, in the follow-up of the teams and players and in the writing the manuscript.

  • Competing interests None.

  • Ethics approval South-Eastern Norway Regional Committee for Research ethics.

  • Provenance and peer review Not commissioned; externally peer reviewed.