Arthroscopy: The Journal of Arthroscopic & Related Surgery
Systematic ReviewNeuromuscular Retraining Intervention Programs: Do They Reduce Noncontact Anterior Cruciate Ligament Injury Rates in Adolescent Female Athletes?
Section snippets
Literature Search
From January 1994 through May 2013, we searched the Medline and Cochrane databases for all published literature using the following key words and phrases: anterior cruciate ligament injury, ACL injury prevention, ACL neuromuscular retraining, and ACL training. Inclusion criteria were English language, clinical trials of all kinds, Level I to Level IV evidence, female adolescent athletes, noncontact ACL injuries, and injury incidence rates determined according to athlete-exposures. The age limit
Literature Search
Our search initially identified 578 original research studies. We also found 116 general review articles, current concepts, commentaries, systematic reviews, and meta-analyses that were reviewed for additional studies but were not included in the final study. A total of 403 articles were excluded because they were off-topic. We reviewed the abstracts and content of the remaining 175 articles, 167 of which were also excluded, as shown in Fig 1. This left 8 articles that were included in this
Discussion
The main finding of this systematic review was that 3 neuromuscular retraining intervention programs significantly reduced the noncontact ACL injury incidence rates in female adolescent athletes. These were the Sportsmetrics program, PEP, and KIPP. The number of athletes who needed to train to prevent 1 ACL injury in these 3 studies ranged from 70 to 98, and the relative risk reduction ranged from 75% to 100%. Although the number of athletes needed to treat appears somewhat high, in our
Conclusions
Three ACL intervention programs successfully reduced noncontact ACL injury incidence rates in female adolescent athletes. Pooling of data of all ACL intervention programs is not recommended because of numerous methodologic differences among studies.
Acknowledgment
Sportsmetrics is a nonprofit injury prevention program administered by the Noyes Knee Institute. The authors thank Tommy Campbell and Stephanie Tutalo Smith for their assistance with athlete training and injury tracking and Marty Levy for statistical consultation.
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2022, Clinics in Sports MedicineCitation Excerpt :Neuromuscular training programs have been found to be significantly effective in athletes in ACL risk reduction, particularly for female athletes, resulting in up to 67% risk reduction93 through biomechanical optimization and focusing on posterior chain strength development.66 In a systematic review, three neuromuscular training programs were found to be effective in reducing injury risk: (1) Sportsmetrics, (2) Knee Injury Prevention Program (KIPP), and (3) Prevent Injury and Enhance Performance (PEP) program.94 In addition to plyometric training, robust resistance training is also imperative for youth athletes regarding strength and control adaptations.95
Unique Considerations for the Pediatric Athlete During Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction
2022, Arthroscopy, Sports Medicine, and RehabilitationCitation Excerpt :These neuromuscular deficits are similar to primary ACL injury risk.29 Neuromuscular training (NMT) effectively improves landing mechanics and performance and has shown to reduce ACL injury rate in healthy adolescents.116-121 Therefore NMT program should be an important component of rehabilitation after ACLR to reduce the risk of a second injury to the ipsilateral leg and to the contralateral leg.
Association of lower extremity injuries and injury mechanism with previous concussion history in adolescent athletes
2021, Physical Therapy in SportCitation Excerpt :For example, clinical measurements of gait and balance have identified deficits in individuals several months to over a year after a concussion (Chou et al., 2004; Martini et al., 2011; Powers et al., 2014b), and a recent study of drop-landing biomechanics identified that adolescents with a history of concussion had decreased ankle and knee flexion compared to adolescents without a history of concussion (Avedesian, Covassin, & Dufek, 2020). The latter study identified changes in lower extremity (LE) landing mechanics that may increase the risk for LE injuries following a concussion, especially non-contact LE injuries, which have been linked with decreased neuromuscular control (Mandelbaum et al., 2005; Noyes & Barber-Westin, 2014). Several studies have reported the association of concussion with subsequent time-loss injuries (Herman et al., 2017; Lynall et al., 2017).
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2021, A Comprehensive Guide to Sports Physiology and Injury Management: An Interdisciplinary ApproachRotator Cuff Function and Injury in the Female Athlete
2021, The Female AthleteEvaluation of adolescent sport specialization and injury mechanism by sex: A secondary analysis
2020, Journal of Science and Medicine in SportCitation Excerpt :Theoretically, highly specialized athletes may have an increased risk of injury not just because of an increase in training volume but also as a result of repetitive motor patterns that can cause muscle imbalances or decreased neuromuscular control.3,18,19 If sport specialization does in fact impact neuromuscular control, there are several studies that have demonstrated the association of decreased neuromuscular control with both acute and overuse injuries.20–22 A few recent studies have explored the plausibility that sport specialization may affect neuromuscular control and both studies observed differences in neuromuscular control between athletes that played two or more sports compared to single sport athletes.18,19
The authors report that they have no conflicts of interest in the authorship and publication of this article.