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INJURY PREVENTION FOOTBALL
TABLE 3: COMMON MECHANISMS OF ACL INJURY – THIS IS AN IMPORTANT TABLE – INCLUDE THIS FOR CERTAIN
Non-contact
Accounts for 70% of all reported ACL injuries Caused by manoeuvres:
n One-step stop deceleration n Cutting task n Sudden change of direction n Landing from jump with inadequate knee/hip flexion
n Deceleration manoeuvre and change of direction while foot is in closed-chain position
injuries. They studied 93 athletes (41 males and 52 females) who had sustained a non-contact ACL injury when playing soccer. For non-contact ACL injuries, roughly half occurred in the preferred kicking leg (n = 30) and almost half in the contralateral leg (n = 28). However, there was a significant sex difference in the distribution of non-contact injuries: 74.07% of males (20 out of 27) were injured on the dominant kicking leg compared to 32.26% (10 out of 31) of females (P < 0.002). In this study, females were more likely to injure the ACL in their supporting leg and males in their kicking leg. This suggests that limb dominance does serve as an aetiologic factor with regard to ACL injuries sustained while playing soccer (39). If follow-up studies confirm that females are more likely to injure their preferred supporting leg, future research should investigate the cause for this discrepancy, which could result from underlying sex-related anatomical differences as well as differences in neuromuscular patterns during cutting manoeuvres or kicking. This information could allow optimisation of prescribed sex-specific prevention programmes.
Prevention of injury Prevention programmes that focus on skiing, basketball and European team handball and soccer have been conducted in the past, with outcomes ranging in an overall reduction of severe ACL injuries from 60% to 89% (4,5,8,10,12). Caraffa et al. (40) implemented a proprioceptive balance-
training programme among 600 semiprofessional and amateur soccer players in Italy. The study consisted of a 20-minute training programme divided into five phases of increasing difficulty. The prospective study was completed over the duration of three complete soccer seasons. An incidence rate of 1.15 ACL injuries per team per year was found in the control group (untrained semiprofessional soccer players) compared to a rate of 0.15 in the trained athletes. This corresponded to an 87% decrease in ACL injury compared to the control group. Hewitt et al. (41) conducted a prospective analysis of 1263
male and female athletes from various sports undertaking a neuromuscular training programme. This 6-week intervention consisted of stretching, plyometrics, and weight-training with emphasis on proper alignment and technique. The incidence of serious knee injury was 2.4 to 3.6 times higher in the athletes who were untrained group compared to those who
www.sportEX.net Contact
Accounts for 30% of all reported ACL injuries
Contact with: n Another player n Goal-post n Equipment n Object on the field or court n Surface
were trained using the injury-prevention protocol. Of the non- contact ACL injuries, five were in untrained females (relative incidence 0.26), none were in trained females (0.0), and one occurred in a male athlete (0.05).
Myklebust et al. (26) conducted a proprioceptive training
programme among elite female team handball players. This five-phase programme consisted of floor exercises, wobble- board activities and a balance mat, performed two to three times a week over the course of 5–7 weeks during the preseason, and once a week during the playing season. Fifty- eight teams (855 players) participated in the first season in 1999–2000, and 52 teams (850 players) participated in the second season in 2000–2001. Sixty teams (942 players) in the preceding season (1998–1999) served as the control. There were 29 ACL injuries in the control season, 23 ACL injuries in the first intervention season and 17 injuries in the second intervention season.
Mandelbaum et al. (12) used the PEP (Prevent Injury and Enhance Performance) ACL prevention programme in two age cohorts of female soccer athletes: 14–18-year-olds and 18–22-year-olds. The programme consisted of a 20-minute warm-up protocol before a normal training session. A total of two ACL tears confirmed by MRI were reported for the intervention group, with an incidence rate of 0.05 ACL injuries per 1000 AE. Thirty-two tears were reported in the control group, resulting in an incidence rate of 0.47 ACL injuries per 1000 AE. These results represent an 88% overall reduction of ACL injuries in an individual athlete compared to a skill- and age-matched control athlete. In the second year of the study, four ACL tears were reported in the intervention group, with an incidence rate of 0.13 injuries per athlete per 1000 AE. Thirty- five ACL tears were reported in the control group, with an incidence rate of 0.51 injuries per 1000 AE. This corresponds to overall 74% fewer ACL tears in the intervention group than in age- and skill-matched controls in year 2 (12). This study was followed by a randomised controlled
trial that used the PEP programme in Division 1 NCAA women’s soccer teams. Sixty-one teams with 1429 athletes completed the study, with 854 in 35 control teams and 575 in 26 intervention teams. No significant differences were noted between the intervention and control groups with regard to age, height, weight or history of past ACL injuries. After establishing the efficacy of the intervention, the ACL injury rates were compared. In total, there were 7 non-contact ACL injuries in the intervention group compared to 18 in the controls (0.14 vs 0.25; P = 0.15). During practice sessions, there were 0 injuries in the intervention group compared to 6 in the controls (0.10; P = 0.01). There were three times more non-contact injuries in the controls than in the intervention group (0.14 vs 0.04; P = 0.06). Athletes in the control group with a prior history of ACL injury had five times as many reoccurrences than the intervention group (0.10 vs 0.02; P = 0.06), and this difference was
IN THEIR SUPPORTING LEG AND MALES IN THEIR KICKING LEG.
FEMALES WERE MORE LIKELY TO INJURE THE ACL
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