An ACL injury can end an athlete's career and increase their risk for further surgery, reinjury, and arthritis. Preventing ACL injuries through neuromuscular training programs that target landing mechanics, balance, and strength imbalances can reduce ACL injury rates in female athletes by 74-83%. Such programs aim to change vulnerable positions during cutting and landing and decrease knee forces. More widespread implementation of proven prevention programs is needed, especially for younger athletes.

2. Peter N Ove, MD
Sports Medicine, Arthroscopic Knee and Shoulder Surgery
Orthopaedics and Sports Medicine
pove@osmc.net

6.  ACL injury can be career ending
 Even if get back, risk for further surgery, re-
injury, arthritis
 Focus on preventable ACL injuries

9.  Bracing: no conclusive evidence
 Footwear: increased friction coefficient more
risky
 Playing surface: lower friction (wooden vs
artificial, turf vs. grass?, even vs uneven
surface) better
 Environmental conditions: outdoor turf, grass
cold better than hot weather

10.  ACL tears 4-6x more common in girls than
boys
 Why?
 Anatomy & Physiology
 Hormonal, ligament/house
size, biomechanics
 Technique
 Environment, other factors’ contribution
notwithstanding

12.  38,000 estimated
female ACL injuries
each year
 Estimated 2,200 at
the collegiate level
 May be 4 times as
high at HS level
(8000-9000!!)

13.  Increased Participation
in sports (Title IX)
 Female basketball players are
2x more likely to suffer an ACL
tear than their male
counterparts
 Female soccer players are 4x
more likely to suffer an ACL
tear than their male
counterparts

14.  Anatomical
Differences
 Biomechanical
Factors
 Hormonal
Influences
 Neuromuscular
Differences

15.  Women tend to have a
more “knock-kneed”
leg alignment
 The femoral notch, in
women tends to be
narrower

16.  Compared with men,
women:
 Have less muscle mass
 Are slower at the rate of
muscle force development
(ms)
 Have a stronger, quicker
reacting quadriceps relative
to hamstrings
 Tend to be more upright
when landing
 Tend to be “quad dominant”

17.  Ligament Dominance
 Knee ligaments rather than knee muscles absorb the
landing forces during sports maneuvers
 Quadriceps Dominance
 Quads react more quickly to forces than the hamstrings
 Leg Dominance
 The non-dominant knee is at
greater risk because it’s weaker

18.  ACL injury prevention programs have
demonstrated a reduction in the rate of ACL
injuries in 14-18 year old girls by 74-83%!!
 Helping to change the position of the knee when
landing or cutting and pivoting
 Decreasing landing forces on the knee when landing
from a jump

21. • Avoid vulnerable
positions
• Increase flexibility
• Increase strength
• Increase balance
through agility
training
• Include sports specific
exercises into the
training program

22. Research-proven ACL injury prevention programs:
-Preseason
-In-season
-Multi-year
Randomized Trials in high school, college, and
professional athletes; female and male
Examples: Sportsmetrics, PEP, Frappier, BAPS

23. • Technique changes
– Landing properly
– Accelerated round turns, multi-step stop
deceleration
• Balance, proprioceptive training
• Neuromuscular training
– Correct imbalances (leg, muscle groups)
– Improve strength, flexibility via plyometrics,
weight training with proper alignment and
technique

24.  Reduction in ACL injuries by 5X in many
studies
 Usually most impressive statistics when you
separate out non-contact injuries
 Improvement in performance (vertical jump)

25.  The research and development of training
programs to prevent ACL injuries is evolving
rapidly
 More attention needs to be placed on
implementing these programs to younger
athletes during their developmental years