Too often on TV, we see professional athletes suffer gruesome hits to their legs, causing season-ending injuries such as anterior cruciate ligament (ACL) tears. School-aged children and teenagers are more involved than ever in year-round sports, with the drive to hopefully be the future athlete on TV evermore present.
As a result of this mentality, we as physicians see more and more sports related injuries. A recent study showed that the number of ACL tears seen in kids aged 10 to 14 years old increased by 18.9% between 2007 and 2011. ACL tears are particularly traumatic because, regardless of treatment options, the recovery is long and the rehab intensive.
Many do not know that approximately 75% of ACL tears are noncontact injuries, even though we usually associate them with hard hits. Females sustain these injuries more often than males. Studies and videos have shown that females often land with their knees in a more knock-kneed position, or valgus moment. Decreased knee flexion and weaker hamstrings-to-quadriceps ratios also increase the risk of such injuries in females. There are a few anatomic risk factors as well. One study shows that females with a certain gene are actually at less of a risk for sustaining an ACL tear, although this is not routinely tested for.
As these injuries have become more common, there has been a lot of study and focus on ACL injury prevention in our young athletes. There are many studies looking at braces, programs and risk factor reduction to prevent ACL injuries. Programs exist to screen athletes who exhibit the known risk factors, followed by formal neuromuscular training to help prevent injury. We have evidence that these programs do work if implemented properly. A recent review showed specifically the Prevent Injury and Enhance Performance (PEP), the Knee Injury Prevention Program (KIPP) and the Sportsmetrics program all work to decrease the incidence of ACL injuries from noncontact mechanisms, specifically in females.
All of these programs can be found in detail on the internet. A lot of what is involved is teaching athletes how to properly jump and land, attempting to decrease the valgus or inwards load on the knee and increase knee flexion. The PEP and the KIPP program both are based on a coach-directed warm up, stretching, strength training, plyometric (jumping) training and agility training with sports-specific exercises.
The PEP is recommended three times a week and takes 15 to 20 minutes. The KIPP program is a daily routine taking the same 15 to 20 minutes. Sportsmetrics is a 6-week program stressing a short dynamic warm-up, plyometric/jump training and high-intensity strength training, followed by flexibility and stretching work. You will notice all of these programs stress similar areas of training.
Studies are inconclusive as to whether we should first screen people that are at risk for ACL tears and then implement neuromuscular prevention programs where appropriate, or simply apply them to all of our young athletes. Evidence shows that it takes 70-98 athletes to undergo training before one ACL tear is prevented.
For my athletes and as general advice to all, I recommend a basic 15- to 20-minute neuromuscular training program and warm up before sporting activities, regardless of if it is recreational sports or year-round travel teams, as the treatment and recovery for ACL tears is long and tedious.