ACL Injuries in the Female Athlete: Causes, Impacts, and Conditioning Programs

658 Pages·2018·33.18 MB·English

by  Frank R. Noyes, Sue Barber-Westin

ACL Injuries in
the Female Athlete
Causes, Impacts,
and Conditioning Programs
Frank R. Noyes
Sue Barber-Westin
Editors
Second Edition
123
ACL Injuries in the Female Athlete
Frank R. Noyes • Sue Barber-Westin
Editors
ACL Injuries in the
Female Athlete
Causes, Impacts, and Conditioning
Programs
Second Edition
Editors
Frank R. Noyes Sue Barber-Westin
Cincinnati Sportsmedicine Cincinnati Sportsmedicine Research and
and Orthopaedic Center Education Foundation
Cincinnati Cincinnati
Ohio Ohio
USA USA
ISBN 978-3-662-56557-5 ISBN 978-3-662-56558-2 (eBook)
https://doi.org/10.1007/978-3-662-56558-2
Library of Congress Control Number: 2018949602
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Preface
This second edition of ACL Injuries in the Female Athlete: Causes, Impacts,
and Conditioning Programs represents a significant update of all of the issues
pertaining to the dilemma of the gender disparity in anterior cruciate ligament
(ACL) injuries, first noted nearly 25 years ago. This textbook was designed to
compile the many different approaches taken by clinicians and scientists
regarding the female ACL injury problem. Our goal is to highlight the find-
ings and current viewpoints of some of the individuals actively involved in
this area of research. We are grateful to the guest authors, many of whom
have published extensively on this topic, for their contributions to this effort.
In 1999, the first neuromuscular training program developed at Cincinnati
Sports Medicine by Frank Noyes, M.D., and colleagues was published that
reduced the incidence of ACL injuries in female high school athletes [1].
Researchers from around the world were soon involved in studying risk fac-
tors hypothesized to cause the ACL injury gender disparity, and similar train-
ing programs were developed in an attempt to reduce the incidence of
noncontact ACL injuries. At the time of writing (July 2018), nearly 600 origi-
nal research investigations and 100 reviews had been published that focused
on ACL injuries in the female athlete. A recent Google search of “ACL Injury
Prevention Training” revealed over one million hits, highlighting the popular-
ity of this topic.
Having been at the forefront of this research topic, the editors find it
refreshing to see the amount of intellectual energy and dollars that have been
devoted to this area. In fact, multiple “ACL research retreats” (occurred in
1999, 2001, 2003, 2005, 2006, 2008, 2010, 2012, 2015) and consensus state-
ments from organizations such as the International Olympic Committee [2]
and the American Academy of Pediatrics [3] demonstrate the attention and
emphasis the female athlete ACL injury dilemma has received throughout the
world. Our nonprofit research foundation has certified over 2017 individuals
across the USA and abroad to conduct neuromuscular ACL injury prevention
programs in their communities.
As shown in this textbook, the majority of investigators have studied the
causative factors producing the gender disparity in ACL injuries. Debate con-
tinues regarding the problem of deciphering the most relevant risk factors,
and in fact, there remain questions on the exact mechanisms of this injury.
Unfortunately, not everyone has jumped on the bandwagon regarding ACL
injury prevention training. There remains a tremendous need and responsibil-
ity of medical health professionals to educate those involved with female
v
vi Preface
athletes of the devastating consequences of ACL injuries and the need to pre-
vent them. One potential solution to the “coach-not-interested” problem is to
provide training programs that both enhance athletic performance and reduce
the incidence of ACL injuries. This textbook describes programs designed for
high-risk sports such as soccer and basketball that have accomplished both of
these goals.
Another area still under investigation is the development of simple field
tests to detect athletes with neuromuscular problems and imbalances that
require correction. While laboratory work must continue using the most
advanced three-dimensional motion, forceplate, electromyographic, and
other equipment available, realistic and cost-effective tests are required.
These could be incorporated into preseason physicals done by physicians or
conducted by coaches as part of their athlete testing regimen. Several such
field tests are detailed in this book.
It is our hope that someday ACL injury prevention training will truly be
widespread and perhaps even a part of routine physical education classes at
schools. Only through widespread use of prevention training will the female
ACL injury problem be solved or at least significantly reduced. Until then, it
remains the responsibility of those clinicians and scientists involved to con-
tinue their efforts to educate the general public and conduct research in the
areas of risk factors, risk screening, and prevention programs.
In recent years, an even more pressing problem is the high rate of second
ACL tears in athletes in the operative or opposite knee after an ACL recon-
struction. Repeat ACL injuries have been reported to occur in as high as 30%
of athletes [4, 5]. This is an enormous problem that needs research and devel-
opment of postoperative programs that include neuromuscular training such
as Sportsmetrics before an athlete returns to sports. In addition, the use of
strict return to sport testing parameters, as detailed by the authors in this
book, is required to objectively determine that neuromuscular, strength, and
agility indices are in the normal to near normal range. It remains the respon-
sibility of the surgeon and team of physical therapists and trainers treating
athletes to adopt effective postoperative programs that combine all of the fea-
tures of ACL preventive programs to lessen the risk of a serious repeat knee
injury.
Cincinnati, OH Frank R. Noyes
Cincinnati, OH Sue Barber-Westin
References
1. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR (1999) The effect of neuromuscu-
lar training on the incidence of knee injury in female athletes. A prospective study. Am
J Sports Med 27(6):699–706
2. Ardern CL, Ekas G, Grindem H, Moksnes H, Anderson AF, Chotel F, Cohen M,
Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee
M, Mandelbaum B, Micheli L, Mohtadi NGH, Reider B, Roe JP, Seil R, Siebold
R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L (2018) 2018
Preface vii
International Olympic Committee Consensus Statement on Prevention, Diagnosis, and
Management of Pediatric Anterior Cruciate Ligament Injuries. Orthop J Sports Med
6(3):2325967118759953. https://doi.org/10.1177/2325967118759953
3. LaBella CR, Hennrikus W, Hewett TE; Council on Sports Medicine and Fitness,
and Section on Orthopaedics (2014) Anterior cruciate ligament injuries: diagnosis,
treatment, and prevention. Pediatrics. 133(5):e1437–1450. https://doi.org/10.1542/
peds.2014-0623
4. Dekker TJ, Godin JA, Dale KM, Garrett WE, Taylor DC, Riboh JC (2017) Return to
sport after pediatric anterior cruciate ligament reconstruction and its effect on sub-
sequent anterior cruciate ligament injury. J Bone Joint Surg Am 99(11):897–904.
https://doi.org/10.2106/JBJS.16.00758
5. Salmon LJ, Heath E, Akrawi H, Roe JP, Linklater J, Pinczewski LA (2018) 20-Year out-
comes of anterior cruciate ligament reconstruction with hamstring tendon autograft: the
catastrophic effect of age and posterior tibial slope. Am J Sports Med 46(3):531–543.
https://doi.org/10.1177/0363546517741497
Acronyms
ACL Anterior cruciate ligament
ACL-RSI ACL-Return to Sports After Injury scale
AE Athlete exposure
JPS Active joint position sense
AM Anteromedial
AMI Arthrogenic muscle inhibition
ANOVA Analysis of variance
AP Anteroposterior
BMD Bone mineral density
BMI Body mass index
B-PT-B Bone-patellar tendon-bone
BSSTM Behavioral and social science theories and models
BW Body weight
CD Compact disc
CEA Center-edge angle
CKC Closed kinetic chain
CNS Central nervous system
cm Centimeters
COF Coefficient of friction
COM Center of mass
COP Center of pressure
COMP Cartilage oligomeric matrix protein
CRI Concussion Resolution Index
DEXA Dual energy X-ray absorptiometry
DPSI Dynamic postural stability index
EMG Electromyographic or electromyography
EMS Electrical muscle stimulation
ER External rotation
FAI Femoral acetabular impingement
FAST-FP Functional Agility Short-Term Fatigue Protocol
FIFA Federation Internationale de Football Association
FLE:EXT R Absolute flexion force to absolute extension force
ratio
FMS Functional Movement System
FPPA Frontal plane projection angle
FT Fast twitch
FTA Functional testing algorithm
ix
x Acronyms
GAG Glycosaminoglycans
GMAX Gluteus maximus
GMED Gluteus medius
GRF Ground reaction force
GRFV Ground reaction force vector
rGRFV Resultant ground reaction force vector
GTO Golgi tendon organs
HBM Health Belief Model
HHD Hand-held dynamometry
H:Q Hamstrings:quadriceps
IC Initial contact
ICC Intraclass correlation coefficients
IEMG Integrated electromyography
IKDC International Knee Documentations Committee
ImPACT Immediate Post-Concussion Assessment and
Cognitive Testing
IR Internal rotation or incidence rates
IR/ER Internal rotation/external rotation
ITB Iliotibial band
JPS Joint position sense
KIPP Knee Injury Prevention Program
kg Kilograms
KLIP Knee Ligament Injury Prevention
KT and KT-2000 Knee arthrometer
LESS Landing Error Scoring System
M Meters
MAOT Muscle activation onset time
min Minutes
MMPs Metalloproteinases
MMT Manual muscle testing
mo Month
MRI Magnetic resonance imaging
MSFT Multi-stage fitness test
ms Milliseconds
MVC Maximal voluntary contraction
MVE Maximal voluntary excursions
NCAA National Collegiate Athletic Association
NFL National Football League
N Newton
NA Not available
Nm Newton meters
NS Not significant (statistically)
OA Osteoarthritis
OKC Open kinetic chain
OR Odds ratio
PA Posteroanterior
pEKAbM Peak external knee abduction moment
PEP Prevent Injury and Enhance Performance
Acronyms xi
PL Posterolateral
PCL Posterior cruciate ligament
pTIRM Peak tibial internal rotation moment
PTP Preventive training program
PTOA Post-traumatic osteoarthritis
QH Quadriceps-hamstrings
RE-AIM Reach, Effectiveness, Adoption, Implementation,
Maintenance
RE-AIM SSM Reach, Effectiveness, Adoption, Implementation,
Maintenance in a Sports Setting Matrix
RFD Rate of force development
RM Repetition max
RR Relative risk
ROM Range of motion
RTP Return to play
RTS Return to sport
s Seconds
SEBT Star Excursion Balance Test
SEPs Somatosensory evoked potentials
SLO-FP Slow Linear Oxidative Fatigue Protocol
SPECT Single-photon emission computed tomography
ST Slow twitch
StAART Strategic Assessment of Risk and Risk Tolerance
STG Semitendinosus-gracilis
TIMP Tissue inhibitors of metalloproteinases
TDPM and TTDPM Threshold for detection of passive motion
TLS Total leg strength
TRIPP Translating Research into Injury Prevention Practice
TSK Tampa Scale for Kinesiophobia
TTDPM Threshold to detect passive motion
US United States
vGRF Vertical ground reaction force
VMO Vastus medialis oblique
VOmax Maximal oxygen uptake
2
VPAC Volitional preemptive abdominal contraction
VSRP Velocity spectrum rehabilitation protocols
WIPP Warm-up for Injury Prevention and Performance
wk Week
x Times
yr Year
3-D 3 Dimensional
2-D 2 Dimensional