The current status of ACL injury research

Dr. Jeff Cubos, a Chiropractor and author of the “evidence-informed sports health” blog, does a comprehensive review of the current status of ACL injury research, here.  The short post does a great job summarizing the main points in the full-length research article entitled “Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement” (published in 2008).  The points I’d like to highlight include:

• “As a whole, ACL injuries most commonly result from non-contact mechanisms” - Why do I think this is so important?  Because it means that young women who suffer this injury most likely “do it to themselves.”  Not consciously or premeditated, just that something about being a woman or the way women train causes this to happen.
• “…younger female athletes are at higher risk (than aged- and sport-matched males)” – This happens to girls as early as pre-teens!  And often, to the “strongest” player on the team.  Why are young women more likely to suffer it?  There are tons of theories, but the important thing to realize is parents and coaches need to step up and take control over their daughter’s health as most girls don’t think it can happen to them.  I knew about this injury before it happened to me.  But I never thought it was something I needed to worry about!
• The risk factors he mentions are the width of the intercondylar notch (the notch in the femur where the ACL rests), sex-hormones and oral contraceptives, and a higher risk during the pre-ovulatory phase of the menstrual cycle.  But what about things we can control?  No surgeon is going to alter the width of the intercondylar notch before an injury happens.  And sex hormones and menstrual cycles are something women can’t necessarily alter.  The important thing to remember concerning these risk factors is that
• “Injuries most often occur when landing from a jump, cutting, or deceleration.”
• Women tend to play more upright with a greater knee extension (straighter legs) and higher quadriceps activation.  If you compare a girls’ soccer game with a boy’s game, I’m sure you’ll noticed how much lower the boys’ center of gravity is.  They cut, turn, and land with knees bent much more than their girl counterparts

And, a few notes on prevention programs.  Most…

…Include neuromuscular and proprioception training.
…Require 4-8 weeks to work.
…are generally the most successful with the least amount of equipment.
…need to be implemented as early as possible.
…The drop jump vertical test is a good way to detect at-risk athletes.  Check out four videos, here.

Thanks Dr. Cubos for a great summary!