Evidence for Neuromuscular Retraining to Reduce Noncontact ACL Injuries in Female Athletes Continues to Mount

In the last two years, several meta-analyses and systematic reviews have been published that strongly support the need and rationale for neuromuscular training in young female athletes. These publications reported relative risk reduction rates for noncontact ACL injuries that ranged from 52-100%. Relative risk reduction refers to the estimate of the percentage of risk that is reduced for trained athletes compared with untrained athletes.

In the February 2014 issue of the journal Arthroscopy, we published our systematic review that included eight neuromuscular training programs. Our rigorous analysis found that three programs – Sportsmetrics, PEP, and KIPP – had a statistically significant impact in reducing the risk of ACL injuries in female soccer and basketball players. We believe it is important to understand that not all ACL prevention programs are effective, a concept that is not always made clear in both the scientific literature and in the media. This article is available for download on our website.

In the May 7, 2014 issue of the Journal of Bone and Joint Surgery, a unique article was published on the cost-effectiveness of ACL injury prevention training. The authors (Swart et al, from Columbia University Medical Center, New York) compared three strategies for young athletes who regularly participate in organized sports: 1) no neuromuscular training or ACL injury screening, 2) universal neuromuscular training, and 3) universal screening, with neuromuscular training only done in high-risk athletes. An analysis of the total costs and gains in quality-adjusted life years was conducted of these strategies, assuming that all ACL ruptures would be reconstructed. The neuromuscular training program costs were based on a protocol that included dynamic warm-up, plyometrics, strengthening, sport-specific agility drills, and flexibility and included programs such as Sportsmetrics and PEP. In addition, costs were based on personal and equipment needs for neuromuscular training and injury screening.

The study found that universal neuromuscular training would reduce the incidence of ACL injuries by an average of 63%, whereas screening would reduce the incidence by an average of 40%. The example was given that, in 10,000 athletes, ACL injuries would be sustained by: 1) 300 athletes in the no-screening or training group, 2) 180 in the screen-and-treat high-risk athletes only group, and 3) 110 in the train all group. The average cost of the universal training group was $100 lower than the no train group and $25 lower than screen-and-treat group. The authors concluded that universal neuromuscular training was the most cost-effective strategy for reducing costs and morbidity from ACL injuries. This article is also available for download on our website.

References

1.         Gagnier JJ, Morgenstern H, Chess L. Interventions Designed to Prevent Anterior Cruciate Ligament Injuries in Adolescents and Adults: A Systematic Review and Meta-analysis. Am J Sports Med. 2013;41(8):1952-1962.

2.         Noyes FR, Barber-Westin SD. Neuromuscular retraining intervention programs: do they reduce noncontact anterior cruciate ligament injury rates in adolescent female athletes? Arthroscopy. 2014;30(2):245-255.

3.         Paszkewicz J, Webb T, Waters B, Welch McCarty C, Van Lunen B. The effectiveness of injury-prevention programs in reducing the incidence of anterior cruciate ligament sprains in adolescent athletes. J Sport Rehabil. 2012;21(4):371-377.

4.         Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94(9):769-776.

5.         Stojanovic MD, Ostojic SM. Preventing ACL injuries in team-sport athletes: a systematic review of training interventions. Res Sports Med. 2012;20(3-4):223-238.

6.         Sugimoto D, Myer GD, Bush HM, Klugman MF, Medina McKeon JM, Hewett TE. Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: a meta-analysis. J Athl Train. 2012;47(6):714-723.

7.         Swart E, Redler L, Fabricant PD, et al. Prevention and screening programs for anterior cruciate ligament injuries in young athletes. A cost-effectiveness analysis. J Bone Joint Surg Am 2014;96(9):705-71.

8.         Sugimoto D, Myer GD, McKeon JM, Hewett TE. Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses. Br J Sports Med. 2012;46(14):979-988.

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