June 09, 2011
The Herald-Dispatch
By: John Oxley, DPT

Anterior Cruciate Ligament (ACL) tears are devastating injuries in young athletes, especially in female athletes. Young females are four to six times more likely to tear their ACL than men. The reported incidence of ACL injury is as high as 1.6 per 1,000 player-hours for elite female athletes playing soccer and there are about 38,000 cases in the United States each year. Therefore, prevention is an important component in reducing the effect on young athletes and their families.

Many theories have been proposed to explain the higher incidence of ACL injury in females. The three most well accepted hypotheses include anatomical, hormonal, and neuromuscular differences as compared to male counterparts. The research has focused on neuromuscular control which can be addressed through training.

The majority of ACL injuries, approximately 70 percent, occur with noncontact injuries and typically during deceleration, change of direction or landing after jumping. We obviously cannot prevent contact ACL injuries, but research has shown that incorporating plyometric, balance and strengthening exercises into a program can reduce noncontact ACL injuries.

Specific time and frequency prescriptions for these exercise programs have not been agreed upon in the research, but one thing is certain: there is a measurable decrease in incidence of ACL injury when players or teams are participating in these programs. Many different programs have been designed that vary with respect to intensity, duration and frequency of exercise and you must consult your local physical therapist or orthopedic surgeon to see what program they prefer.

Typically, young athletes and parents are reluctant to participate in preventative exercise due to cost or time investment but if the program can also be used to enhance performance they might be more amenable to the idea. Each program must contain plyometrics, balance, and strengthening components to be successful. Anecdotally, I would say each program needs to focus on jumping/landing training as well. This can be a tool for the future to prevent these catastrophic injuries to our young athletes.

Everyone has heard the old saying “an ounce of prevention is worth a pound of cure” and that saying by Benjamin Franklin is definitely appropriate for this topic. Too often, orthopedic surgeons are having to reconstruct young damaged knees that will inevitably have further problems in the future. We certainly can not prevent all of these injuries but with performance training directed by a qualified professional the research shows that we can decrease the frequency of this significant injury in our young athletes.