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Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: A review of prevention programs aimed to modify risk factors and to reduce injury rates

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players participating in the game as on 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes a significant loss of time from competition in soccer, which has served as the strong impetus to conduct research that focuses to determine the risk factors for injury, and more importantly, to identify and teach techniques to reduce this injury in the sport. This research emphasis has afforded a rapid influx of literature aimed to report the effects of neuromuscular training on the risk factors and the incidence of non-contact ACL injury in high-risk soccer populations. The purpose of the current review is to sequence the most recent literature relating the effects of prevention programs that were developed to alter risk factors associated with non-contact ACL injuries and to reduce the rate of non-contact ACL injuries in soccer players. To date there is no standardized intervention program established for soccer to prevent non-contact ACL injuries. Multi-component programs show better results than single-component preventive programs to reduce the risk and incidence of non-contact ACL injuries in soccer players. Lower extremity plyometrics, dynamic balance and strength, stretching, body awareness and decision-making, and targeted core and trunk control appear to be successful training components to reduce non-contact ACL injury risk factors (decrease landing forces, decrease varus/valgus moments, and increase effective muscle activation) and prevent non-contact ACL injuries in soccer players, especially in female athletes. Pre-season injury prevention combined with an in-season maintenance program may be advocated to prevent injury. Compliance may in fact be the limiting factor to the overall success of ACL injury interventions targeted to soccer players regardless of gender. Thus, interventional research must also consider techniques to improve compliance especially at the elite levels which will likely influence trickle down effects to sub-elite levels. Future research is also needed for male soccer athletes to help determine the most effective intervention to reduce the non-contact ACL injury risk factors and to prevent non-contact ACL injuries.

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References

  1. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R (2009) Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traum Arthrosc May 19. [Epub ahead of print]

  2. Arendt E, Dick R (1995) Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 23:694–701

    Article  PubMed  CAS  Google Scholar 

  3. Arnason A, Engebretsen L, Bahr R (2005) No effect of a video-based awareness program on the rate of soccer injuries. Am J Sport Med 33:77–84

    Article  Google Scholar 

  4. Ben-Sira D, Ayalon A, Tavi M (1995) The effect of different types of strength training on concentric strength in women. J Strength Cond Res 9:143–148

    Article  Google Scholar 

  5. Besier TF, Lloyd DG, Ackland T, Cochrane JL (2001) Anticipatory effects on knee joint loading during running and cutting maneuvers. Med Sci Sports Exerc 33:1176–1181

    PubMed  CAS  Google Scholar 

  6. Besier TF, Lloyd DG, Cochrane JL, Ackland T (2001) External loading of the knee joint during running and cutting maneuvers. Med Sci Sports Exerc 33:1168–1175

    PubMed  CAS  Google Scholar 

  7. Bjordal JM, Arnoy F, Hannestad B, Strand T (1997) Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med 25:341–345

    Article  PubMed  CAS  Google Scholar 

  8. Blackburn JT, Padua DA (2008) Influence of trunk flexion on hip and knee joint kinematics during a controlled drop landing. Clin Biomech (Bristol, Avon) 23:313–319

    Article  Google Scholar 

  9. Caraffa A, Cerulli G, Projetti M, Aisa G, Rizzo A (1996) Prevention of anterior cruciate ligament injuries in soccer: a prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc 4:19–21

    Article  PubMed  CAS  Google Scholar 

  10. Chappell JD, Creighton RA, Giuliani C, Yu B, Garrett WE (2007) Kinematics and electromyography of landing preparation in vertical stop-jump: risks for noncontact anterior cruciate ligament injury. Am J Sports Med 35:235–241

    Article  PubMed  Google Scholar 

  11. Chappell JD, Limpisvasti O (2008) Effect of a neuromuscular training program on the kinetics and kinematics of jumping tasks. Am J Sports Med 36:1081–1086

    Article  PubMed  Google Scholar 

  12. Chimera NJ, Swanik KA, Swanik CB, Straub SJ (2004) Effects of plyometric training on muscle-activation strategies and performance in female athletes. J Athl Train 39:24–31

    PubMed  Google Scholar 

  13. Delfico AJ, Garrett WE (1998) Mechanisms of injury of the ACL in soccer players. Clin Sport Med 17:779–785

    Article  CAS  Google Scholar 

  14. Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R (2008) Prevention of injuries among male soccer players: a prospective, randomized intervention study targeting players with previous injuries or reduced function. Am J Sport Med 36:1052–1060

    Article  Google Scholar 

  15. Engström B, Forssblad M, Johansson C, Törnkvist H (1990) Does a major knee injury definitely sideline an elite soccer player? Am J Sports Med 18:101–105

    Article  PubMed  Google Scholar 

  16. Engström B, Johansson C, Törnkvist H (1991) Soccer injuries among elite female players. Am J Sports Med 19:372–375

    Article  PubMed  Google Scholar 

  17. Fauno P, Wulff Jakobsen B (2006) Mechanism of ACL injuries in soccer. Int J Sports Med 27:75–79

    Article  PubMed  CAS  Google Scholar 

  18. Fédération Internationale de Football Association (FIFA) (2008) Available at: http://www.fifa.com/mm/document/fifafacts/bcoffsurv/bigcount.statspackage_7024.pdf

  19. Gilchrist JR, Mandelbaum BR, Melancon H, Ryan G, Griffin LY, Silvers HJ, Watanabe DS, Dick RW (2004) A randomized controlled trial to prevent non-contact ACL injuries in female collegiate soccer players. Presented at AOSSM Specialty Day, San Francisco, CA, March 13

  20. Gilchrist JR, Mandelbaum BR, Melancon H, Ryan GW, Silvers HJ, Griffin LY, Watanabe DS, Dick RW, Dvorak J (2008) A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med 36:1476–1483

    Article  PubMed  Google Scholar 

  21. Gottlob CA, Baker CL (2000) Anterior cruciate ligament reconstruction: socioeconomic issues and cost effectiveness. Am J Orthop 29:472–476

    PubMed  CAS  Google Scholar 

  22. Gottlob CA, Baker CL, Pellissier JM, Colvin L (1999) Cost effectiveness of anterior cruciate ligament reconstruction in young adults. Clin Orthop Relat Res (367):272282

  23. Griffin LY (2001) The Henning program. In: Griffin LY (ed) Prevention of non-contact ACL injuries. American Academy of Orthopaedic Surgeons, Rosemont, pp 93–96

    Google Scholar 

  24. Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, De Maio M, Dick RW, Engebretsen L, Garrett WE, Hannafin JA, Hewett TE, Huston LJ (2006) Understanding and preventing noncontact anterior cruciate ligament injuries. A review of the Hunt Valley II Meeting, January 2005. Am J Sports Med 34:1512–1532

    Article  PubMed  Google Scholar 

  25. Griffis ND, Nequist SW, Yearout K (1989) Injury prevention of the anterior cruciate ligament. In: 15th annual meeting of the American Orthopaedic Society for Sports Medicine: meeting abstracts, symposia, and instructional courses, Traverse City, MI, 19–22 Jun 1989

  26. Hakkinen K, Alen M, Kraemer WJ, Gorostiaga E, Izquierdo M, Rusko H, Mikkola J, Hakkinen A, Valkeinen H, Kaarakainen E, Romu S, Erola V (2003) Neuromuscular adaptations during concurrent strength and endurance training versus strength training. Eur J Appl Physiol 89:42–52

    Article  PubMed  CAS  Google Scholar 

  27. Heidt RS, Sweeterman LM, Carlonas RL, Traub JA, Tekulve FX (2000) Avoidance of soccer injuries with preseason conditioning. Am J Sports Med 28:659–662

    PubMed  Google Scholar 

  28. Herman DC, Weinhold PS, Guskiewicz KM, Garrett WE, Yu B, Padua DA (2008) The effects of strength training on the lower extremity biomechanics of female recreational athletes during a stop-jump task. Am J Sports Med 36:733–740

    Article  PubMed  Google Scholar 

  29. Hewett TE (2007) ACL injury prevention programs. In: Hewett TE, Shultz SJ, Griffin LY (eds) Understanding and preventing non-contact ACL injuries, 1st edn. Human Kinetics, Champaign, pp 57–60

    Google Scholar 

  30. Hewett TE, Ford KR, Myer GD (2006) Anterior cruciate ligament injuries in female athletes. Part 2: A meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med 34:490–498

    Article  PubMed  Google Scholar 

  31. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR (1999) The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study. Am J Sports Med 27:699–706

    PubMed  CAS  Google Scholar 

  32. Hewett TE, Myer GD, Ford KR (2006) Anterior cruciate ligament injuries in female athletes. Part 1: Mechanisms and risk factors. Am J Sports Med 34:299–311

    Article  PubMed  Google Scholar 

  33. Hewett TE, Myer GD, Ford KR, Heidt RS, Colosimo AJ, McLean SG, Van den Bogert AJ, Paterno MV, Succop P (2005) Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 33:492–501

    Article  PubMed  Google Scholar 

  34. Hewett TE, Stroupe AL, Nance TA, Noyes FR (1996) Plyometric training in female athletes. Decreased impact forces and increased hamstring torques. Am J Sports Med 24:765–773

    Article  PubMed  CAS  Google Scholar 

  35. Holcomb WR, Rubley MD, Lee HJ, Guadagnoli MA (2007) Effect of hamstring-emphasized resistance training on hamstring:quadriceps strength ratios. J Strength Cond Res 21:41–47

    Article  PubMed  Google Scholar 

  36. Ireland ML (1999) Anterior cruciate ligament injury in female athletes: epidemiology. J Athl Train 34:150–154

    PubMed  Google Scholar 

  37. Irmischer BS, Harris C, Pfeiffer RP, De Beliso MA, Adams KJ, Shea KG (2004) Effects of a knee ligament injury prevention exercise program on impact forces in women. J Strength Cond Res 18:703–707

    Article  PubMed  Google Scholar 

  38. Johnson RJ (2001) The ACL injury in female skiers. In: Griffin LY (ed) Prevention of non-contact ACL injuries. American Academy of Orthopaedic Surgeons, Rosemont, pp 230–257

    Google Scholar 

  39. Junge A, Rösch D, Peterson L, Graf-Baumann T, Dvorak J (2002) Prevention of soccer injuries: a prospective intervention study in youth amateur players. Am J Sport Med 30:652–659

    Google Scholar 

  40. Kraemer WJ, Duncan ND, Volek JS (1998) Resistance training and elite athletes: adaptations and program considerations. J Orthop Sports Phys Ther 28:110–119

    PubMed  CAS  Google Scholar 

  41. Lephart SM, Abt JP, Ferris CM, Sell TC, Nagai T, Myers JB, Irrgang JJ (2005) Neuromuscular and biomechanical characteristic changes in high school athletes: a plyometric versus basic resistance program. Br J Sports Med 39:932–938

    Article  PubMed  CAS  Google Scholar 

  42. Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35:1756–1769

    Article  PubMed  Google Scholar 

  43. Malina RM, Bouchard C (1991) Timing and sequence of changes in growth, maturation, and performance during adolescence. In: Malina RM, Bouchard C, Bar-On O (eds) Growth, maturation, and physical activity, 2nd edn. Human Kinetics, Champaign, pp 267–272

    Google Scholar 

  44. Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garrett WE (2005) Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow up. Am J Sports Med 33:1003–1010

    Article  PubMed  Google Scholar 

  45. McLean SG, Fellin RE, Suedekum N, Calabrese G, Passerallo A, Joy S (2007) Impact of fatigue on gender-based high-risk landing strategies. Med Sci Sports Exerc 39:502–514

    Article  PubMed  Google Scholar 

  46. Melnyk M, Kofler B, Faist M, Hodapp M, Gollhofer A (2008) Effect of whole-body vibration session on knee stability. Int J Sports Med 29:839–844

    Article  PubMed  CAS  Google Scholar 

  47. Meunier A, Odensten M, Good L (2007) Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up. Scand J Med Sci Sports 17:230–237

    PubMed  CAS  Google Scholar 

  48. Mjolsnes R, Arnason A, Osthagen T, Raastad T, Bahr R (2004) A 10-week randomized trial comparing eccentric versus concentric hamstring strength training in well-trained soccer players. Scand J Med Sci Sports 14:311–317

    Article  PubMed  Google Scholar 

  49. Myer GD, Ford KR, Brent JL, Hewett TE (2007) Differential neuromuscular training effects on ACL injury risk factors in “high-risk” versus “low-risk” athletes. BMC Musculoskelet Disord 8:39

    Article  PubMed  Google Scholar 

  50. Myer GD, Ford KR, Hewett TE (2004) Methodological approaches and rationale for training to prevent anterior cruciate ligament injuries in female athletes. Scand J Med Sci Sports 14:275–285

    Article  PubMed  Google Scholar 

  51. Myer GD, Ford KR, Hewett TE (2008) Tuck jump assessment for reducing anterior cruciate ligament injury risk. Athl Ther Today 13:39–44

    Google Scholar 

  52. Myer GD, Ford KR, McLean SG, Hewett TE (2006) The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. Am J Sports Med 34:445–455

    Article  PubMed  Google Scholar 

  53. Myer GD, Ford KR, Palumbo JP, Hewett TE (2005) Neuromuscular training improves performance and lower extremity biomechanics in female athletes. J Strength Cond Res 19:51–60

    Article  PubMed  Google Scholar 

  54. Myklebust G, Engebretsen L, Braekken IH, Skjolberg A, Olsen OE, Bahr R (2003) Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med 13:71–78

    Article  PubMed  Google Scholar 

  55. Neuman P, Englund M, Kostogiannis I, Fridén T, Roos H, Dahlberg LE (2008) Prevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study. Am J Sports Med 36:1717–1725

    Article  PubMed  Google Scholar 

  56. Nyland JA, Caborn DN, Shapiro R, Johnson DL (1999) Crossover cutting during hamstring fatigue produces transverse plane knee control deficits. J Athl Train 34:137–143

    PubMed  Google Scholar 

  57. Olsen OE, Myklebust G, Engebretsen L, Holme I, Bahr R (2005) Exercises to prevent lower limb injuries in youth sports: cluster randomized controlled trial. BMJ 330:449

    Article  PubMed  Google Scholar 

  58. Onate JA, Guskiewicz KM, Marshall SW, Giuliani C, Yu B, Garrett WE (2005) Instruction of jump-landing technique using videotape feedback: altering lower extremity motion patterns. Am J Sports Med 33:831–842

    Article  PubMed  Google Scholar 

  59. Onate JA, Guskiewicz KM, Sullivan RJ (2001) Augmented feedback reduces jump landing forces. J Orthop Sports Phys Ther 31:511–517

    PubMed  CAS  Google Scholar 

  60. Paterno MV, Myer GD, Ford KR, Hewett TE (2004) Neuromuscular training improves single-limb stability in young female athletes. J Orthop Sports Phys Ther 34:305–316

    PubMed  Google Scholar 

  61. Pfeiffer RP, Shea KG, Roberts D, Grandstrand S, Bond L (2006) Lack of effect of a knee ligament injury prevention program on the incidence of noncontact ACL injury. J Bone Joint Surg Am 88:1769–1774

    Article  PubMed  Google Scholar 

  62. Pollard CD, Sigward SM, Ota S, Langford K, Powers CM (2006) The influence of in-season injury prevention training on lower-extremity kinematics during landing in female soccer players. Clin J Sport Med 16:223–227

    Article  PubMed  Google Scholar 

  63. Powers CM, Pollard CD, Sigward SM (2007) Effects of prevention programs on performance. In: Hewett TE, Shultz SJ, Griffin LY (eds) Understanding and preventing non-contact ACL injuries, 1st edn. Human Kinetics, Champaign, pp 103–108

    Google Scholar 

  64. Powers CM, Sigward SM, Ota S, Pelley K (2004) The influence of an ACL injury training program on knee mechanics during a side-step cutting maneuver. J Athl Train 39:S27

    Google Scholar 

  65. Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, Mandelbaum B, Micheli L, Myklebust G, Roos E, Roos H, Schamasch P, Shultz S, Werner S, Wojtys E, Engebretsen L (2008) Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 42:394–412

    Article  PubMed  CAS  Google Scholar 

  66. Rochcongar P, Laboute E, Jan J, Carling C (2009) Ruptures of the anterior cruciate ligament in soccer. Int J Sports Med 30:372–378

    Article  PubMed  CAS  Google Scholar 

  67. Rovere G, Haupt H, Yates S (1987) Prophylactic knee bracing in college football. Am J Sports Med 15:111–116

    Article  PubMed  CAS  Google Scholar 

  68. Ryder SH, Johnson RJ, Beynnon BD, Ettlinger CF (1997) Prevention of ACL injuries. J Sport Rehab 6:80–96

    Google Scholar 

  69. Shultz SJ (2007) Preventive training programs. Changing strength ratios versus positions of muscular efficiency. In: Hewett TE, Shultz SJ, Griffin LY (eds) Understanding and preventing non-contact ACL injuries, 1st edn. Human Kinetics, Champaign, pp 91–102

    Google Scholar 

  70. Silvers HJ (2007) ACL injury prevention programs. Components of prevention programs. In: Hewett TE, Shultz SJ, Griffin LY (eds) Understanding and preventing non-contact ACL injuries, 1st edn. Human Kinetics, Champaign, pp 61–74

    Google Scholar 

  71. Sitler M, Ryan CJ, Hopkinson W, Wheeler J, Santomier J, Kolb R, Polley D (1990) The efficacy of a prophylactic knee brace to reduce knee injuries in football. A prospective randomized study at West Point. Am J Sports Med 18:310–315

    Article  PubMed  CAS  Google Scholar 

  72. Soderman K, Werner S, Pietila T, Engstrom B, Alfredson H (2000) Balance board training: prevention of traumatic injuries of the lower extremity in female soccer players? A prospective randomized intervention study. Knee Surg Sports Traumatol Arthrosc 8:356–363

    Article  PubMed  CAS  Google Scholar 

  73. Steffen K, Myklebust G, Olsen OE, Holme I, Bahr R (2008) Preventing injuries in female youth football—a cluster-randomized controlled trial. Scand J Med Sci Sports Jan 14 (Epub ahead of print)

  74. Teitz CC, Hermanson BK, Kronmal RA, Diehr PH (1987) Evaluation of the use of braces to prevent injury to the knee in collegiate football players. J Bone Joint Surg Am 69:2–9

    PubMed  CAS  Google Scholar 

  75. Wilk KE, Escamilla RF, Fleisig GS, Barrentine SW, Andrews JR, Boyd ML (1996) A comparison of tibiofemoral joint forces and electromyographic activity during open and closed kinetic chain exercises. Am J Sports Med 24:518–527

    Article  PubMed  CAS  Google Scholar 

  76. Wilkerson GB, Colston MA, Short NI, Neal KL, Hoewischer PE, Pixley JJ (2004) Neuromuscular changes in female collegiate athletes resulting from a plyometric jump-training program. J Athl Train 39:17–23

    PubMed  Google Scholar 

  77. Wroble RR, Moxley DR (2001) The effect of winter sports participation on high school football players: strength, power, agility, and body composition. J Strength Cond Res 15:132–135

    Article  PubMed  CAS  Google Scholar 

  78. Yu B, Garrett WE (2007) Mechanisms of non-contact ACL injuries. Br J Sports Med 41(Suppl 1):i47–i51

    Article  PubMed  Google Scholar 

  79. Zazulak BT, Hewett TE, Reeves NP, Goldberg B, Cholewicki J (2007) Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study. Am J Sports Med 35:1123–1130

    Article  PubMed  Google Scholar 

  80. Zebis MK, Bencke J, Andersen LL, Dossing S, Alkjaer T, Magnusson SP, Kjaer M, Aagaard P (2008) The effects of neuromuscular training on knee joint motor control during sidecutting in female elite soccer and handball players. Clin J Sport Med 18:329–337

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Professor Rodrigo C Miralles, from Universitat Rovira i Virgili and Hospital de Sant Joan, Reus, for his excellent contributions, helpful comments and interesting suggestions on this topic. We would also like to thank Dr. Gerard Moras for his advice and critical reading of the manuscript. One author (GDM) would like to acknowledge funding support from National Institutes of Health Grants R01-AR049735 and R01-AR055563.

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Alentorn-Geli, E., Myer, G.D., Silvers, H.J. et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: A review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee Surg Sports Traumatol Arthrosc 17, 859–879 (2009). https://doi.org/10.1007/s00167-009-0823-z

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