Prevention of ACL injuries in children and adolescents
The number of anterior cruciate ligament (ACL) injuries reported in athletes younger than 18 years has increased over the past 2 decades. Reasons for the increasing ACL injury rate include the growing number of children and adolescents participating in organized sports, intensive sports training at an earlier age, and greater rate of diagnosis because of increased awareness and greater use of advanced medical imaging.
ACL injury rates are low in young children and increase sharply during puberty, especially for girls, who have higher rates of noncontact ACL injuries than boys do in similar sports. Intrinsic risk factors for ACL injury include higher Body Mass Index (BMI), subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of knee motion.
ACL injuries often require surgery and/or many months of rehabilitation and substantial time lost from school and sports participation. Unfortunately, regardless of treatment, athletes with ACL injuries are up to 10 times more likely to develop degenerative arthritis of the knee.
Safe and effective surgical techniques for children and adolescents continue to evolve. Neuromuscular training can reduce risk of ACL injury in adolescent girls.
According to a clinical report from the American Academy of Pediatrics neuromuscular training programs can cut the risk of a serious ACL injury and should be recommended to at-risk young athletes, especially girls.
The theory is that during the growth spurt that is part of puberty, a burst of testosterone helps boys get bigger muscles to go along with their new larger frames, says Cynthia LaBella, lead author of the report and a pediatric sports medicine specialist at Lurie Children's Hospital of Chicago. "Girls don't get that burst" or the resulting bigger muscles, she says, which makes it harder to control their new, taller bodies. But their muscles can be trained.
A host of different approaches used in the preseason, active season or both, have been studied for their ability to prevent injuries in sports including soccer, basketball and volleyball. The report cites a 2013 analysis of existing research that found a 72 percent lower risk of an ACL injury in female athletes aged 18 and younger who used the programs.
The authors of the AAP report say the successful routines included plyometric training — progressively more difficult jumping exercises — instruction on proper technique and feedback on using the right form. Programs that included strength training were among the most effective, though some of the successful routines didn't include strength work.
While these programs were designed specifically to prevent ACL injuries, studies show they can also stave off other lower leg injuries like ankle and knee sprains, says LaBella. She hopes this report will encourage coaches and parents to seek out the programs. "We still see people who are unaware of them, or who are unwilling to change their usual routine," she says.
But persuading schools and coaches to use them can be tough, says Timothy McGuine, a sports medicine researcher at the University of Wisconsin. "It's one thing to know what to do, and it's another to actually do it," he says. Many coaches say they lack the time and space to put injury programs into practice, or they have difficulty keeping it up over time, he says. What would really help? McGuine says a program that could be done in less than 10 minutes, two or three times a week, that would cut the risk of leg injuries and was also proven to increase performance – say, boosting vertical jump, which would help sell them to parents and coaches.
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