Literature Update: Preventing ACL Injuries after Reconstruction

Anterior cruciate ligament (ACL) injuries are a hot topic again after RG III underwent reconstruction. And this is his 2nd reconstruction in the last 4 years. While some researchers suggest that a primary ACL reconstruction will not increase a risk of second injury, studies have suggested that there may be an increased risk of re-injuring the same knee or injuring the other knee  in up to 20% of those who have undergone a first reconstruction. This means that it is very important for athletes and health care providers to not only rehabilitate the reconstructed knee but also to minimize a risk of another ACL injury after returning to sports. We know from past studies that there are predisposing risk factors including muscle imbalance, poor biomechanics of high risk movement patterns, decreased neuromuscular control, etc. The same approach can be used to prevent a secondary ACL injury. However, a recent study suggests that asymmetries between a reconstructed knee and healthy knee are the key factors to prevent an ACL injury after reconstruction. Especially after a surgery, it is not rare that the athlete presents decreased muscle strength compared to the other healthy knee mostly in quads. Some athletes may have decreased range of motion. When returning to sports, it is very important that the athlete has optimal symmetries in muscle strength and balance, neuromuscular control, biomechanics of trunk and lower extremities, in addition to minimizing other risk factors.

Literature Undate: Preventing ACL Injuries

Anterior cruciate ligament injuries are a huge concern for athletes involved in high risk sports such as women's soccer and basketball, women's gymnastics, football, etc. Studies have shown that female athletes are 4-6 times more prone to an ACL injury. Researchers have done extensive studies on ACL injury risk factors and we now know more about the injury than in the past, even though there are still things that are not clear to health care providers and sports medicine personnel. One of the possible factors that make female athletes more prone to an ACL injury is a neuromuscular deficit that female athletes demonstrate. This neuromuscular deficit is shown to be developed after puberty in females. Also, it is shown that neuromuscular training can reduce the risk of ACL injuries in female athletes. A recent meta-analysis study shows that there may be a window where the neuromuscular training to prevent ACL injuries should be done. It collected study data from the literature published in the past and showed that preventative neuromuscular training may need to be done before female athletes develop the deficit. 

 

It may be difficult for parents and athletes to understand why. However, it is important to utilize injury prevention training/program earlier, especially if athletes are already demonstrating injury risk factors.