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Song Y, Li L, Dai B. Trunk Neuromuscular Function and Anterior Cruciate Ligament Injuries: A Narrative Review of Trunk Strength, Endurance, and Dynamic Control. Strength Cond J 2022. [DOI: 10.1519/ssc.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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2
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Rugg CM, Coughlan MJ, Li JN, Hame SL, Feeley BT. Early Sport Specialization Among Former National Collegiate Athletic Association Athletes: Trends, Scholarship Attainment, Injury, and Attrition. Am J Sports Med 2021; 49:1049-1058. [PMID: 33719607 DOI: 10.1177/0363546520988727] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many youth athletes focus on 1 sport to gain a competitive advantage, but early sport specialization may increase risk of overuse injuries and burnout. College athletes have successfully achieved advanced status; therefore, the study of their specialization patterns is a method to assess how specialization affects an athletic career. PURPOSE To determine trends in sport specialization by sex, sport, and decade of participation in National Collegiate Athletic Association (NCAA) athletes and assess the effect of specialization on scholarship attainment, injury, and attrition. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS An electronic survey was distributed to NCAA athletes who participated from 1960 to 2018. Survey topics included sex, sport, decade of participation, scholarship status, ≥30-day time-loss injuries sustained in college, orthopaedic surgery in college, career length, and age of single-sport specialization. Early specialization was defined as specialization in a single sport before age 15 years. Rates of early specialization were calculated for each sport, sex, individual and team sports, and decade of participation. Rates of scholarship attainment, injury, and attrition were compared between groups. Univariate associations were queried with logistic regression analysis to determine predictors of specialization, scholarship attainment, injury, and early attrition. RESULTS Of 1550 athletes who participated (17% response rate), 544 (35.1%) were women. Overall, 18.1% of athletes specialized before age 15 years (n = 281). Athletes in gymnastics, tennis, swimming and diving, and soccer were significantly more likely to specialize early, whereas football and baseball athletes were more likely to specialize late (P < .05 for all groups). Early specialization was more common among women (23.4% vs 15.2%; odds ratio, 1.72; P < .01). There was a trend toward earlier specialization for recent college graduates, with graduates from the last decade more likely to be classified as early specialization than those from previous decades (P = .036). Scholarship attainment was overall equivalent between groups. Time-loss injuries, lower extremity injuries, and orthopaedic surgery in college were not statistically different between groups. Career lengths were similar, but burnout was more common among early specialization athletes (10.5% vs 7.0%; odds ratio, 3.76; P < .01). CONCLUSION Less than one-fifth of NCAA athletes surveyed specialized before age 15 years, and neither scholarship attainment nor time-loss injury rate was affected by early specialization. Early specialization is on the rise but is associated with increased burnout.
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Affiliation(s)
- Caitlin M Rugg
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Monica J Coughlan
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Justine N Li
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Sharon L Hame
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California, USA
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3
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Zampogna B, Vasta S, Torre G, Gupta A, Hettrich CM, Bollier MJ, Wolf BR, Amendola A. Return to Sport After Anterior Cruciate Ligament Reconstruction in a Cohort of Division I NCAA Athletes From a Single Institution. Orthop J Sports Med 2021; 9:2325967120982281. [PMID: 33681400 PMCID: PMC7900794 DOI: 10.1177/2325967120982281] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Anterior cruciate ligament (ACL) tears are common in collegiate athletes. The
rate of return to the preinjury level of sport activities after ACL
reconstruction continues to evolve. Purpose/Hypothesis: The purpose was to determine the return-to-sport rate after ACL
reconstruction in a cohort of National Collegiate Athletic Association
Division I athletes in different sports. It was hypothesized that, with
intensive supervision of rehabilitation, the return-to-sport rate would be
optimal. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed the records of 75 collegiate athletes from a
single institution who had undergone unilateral or bilateral ACL
reconstruction between 2001 and 2013 and participated in an extensive
supervised rehabilitation program. Prospectively collected athlete data as
well as data about preinjury exposure, associated lesions, surgical
technique, time lost to injury, number of games missed, time to return to
full sport activity or retire, and subsequent surgical procedures were
extracted from the medical and athletic trainer records. Results: The 75 patients (40 male, 35 female; mean age, 20.1 years) underwent 81
reconstruction procedures (73 primary, 8 revision). The mean follow-up was
19.3 months. The overall return-to-sport rate was 92%. After reconstruction,
9 athletes (12%) retired from collegiate sports, but 3 of them returned to
sport activities after graduation. Overall, 8 athletes (11%) experienced an
ACL graft retear. Conclusion: The return-to-sport rate in our National Collegiate Athletic Association
Division I athletes compared favorably with that reported in other studies
in the literature. The strict follow-up by the surgeon, together with the
high-profile, almost daily technical and psychological support given mainly
by the athletic trainers during the recovery period, may have contributed to
preparing the athletes for a competitive rate of return to sport at their
preinjury level.
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Affiliation(s)
- Biagio Zampogna
- Orthopedics and Trauma Surgery Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Sebastiano Vasta
- Orthopedics and Trauma Surgery Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Guglielmo Torre
- Orthopedics and Trauma Surgery Department, University Campus Bio-Medico of Rome, Rome, Italy
| | - Akhil Gupta
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Carolyn M Hettrich
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Matthew J Bollier
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Brian R Wolf
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
| | - Annunziato Amendola
- Department of Orthopaedic Surgery, University of Iowa Health Care, Iowa City, Iowa, USA
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4
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Webster KE. Return to Sport and Reinjury Rates in Elite Female Athletes After Anterior Cruciate Ligament Rupture. Sports Med 2021; 51:653-660. [PMID: 33415667 DOI: 10.1007/s40279-020-01404-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 01/14/2023]
Abstract
While there has been significant interest in the documentation of return to sport outcomes following anterior cruciate ligament (ACL) injury, the elite level female athlete has not been a focus of this research. This is despite women being at increased risk for ACL injury and considerable global growth in women participating in sport. Therefore, the focus of this review was to examine the available literature regarding return to sport outcomes in elite level women with an ACL injury. The topics of discussion focus on return to sport rates, timing and determinants of return to sport, longevity of play, return to sport performance, and further ACL injury. Knee health in the longer term is also briefly discussed along with the limitations of the existent literature.
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Affiliation(s)
- Kate E Webster
- School of Allied Health, Human Services and Sport, La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
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5
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Zhang X, Deng XH, Song Z, Croen B, Carballo CB, Album Z, Zhang Y, Bhandari R, Rodeo SA. Matrix Metalloproteinase Inhibition With Doxycycline Affects the Progression of Posttraumatic Osteoarthritis After Anterior Cruciate Ligament Rupture: Evaluation in a New Nonsurgical Murine ACL Rupture Model. Am J Sports Med 2020; 48:143-152. [PMID: 31756130 DOI: 10.1177/0363546519887158] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Doxycycline has broad-spectrum activity as a matrix metalloproteinase (MMP) inhibitor and thus could reduce the progression of posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) rupture. HYPOTHESIS Doxycycline would inhibit progression of PTOA in a murine ACL rupture model. STUDY DESIGN Controlled laboratory study. METHODS For the in vitro study, cadaveric C57BL/6 male mice knees (N = 108) were used for the development of a nonsurgical ACL rupture model. For the in vivo study, 24 C57BL/6 male mice then underwent ACL rupture with our manual procedure and were divided into 4 groups: untreated control; doxycycline, 10 mg/kg/d; doxycycline, 50 mg/kg/d; and doxycycline, 100 mg/kg/d. Doxycycline was administered in drinking water beginning immediately after ACL rupture. Radiographic imaging and paw prints were evaluated at 3, 7, 14, and 28 days. The foot length and toe spread were analyzed as measures of function. Histology and MMP-13 immunohistochemistry were done at 4 weeks. RESULTS Radiographs demonstrated anterior tibial subluxation and meniscal extrusion after ACL rupture, confirming knee joint instability without fractures. Statistically significant differences in gait were found between the intact and experimental groups. Histologic examination demonstrated cartilage damage, meniscal tears, and mild osteoarthritis after ACL rupture, similar to what occurs in human patients. Hypertrophy of the posterior horn of the medial and lateral meniscus was found, and tears of the posterior horn of the menisci were common. All doxycycline groups had a lower score than the untreated control group, indicating less cartilage damage. The posterior tibia of the untreated group had the most cartilage damage as compared with the 3 doxycycline groups, with a significant difference between the untreated and 50-mg/kg/d doxycycline groups, suggesting that the latter dose may protect against proteoglycan loss and decrease the progression of osteoarthritis. The nondoxycycline group had the highest synovial inflammation score among all groups, indicating that doxycycline has an inhibitory effect on synovitis. There was significantly lower MMP-13 expression on the tibia in the doxycycline-treated groups, with a positive correlation between doxycycline concentration and MMP-13 inhibition. CONCLUSION Modulation of MMP-13 activity by doxycycline treatment may offer a novel biological pathway to decrease the progression of PTOA after ACL rupture. CLINICAL RELEVANCE Doxycycline is an approved, readily available drug with infrequent side effects of photosensitivity and gastrointestinal symptoms. Future clinical trials could evaluate doxycycline to reduce or prevent progressive cartilage damage after ACL rupture.
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Affiliation(s)
- Xueying Zhang
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA.,Department of Sports Medicine & Research Centre of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xiang-Hua Deng
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Zhe Song
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Brett Croen
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Camila B Carballo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Zoe Album
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Ying Zhang
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Reyna Bhandari
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Laboratory for Joint Tissue Repair and Regeneration, Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York, USA
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Shultz SJ, Schmitz RJ, Cameron KL, Ford KR, Grooms DR, Lepley LK, Myer GD, Pietrosimone B. Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14-16, 2019, Greensboro, NC. J Athl Train 2019; 54:970-984. [PMID: 31461312 PMCID: PMC6795093 DOI: 10.4085/1062-6050-54.084] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sandra J. Shultz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Randy J. Schmitz
- Applied Neuromechanics Research Laboratory, University of North Carolina at Greensboro
| | - Kenneth L. Cameron
- John A. Feagin Jr Sports Medicine Fellowship, Keller Army Hospital, United States Military Academy, West Point, NY
| | - Kevin R. Ford
- Human Biomechanics and Physiology Laboratory, Department of Physical Therapy, High Point University, NC
| | - Dustin R. Grooms
- Ohio Musculoskeletal & Neurological Institute and Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens
| | | | - Gregory D. Myer
- The SPORT Center, Division of Sports Medicine, and Departments of Pediatrics and Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, OH
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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7
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The impact of prior upper-extremity surgery on orthopedic injury and surgery in collegiate athletes. J Shoulder Elbow Surg 2019; 28:1371-1377. [PMID: 31230783 DOI: 10.1016/j.jse.2019.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The influence of prior upper-extremity (UE) surgery on a collegiate athletic career is poorly understood. This study aimed to investigate the impact of prior UE surgery on participation, injury, and surgery rates in collegiate athletes. METHODS Division I athletes who commenced collegiate athletics from 2003-2009 were retrospectively identified. Pre-participation evaluation forms were queried for the history of pre-collegiate UE surgery. Data on sport played, seasons played, injuries, days missed, and orthopedic imaging and surgical procedures were collected through athletic and medical records and compared with those of athletes without prior UE surgery. Subgroup analysis was performed for shoulder surgery, elbow surgery, and wrist and/or hand surgery. RESULTS Between 2003 and 2009, 1145 athletes completed pre-participation evaluations. Of these athletes, 77 (6.7%) underwent at least 1 pre-collegiate UE surgical procedure. Prior UE surgery was most common in men's water polo (15.0%), baseball (14.9%), and football (12.6%). The UE surgery group had a higher rate of collegiate UE injury (hazard ratio, 4.127; P < .01) and missed more days per season because of UE injury (16.5 days vs. 6.7 days, P = .03) than controls. Athletes with prior shoulder surgery (n = 20) also experienced more UE injuries compared with controls (hazard ratio, 15,083; P = .02). They missed more days per season (77.5 days vs. 29.8 days, P < .01), underwent more magnetic resonance imaging scans (0.96 vs. 0.40, P < .01), and underwent more orthopedic surgical procedures per season (0.23 vs. 0.08, P < .01). The elbow subgroup and wrist and/or hand subgroup were comparable with controls on all measures. CONCLUSIONS Collegiate athletes with prior shoulder surgery missed more days and underwent more magnetic resonance imaging scans and surgical procedures in college, whereas those with prior elbow surgical procedures and wrist and/or hand surgical procedures were comparable with controls.
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8
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Padua DA, DiStefano LJ, Hewett TE, Garrett WE, Marshall SW, Golden GM, Shultz SJ, Sigward SM. National Athletic Trainers' Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. J Athl Train 2018; 53:5-19. [PMID: 29314903 DOI: 10.4085/1062-6050-99-16] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To provide certified athletic trainers, physicians, and other health care and fitness professionals with recommendations based on current evidence regarding the prevention of noncontact and indirect-contact anterior cruciate ligament (ACL) injuries in athletes and physically active individuals. BACKGROUND Preventing ACL injuries during sport and physical activity may dramatically decrease medical costs and long-term disability. Implementing ACL injury-prevention training programs may improve an individual's neuromuscular control and lower extremity biomechanics and thereby reduce the risk of injury. Recent evidence indicates that ACL injuries may be prevented through the use of multicomponent neuromuscular-training programs. RECOMMENDATIONS Multicomponent injury-prevention training programs are recommended for reducing noncontact and indirect-contact ACL injuries and strongly recommended for reducing noncontact and indirect-contact knee injuries during physical activity. These programs are advocated for improving balance, lower extremity biomechanics, muscle activation, functional performance, strength, and power, as well as decreasing landing impact forces. A multicomponent injury-prevention training program should, at minimum, provide feedback on movement technique in at least 3 of the following exercise categories: strength, plyometrics, agility, balance, and flexibility. Further guidance on training dosage, intensity, and implementation recommendations is offered in this statement.
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9
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Abstract
PURPOSE OF REVIEW Mechanisms leading to anterior cruciate ligament (ACL) injury have been identified, yet re-injury or a secondary injury persists in the athletic population. The purpose of this review is to identify risk factors associated with ACL injury and investigate programs to prevent injury. RECENT FINDINGS Faulty mechanics during dynamic movement that cause excessive valgus force at the knee increases the risk of ACL injury. Faulty mechanics may be a result of lateral displacement of the trunk, unequal limb loading, and lack of control to avoid the valgus knee position. Altered movements that place the ACL at risk are best identified in a fatigued state; however, could be recognized in a standard dynamic assessment. The faulty movement patterns are modifiable and should be addressed in an injury prevention program. Prevention programs include various modes of exercise such as plyometrics, neuromuscular training, and strength training. This review concludes that those programs which utilize neuromuscular training and strength training at a young age show the most promise in reducing ACL injuries. An ongoing thorough dynamic examination is necessary for all athletes while adjusting the intervention program in order to decrease the risk of ACL injury.
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10
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Williams JZ, Singichetti B, Li H, Xiang H, Klingele KE, Yang J. Epidemiological Patterns of Initial and Subsequent Injuries in Collegiate Football Athletes. Am J Sports Med 2017; 45:1171-1178. [PMID: 28171736 DOI: 10.1177/0363546516685317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A body of epidemiological studies has examined football injuries and associated risk factors among collegiate athletes. However, few existing studies specifically analyzed injury risk in terms of initial or subsequent injuries. PURPOSE To determine athlete-exposures (AEs) and rates of initial and subsequent injury among collegiate football athletes. STUDY DESIGN Descriptive epidemiological study. METHODS Injury and exposure data collected from collegiate football players from two Division I universities (2007-2011) were analyzed. Rate of initial injury was calculated as the number of initial injuries divided by the total number of AEs for initial injuries, while the rate for subsequent injury was calculated as the number of subsequent injuries divided by the total number of AEs for subsequent injury. Poisson regression was used to determine injury rate ratio (subsequent vs initial injury), with adjustment for other covariates. RESULTS The total AEs during the study period were 67,564, resulting in an overall injury rate of 35.2 per 10,000 AEs. Rates for initial and subsequent injuries were 31.7 and 45.3 per 10,000 AEs, respectively, with a rate ratio (RR) of 1.4 for rate of subsequent injury vs rate of initial injury (95% CI, 1.1-1.9). Rate of injury appeared to increase with each successive injury. RR during games was 1.8 (95% CI, 1.1-3.0). The rate of subsequent injuries to the head, neck, and face was 10.9 per 10,000 AEs, nearly double the rate of initial injuries to the same sites (RR = 2.0; 95% CI, 1.1-3.5). For wide receivers, the rate of subsequent injuries was 2.2 times the rate of initial injuries (95% CI, 1.3-3.8), and for defensive linemen, the rate of subsequent injuries was 2.1 times the rate of initial injuries (95% CI, 1.1-3.9). CONCLUSION The method used in this study allows for a more accurate determination of injury risk among football players who have already been injured at least once. Further research is warranted to better identify which specific factors contribute to this increased risk for subsequent injury.
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Affiliation(s)
- Jacob Z Williams
- Medical Student Research Program, The Ohio State University College of Medicine, Columbus, Ohio, USA.,Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Bhavna Singichetti
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Hongmei Li
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu, China
| | - Henry Xiang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Kevin E Klingele
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Sports Medicine and Orthopedics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jingzhen Yang
- Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA.,Department of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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11
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Sugimoto D, Stracciolini A, Dawkins CI, Meehan WP, Micheli LJ. Implications for Training in Youth: Is Specialization Benefiting Kids? Strength Cond J 2017. [DOI: 10.1519/ssc.0000000000000289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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Wang D, Rugg CM, Mayer E, Lai WC, Sulzicki P, Vail J, Hame SL. Precollegiate Knee Surgery Predicts Subsequent Injury Requiring Surgery in NCAA Athletes. Am J Sports Med 2016; 44:2023-9. [PMID: 27022061 DOI: 10.1177/0363546516634306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The effect of precollegiate orthopaedic surgery on injury risk in the elite collegiate athlete is unknown. PURPOSE To (1) assess the relationship between precollegiate surgery and subsequent injury requiring surgery in National Collegiate Athletic Association (NCAA) Division I athletes at a single institution and (2) compare the risk of subsequent surgery in the ipsilateral versus contralateral extremity in those with a history of precollegiate surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective chart review was performed of all athletes who began participation from 2003 to 2009 until completion of eligibility. Athletes who received orthopaedic surgery in college were identified through the Sports Injury Monitoring System and were cross-referenced with medical records. The risk of orthopaedic surgery was evaluated using multivariate Cox and Poisson regression models, with sex and sport as additional covariates. Risk of subsequent surgery in the ipsilateral versus contralateral extremity was compared using Kaplan-Meier survival estimates and Cox proportional hazards regression. Hazard ratios (HRs) and rate ratios (RRs) with corresponding 95% confidence intervals were used to compare groups. RESULTS In total, 1141 athletes were identified for analysis. Of these, 186 athletes (16.3%) had a history of precollegiate orthopaedic surgery. There were 261 documented intracollegiate orthopaedic surgeries in 181 athletes (15.9%). Precollegiate knee surgery was an independent predictor of orthopaedic surgery (HR, 1.85; 95% CI, 1.16-2.83) in college. When examining only surgeries resulting from acute or primary injuries, precollegiate knee surgery was an independent predictor of primary knee injury requiring surgery in college (HR, 4.45; 95% CI, 2.51-7.59). Athletes with a history of precollegiate surgery were more susceptible to subsequent surgery in their ipsilateral extremity compared with their other extremities (HR, 1.89; 95% CI, 1.03-3.53). In contrast, there was no additional risk of receiving subsequent surgery in the contralateral extremity (P = .54). CONCLUSION Precollegiate knee surgery in the Division I athlete is associated with subsequent injury requiring surgery in college. Athletes with a history of precollegiate surgery are at higher risk of subsequent surgery in their ipsilateral extremity compared with other extremities.
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Affiliation(s)
- Dean Wang
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Caitlin M Rugg
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Erik Mayer
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Wilson C Lai
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Pamela Sulzicki
- Department of Athletics, Sacred Heart University, Fairfield, Connecticut, USA
| | - Jeremy Vail
- Department of Athletics, University of California at Los Angeles, Los Angeles, California, USA
| | - Sharon L Hame
- Department of Orthopaedic Surgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA
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13
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Single-leg postural stability deficits following anterior cruciate ligament reconstruction in pediatric and adolescent athletes. J Pediatr Orthop B 2016; 25:338-42. [PMID: 26863483 DOI: 10.1097/bpb.0000000000000276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The objective of this study was to compare the postural stability of pediatric and adolescent athletes without anterior cruciate ligament injury with those who underwent anterior cruciate reconstruction (ACLR). Postural stability ratings derived from a video-force plate system during the three stances of the modified Balance Error Scoring System were collected from pediatric and adolescent athletes who underwent ACLR (N=24; mean 1.2 years after surgery) and from uninjured controls (N=479). The postural control rating was calculated as the mean of the displacement and variance of the torso and center of pressure data, normalized on a scale from 0 to 100. A higher rating indicates greater postural stability. Participants who underwent ACLR showed lower postural stability ratings during single-leg stance compared with uninjured controls (40.0 vs. 48.7; P=0.037). ACLR is associated with deficits in postural stability.
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14
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Stanley LE, Kerr ZY, Dompier TP, Padua DA. Sex Differences in the Incidence of Anterior Cruciate Ligament, Medial Collateral Ligament, and Meniscal Injuries in Collegiate and High School Sports: 2009-2010 Through 2013-2014. Am J Sports Med 2016; 44:1565-72. [PMID: 26940226 DOI: 10.1177/0363546516630927] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous research has noted sex-based differences in anterior cruciate ligament (ACL) injury rates in young athletes, while little is known about medial collateral ligament (MCL) and meniscal injury rates in this population. The objective of this study was to compare injury rates for traumatic knee injuries (ie, ACL, MCL, and meniscal injuries) in collegiate and high school (HS) varsity student-athletes across multiple sports. HYPOTHESIS Knee injury rates vary by sex and across different sports and levels of competition. STUDY DESIGN Descriptive epidemiology study. METHODS Injury and athlete-exposure data were utilized from the National Athletic Treatment, Injury and Outcomes Network (NATION) and National Collegiate Athletic Association (NCAA) Injury Surveillance Program (ISP) during the 2009-2010 to 2013-2014 academic years. Analyses focused on ACL, MCL, and meniscal injuries. Injury rates and injury rate ratios (IRRs) with 95% CIs were calculated for basketball, ice hockey, lacrosse, soccer, and baseball/softball. RESULTS The ACL injury rate was higher for female than male athletes at the collegiate (IRR, 2.49; 95% CI, 1.81-3.41) and HS (IRR, 2.30; 95% CI, 1.67-3.18) levels. At the collegiate level, the highest ACL IRR comparing female to male athletes was reported in softball/baseball (IRR, 6.61; 95% CI, 1.48-29.55). At the HS level, the highest ACL IRR was reported in basketball (IRR, 3.68; 95% CI, 1.91-7.10). The MCL injury rate was higher for female than male athletes at the HS level (IRR, 2.11; 95% CI, 1.25-3.56) but lower for female than male athletes at the collegiate level (IRR, 0.73; 95% CI, 0.59-0.92). The meniscal injury rate was lower for female than male athletes at the HS level (IRR, 0.47; 95% CI, 0.31-0.71), while no differences by sex were seen at the collegiate level (IRR, 1.35; 95% CI, 0.90-2.02). CONCLUSION Knee injury rates varied by sex across 5 different sports in the HS and collegiate settings. Female athletes sustained ACL injuries at a higher rate than male athletes at both the HS and collegiate levels in these 5 sports; however, there was not a distinct sex disparity in MCL and meniscal injuries. Future studies should examine the rates of concomitant and recurrent injuries to inform injury prevention and rehabilitation programs.
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Affiliation(s)
- Laura E Stanley
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Human Movement Science Program, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zachary Y Kerr
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Datalys Center for Sports Injury Research and Prevention Inc, Indianapolis, Indiana, USA
| | - Thomas P Dompier
- Datalys Center for Sports Injury Research and Prevention Inc, Indianapolis, Indiana, USA
| | - Darin A Padua
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Logerstedt D, Arundale A, Lynch A, Snyder-Mackler L. A conceptual framework for a sports knee injury performance profile (SKIPP) and return to activity criteria (RTAC). Braz J Phys Ther 2015; 19:340-59. [PMID: 26537805 PMCID: PMC4647146 DOI: 10.1590/bjpt-rbf.2014.0116] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/18/2015] [Indexed: 12/14/2022] Open
Abstract
Injuries to the knee, including intra-articular fractures, ligamentous ruptures, and
meniscal and articular cartilage lesions, are commonplace within sports. Despite
advancements in surgical techniques and enhanced rehabilitation, athletes returning
to cutting, pivoting, and jumping sports after a knee injury are at greater risk of
sustaining a second injury. The clinical utility of objective criteria presents a
decision-making challenge to ensure athletes are fully rehabilitated and safe to
return to sport. A system centered on specific indicators that can be used to develop
a comprehensive profile to monitor rehabilitation progression and to establish return
to activity criteria is recommended to clear athletes to begin a progressive and
systematic approach to activities and sports. Integration of a sports knee injury
performance profile with return to activity criteria can guide clinicians in
facilitating an athlete's safe return to sport, prevention of subsequent injury, and
life-long knee joint health.
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Affiliation(s)
- David Logerstedt
- Department of Physical Therapy, University of the Sciences, Philadelphia, PA, USA
| | | | - Andrew Lynch
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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16
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Driban JB, Lo GH, Eaton CB, Price LL, Lu B, McAlindon TE. Knee Pain and a Prior Injury Are Associated with Increased Risk of a New Knee Injury: Data from the Osteoarthritis Initiative. J Rheumatol 2015; 42:1463-9. [PMID: 26034152 DOI: 10.3899/jrheum.150016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We explored whether knee pain or a history of knee injury were associated with a knee injury in the following 12 months. METHODS We conducted longitudinal knee-based analyses among knees in the Osteoarthritis Initiative. We included both knees of all participants who had at least 1 followup visit with complete data. Our first sets of exposures were knee pain (chronic knee symptoms and severity) at baseline, 12-month, 24-month, and 36-month visits. Another exposure was a history of injury that we defined as a self-reported injury at any time prior to baseline, 12-month, 24-month, or 36-month visit. The outcome was self-reported knee injury during the past year at 12-month, 24-month, 36-month, and 48-month visits. We evaluated the association between ipsilateral and contralateral knee pain or history of injury and a new knee injury within 12 months of the exposure using generalized linear mixed model for repeated binary outcomes. RESULTS A knee with reported chronic knee symptoms or ipsilateral or contralateral history of an injury was more likely to experience a new knee injury in the following 12 months than a knee without chronic knee symptoms (OR 1.84, 95% CI 1.57-2.16) or prior injury (prior ipsilateral knee injury: OR 1.81, 95% CI 1.56-2.09. Prior contralateral knee injury: OR 1.43, 95% CI 1.23-1.66). CONCLUSION Knee pain and a history of injury are associated with new knee injuries. It may be beneficial for individuals with knee pain or a history of injury to participate in injury prevention programs.
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Affiliation(s)
- Jeffrey B Driban
- From the Division of Rheumatology, and The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University; Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts; Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Texas; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Providence, Rhode Island, USA.J.B. Driban, PhD, ATC, CSCS, Assistant Professor, Division of Rheumatology, Tufts Medical Center; G.H. Lo, MD, MSc, Assistant Professor, Medical Care Line and Research Care Line, HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, and Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine; C.B. Eaton, MD, MS, Director of Primary Care and Prevention, Center for Primary Care and Prevention, Alpert Medical School of Brown University; L.L. Price, MAS, Statistician, Instructor, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University; B. Lu, MD, DrPH, Assistant Professor, Brigham and Women's Hospital, and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Division of Rheumatology, Division of Rheumatology, Tufts Medical Center.
| | - Grace H Lo
- From the Division of Rheumatology, and The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University; Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts; Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Texas; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Providence, Rhode Island, USA.J.B. Driban, PhD, ATC, CSCS, Assistant Professor, Division of Rheumatology, Tufts Medical Center; G.H. Lo, MD, MSc, Assistant Professor, Medical Care Line and Research Care Line, HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, and Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine; C.B. Eaton, MD, MS, Director of Primary Care and Prevention, Center for Primary Care and Prevention, Alpert Medical School of Brown University; L.L. Price, MAS, Statistician, Instructor, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University; B. Lu, MD, DrPH, Assistant Professor, Brigham and Women's Hospital, and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Division of Rheumatology, Division of Rheumatology, Tufts Medical Center
| | - Charles B Eaton
- From the Division of Rheumatology, and The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University; Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts; Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Texas; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Providence, Rhode Island, USA.J.B. Driban, PhD, ATC, CSCS, Assistant Professor, Division of Rheumatology, Tufts Medical Center; G.H. Lo, MD, MSc, Assistant Professor, Medical Care Line and Research Care Line, HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, and Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine; C.B. Eaton, MD, MS, Director of Primary Care and Prevention, Center for Primary Care and Prevention, Alpert Medical School of Brown University; L.L. Price, MAS, Statistician, Instructor, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University; B. Lu, MD, DrPH, Assistant Professor, Brigham and Women's Hospital, and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Division of Rheumatology, Division of Rheumatology, Tufts Medical Center
| | - Lori Lyn Price
- From the Division of Rheumatology, and The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University; Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts; Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Texas; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Providence, Rhode Island, USA.J.B. Driban, PhD, ATC, CSCS, Assistant Professor, Division of Rheumatology, Tufts Medical Center; G.H. Lo, MD, MSc, Assistant Professor, Medical Care Line and Research Care Line, HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, and Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine; C.B. Eaton, MD, MS, Director of Primary Care and Prevention, Center for Primary Care and Prevention, Alpert Medical School of Brown University; L.L. Price, MAS, Statistician, Instructor, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University; B. Lu, MD, DrPH, Assistant Professor, Brigham and Women's Hospital, and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Division of Rheumatology, Division of Rheumatology, Tufts Medical Center
| | - Bing Lu
- From the Division of Rheumatology, and The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University; Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts; Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Texas; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Providence, Rhode Island, USA.J.B. Driban, PhD, ATC, CSCS, Assistant Professor, Division of Rheumatology, Tufts Medical Center; G.H. Lo, MD, MSc, Assistant Professor, Medical Care Line and Research Care Line, HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, and Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine; C.B. Eaton, MD, MS, Director of Primary Care and Prevention, Center for Primary Care and Prevention, Alpert Medical School of Brown University; L.L. Price, MAS, Statistician, Instructor, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University; B. Lu, MD, DrPH, Assistant Professor, Brigham and Women's Hospital, and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Division of Rheumatology, Division of Rheumatology, Tufts Medical Center
| | - Timothy E McAlindon
- From the Division of Rheumatology, and The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center; Tufts Clinical and Translational Science Institute, Tufts University; Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts; Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center; Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, Texas; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Providence, Rhode Island, USA.J.B. Driban, PhD, ATC, CSCS, Assistant Professor, Division of Rheumatology, Tufts Medical Center; G.H. Lo, MD, MSc, Assistant Professor, Medical Care Line and Research Care Line, HSR&D Center of Excellence, Michael E. DeBakey VA Medical Center, and Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine; C.B. Eaton, MD, MS, Director of Primary Care and Prevention, Center for Primary Care and Prevention, Alpert Medical School of Brown University; L.L. Price, MAS, Statistician, Instructor, The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts Clinical and Translational Science Institute, Tufts University; B. Lu, MD, DrPH, Assistant Professor, Brigham and Women's Hospital, and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Division of Rheumatology, Division of Rheumatology, Tufts Medical Center
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17
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Sugimoto D, Myer GD, Micheli LJ, Hewett TE. ABCs of Evidence-based Anterior Cruciate Ligament Injury Prevention Strategies in Female Athletes. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2015; 3:43-49. [PMID: 26042191 DOI: 10.1007/s40141-014-0076-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Anterior cruciate ligament (ACL) injury is a major concern in physically active females. Although ACL reconstruction techniques have seen significant advances in recent years, risk associated with re-injury and future osteoarthritis remains a major concern. Thus, prevention of ACL injury is a logical step to protect and preserve healthy knee joints in young athletes. The current report aims to summarize a list of evidence-based prevention strategies to reduce ACL injury in female athletes. A list of six critical principles, which come from documented, large scale clinical trial studies and further analyses, were presented with ABC format including age, biomechanics, compliance, dosage, exercise, and feedback. Also, a grade for evidence and implications of future research is noted. Finally, in the conclusion section, importance of collaborative efforts from healthcare practitioners, researchers, and personnel associated with athletics is addressed.
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Affiliation(s)
- Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, MA ; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA
| | - Gregory D Myer
- The Micheli Center for Sports Injury Prevention, Waltham, MA ; Cincinnati Children's Hospital Medical Center, Cincinnati, OH ; Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH ; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH ; Departments of Orthopaedic Surgery, Biomedical Engineering and Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH
| | - Lyle J Micheli
- The Micheli Center for Sports Injury Prevention, Waltham, MA ; Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA ; Harvard Medical School, Boston, MA
| | - Timothy E Hewett
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH ; Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH ; Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH ; Departments of Orthopaedic Surgery, Biomedical Engineering and Rehabilitation Sciences, University of Cincinnati, Cincinnati, OH ; OSU Sports Medicine Sports Health & Performance Institute, Department of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine, Anatomy and Biomedical Engineering, The Ohio State University, Columbus, OH
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