Effect of Fatigue Protocols on Lower Limb Neuromuscular Function and Implications for Anterior Cruciate Ligament Injury Prevention Training: A Systematic Review

2017 ◽  
Vol 45 (14) ◽  
pp. 3388-3396 ◽  
Author(s):  
Sue D. Barber-Westin ◽  
Frank R. Noyes
Keyword(s):  
Systematic Review ◽  
Injury Prevention ◽  
Lower Limb ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Inclusion Criteria ◽  
Acl Injuries ◽  
Prevention Training ◽  
Anterior Cruciate ◽  
Acl Injury Prevention

Background: Approximately two-thirds of anterior cruciate ligament (ACL) tears are sustained during noncontact situations when an athlete is cutting, pivoting, decelerating, or landing from a jump. Some investigators have postulated that fatigue may result in deleterious alterations in lower limb biomechanics during these activities that could increase the risk of noncontact ACL injuries. However, prior studies have noted a wide variation in fatigue protocols, athletic tasks studied, and effects of fatigue on lower limb kinetics and kinematics. Purpose: First, to determine if fatigue uniformly alters lower limb biomechanics during athletic tasks that are associated with noncontact ACL injuries. Second, to determine if changes should be made in ACL injury prevention training programs to alter the deleterious effects of fatigue on lower limb kinetics and kinematics. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature using MEDLINE was performed. Key terms were fatigue, neuromuscular, exercise, hop test, and single-legged function tests. Inclusion criteria were original research studies involving healthy participants, use of a fatigue protocol, study of at least 1 lower limb task that involved landing from a hop or jump or cutting, and analysis of at least 1 biomechanical variable. Results: Thirty-seven studies involving 806 athletes (485 female, 321 male; mean age, 22.7 years) met the inclusion criteria. General fatigue protocols were used in 20 investigations, peripheral protocols were used in 17 studies, and 21 different athletic tasks were studied (13 single-legged, 8 double-legged). There was no consistency among investigations regarding the effects of fatigue on hip, knee, or ankle joint angles and moments or surface electromyography muscle activation patterns. The fatigue protocols typically did not produce statistically significant changes in ground-reaction forces. Conclusion: Published fatigue protocols did not uniformly produce alterations in lower limb neuromuscular factors that heighten the risk of noncontact ACL injuries. Therefore, justification does not currently exist for major changes in ACL injury prevention training programs to account for potential fatigue effects. However, the effect of fatigue related to ACL injuries is worthy of further investigation, including the refinement of protocols and methods of analysis.

scholarly journals Prevention of Knee and Anterior Cruciate Ligament Injuries Through the Use of Neuromuscular and Proprioceptive Training: An Evidence-Based Review

2017 ◽  
Vol 52 (12) ◽  
pp. 1171-1172 ◽  
Author(s):  
Lucas Dargo ◽  
Kelsey J. Robinson ◽  
Kenneth E. Games
Keyword(s):  
Anterior Cruciate Ligament ◽  
Lower Limb ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Inclusion Criteria ◽  
Acl Injuries ◽  
Anterior Cruciate Ligament Injuries ◽  
Proprioceptive Training ◽  
Anterior Cruciate

Reference/Citation:  Donnell-Fink LA, Klara K, Collins JE, et al. Effectiveness of knee injury and anterior cruciate ligament tear prevention programs: a meta-analysis. PLoS One. 2015;10(12)e0144063. Clinical Question:  Is neuromuscular and proprioceptive training effective in preventing knee and anterior cruciate ligament (ACL) injuries? Data Sources:  The authors searched CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE/EMBASE, PubMed, and Web of Science databases from 1996 through December 2014 and limited the results to peer-reviewed manuscripts published in English. Search terms for all databases were knee injury OR knee injuries; OR anterior cruciate ligament injury OR anterior cruciate ligament injuries; OR ACL injury OR ACL injuries; OR lower limb injury OR lower limb injuries AND prevention. Study Selection:  Inclusion criteria were (1) English language, (2) published from 1996 through 2014, (3) the intervention used neuromuscular or proprioceptive training to prevent knee or ACL injuries, (4) human participants, (5) the incidence of knee or ACL injury was provided. Data Extraction:  For the articles that met the inclusion criteria, 2 authors worked independently using the Jadad scale to extract the first author, year of publication, title, sport type, participant sex, participant age, country in which the study was conducted, number of participants in the control and intervention groups, intervention characteristics or components, and knee or ACL injury outcome. Main Results:  A total of 24 studies with 1093 participants were included in this review. Intervention efficacy was determined from weighted incidence rate ratios. After the intervention of neuromuscular and proprioceptive training exercises, the incidence ratio (frequency of a disease or injury occurrence in a population over a specific time frame) was calculated at 0.731 (95% confidence interval = 0.614, 0.871) for knee injury and at 0.493 (95% confidence interval = 0.285, 0.854) for ACL injury. This indicated a link between neuromuscular and proprioceptive training programs and injury reduction. No significant correlation was present between more components added to training and a greater decrease in injury to either the knee or ACL. Conclusions:  Neuromuscular and proprioceptive training appeared to decrease the incidence of injury to the knee and specifically the ACL. However, no evidence suggested that a specific group of exercises was better than others.

scholarly journals The Use of Augmented Information for Reducing Anterior Cruciate Ligament Injury Risk During Jump Landings: A Systematic Review

2018 ◽  
Vol 53 (9) ◽  
pp. 844-859
Author(s):  
Cortney N. Armitano ◽  
Justin A. Haegele ◽  
Daniel M. Russell
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Injury Prevention ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Prevention Programs ◽  
Factors Associated ◽  
Methodologic Quality ◽  
Anterior Cruciate ◽  
Acl Injury Prevention

Context:  A comprehensive systematic review of the literature on the use of augmented information in anterior cruciate ligament (ACL) injury-prevention programs to improve jump-landing technique was conducted. The use of motor-learning concepts could provide more robust means of preventing ACL injuries. Objective:  To systematically summarize the effectiveness of augmented information in improving the biomechanical factors associated with an increased risk for ACL injury. Data Sources:  Articles were retrieved using the electronic databases of PubMed, MEDLINE, CINAHL, and Google Scholar and 3 lines of truncated search words: (a) lower extremity, knee, ACL, and anterior cruciate ligament; (b) prevention, injury prevention, and prehab; and (c) augmented information, augmented feedback, feedback, cue, and instruction. We also performed a hand search of the reference lists of the screened articles. Data Extraction:  We independently assessed the methodologic quality using the Cochrane Group on Screening and Diagnostic Test Methods list. Articles were placed in 1 of 3 augmented-information categories: prescriptive, feedback, or transition. Articles were also categorized based on whether the information likely encouraged an internal or external focus of attention. Data Synthesis:  The searches identified a total of 353 studies, of which 18 were included. Most researchers found that augmented information could lead to technique changes to reduce the biomechanical risk factors associated with ACL injury. The average methodologic quality of the studies was 11.8 out of 17, with a range from 8 to 15. The authors of only 7 studies examined retention of the improved techniques. Conclusions:  The evidence suggests that augmented information can be used to significantly improve the biomechanical indicators associated with ACL injury and to enhance current ACL injury-prevention programs. Combined prescriptive and feedback information that encouraged both internal and external foci led to the largest retention effect sizes.

scholarly journals Poor Motor Coordination Elicits Altered Lower Limb Biomechanics in Young Football (Soccer) Players: Implications for Injury Prevention through Wearable Sensors

Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4371
Author(s):  
Stefano Di Paolo ◽  
Stefano Zaffagnini ◽  
Nicola Pizza ◽  
Alberto Grassi ◽  
Laura Bragonzoni
Keyword(s):  
Injury Prevention ◽  
Lower Limb ◽  
Motor Coordination ◽  
Inertial Sensors ◽  
Cruciate Ligament ◽  
Vertical Jump ◽  
Wearable Sensors ◽  
Acl Injury ◽  
Anterior Cruciate ◽  
Acl Injury Prevention

Motor coordination and lower limb biomechanics are crucial aspects of anterior cruciate ligament (ACL) injury prevention strategies in football. These two aspects have never been assessed together in real scenarios in the young population. The present study aimed to investigate the influence of motor coordination on lower limb biomechanics in young footballers during an on-the-pitch training. Eighteen juvenile football players (10 y ± 2 m) were enrolled. Each player performed a training drill with sport-specific movements (vertical jump, agility ladders, change of direction) and the Harre circuit test (HCT) to evaluate players’ motor coordination. Wearable inertial sensors (MTw Awinda, Xsens) were used to assess lower limb joint angles and accelerations. Based on the results of the HCT, players were divided into poorly coordinated (PC) and well-coordinated (WC) on the basis of the literature benchmark. The PC group showed a stiffer hip biomechanics strategy (up to 40% lower flexion angle, ES = 2.0) and higher internal-external hip rotation and knee valgus (p < 0.05). Significant biomechanical limb asymmetries were found only in the PC group for the knee joint (31–39% difference between dominant and non-dominant limb, ES 1.6–2.3). Poor motor coordination elicited altered hip and knee biomechanics during sport-specific dynamic movements. The monitoring of motor coordination and on-field biomechanics might enhance the targeted trainings for ACL injury prevention.

scholarly journals Implementing ACL Injury Prevention in Daily Sports Practice—It’s Not Just the Program: Let’s Build Together, Involve the Context, and Improve the Content

2021 ◽  
Author(s):  
Anne Benjaminse ◽  
Evert Verhagen
Keyword(s):  
Injury Prevention ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Health Impact ◽  
Acl Injuries ◽  
Differential Learning ◽  
Implicit Motor Learning ◽  
Prevention Programmes ◽  
The Individual ◽  
Acl Injury Prevention

AbstractAlthough the benefits of current anterior cruciate ligament (ACL) injury prevention programmes have been demonstrated in efficacy studies, they, unfortunately, have had limited public health impact to date. For example, the incidence of ACL injuries continues to rise in adolescent athletes. Raising awareness and educating coaches and athletes is not enough to facilitate the widespread, sustained use of these programmes in the real-world setting. Considering the profound burden of ACL injuries, it is necessary to continue to improve the current ACL injury prevention programmes through co-creation. First, the uptake of the programmes should be optimized by a better appreciation and understanding of the individual, socio-cultural and environmental context (i.e., community). Second, the content of the programmes should be optimized to better reflect the demands of the sport by creating more ownership and increasing motivation (incorporating challenging, sport-specific and fun elements) with the end-users. In addition, implicit motor learning, random practice and differential learning are concepts that should be integrated when practising to obtain the most optimal results when learning or finetuning skills.

scholarly journals National Athletic Trainers' Association Position Statement: Prevention of Anterior Cruciate Ligament Injury

2018 ◽  
Vol 53 (1) ◽  
pp. 5-19 ◽  
Author(s):  
Darin A. Padua ◽  
Lindsay J. DiStefano ◽  
Timothy E. Hewett ◽  
William E. Garrett ◽  
Stephen W. Marshall ◽  
...  
Keyword(s):  
Physical Activity ◽  
Injury Prevention ◽  
Training Programs ◽  
Cruciate Ligament ◽  
Athletic Trainers ◽  
Indirect Contact ◽  
Acl Injuries ◽  
Lower Extremity Biomechanics ◽  
Prevention Training ◽  
Anterior Cruciate

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.

scholarly journals Limited Evidence Suggests a Protective Association Between Oral Contraceptive Pill Use and Anterior Cruciate Ligament Injuries in Females: A Systematic Review

2017 ◽  
Vol 9 (6) ◽  
pp. 498-510 ◽  
Author(s):  
Kathleen Samuelson ◽  
Ethan M. Balk ◽  
Erika L. Sevetson ◽  
Braden C. Fleming
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Oral Contraceptive ◽  
Menstrual Cycle ◽  
Study Design ◽  
Methodological Quality ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Acl Injuries ◽  
Anterior Cruciate

Context: Female athletes aged 14 to 18 years are at particular risk for anterior cruciate ligament (ACL) injuries. Hormonal factors are thought to predispose them to this injury. Oral contraceptive pills (OCPs) might reduce ACL injury risk, although the literature appears controversial. Objective: To evaluate the association between OCP use and ACL injuries in women. The secondary objective was to determine the rates of ACL injuries in the pre- and postovulatory phases of the menstrual cycle in OCP and non-OCP (NOCP) users. Data Sources: Searches were performed across 4 reference databases (PubMed, CINAHL, Embase, Cochrane), abstracts from 6 specialty societies, ClinicalTrials.gov , and reference lists of relevant papers. Study Selection: We included studies investigating the association between OCP use and ACL injuries in females of any age or the distribution of ACL injuries across the menstrual cycle in OCP and NOCP users. Study Design: Systematic review. Level of Evidence: Level 3. Data Extraction: Data regarding study design, population characteristics, OCP details, outcome definitions, analytic methods, and results were extracted from the included studies. The methodological quality of each study was assessed using the Newcastle-Ottawa scale. Results: The search yielded 1305 citations, of which 7 retrospective observational studies met the inclusion criteria. Two large case-control studies with higher methodological quality suggested that OCP use may reduce the risk of sustaining an ACL injury. Five comparative studies examining injury distribution across the menstrual cycle in OCP and NOCP users had conflicting findings, were heterogeneous, and were limited by low methodological quality. Conclusion: The evidence suggests OCP use may reduce the risk of ACL injury; however, no conclusions can be drawn regarding differences in risk of ACL injuries between OCP and NOCP users across the menstrual cycle. Studies were limited by small sample sizes, heterogeneity, and methodological concerns.

scholarly journals A Systematic Review of Factors Associated with both Bilateral and Recurrent Anterior Cruciate Ligament Disruption

2019 ◽  
pp. 1-12
Author(s):  
Jaquelyn Kakalecik ◽  
John M. Reynolds ◽  
Joseph S. Torg
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Positive Family History ◽  
Acl Injury ◽  
Inclusion Criteria ◽  
Factors Associated ◽  
Anterior Cruciate ◽  
Ligament Disruption

Background: Numerous studies have reported factors associated with recurrent or subsequent contralateral anterior cruciate ligament disruption, but a comprehensive review of the literature has not been performed. Purpose: This study attempts to systematically review the literature and provide an overview of the currently reported risk factors for recurrent and subsequent contralateral ACL reconstructions in order to allow for more efficient identification and intervention of high-risk patients. Study Design: Systematic Review. Methods: The Pubmed and Embase databases were searched using a combination of keywords such as “ACL reconstruction” and “bilateral or recurrent” and “risk factors” and medical subject headings. All studies were screened by two independent reviewers, and articles that met inclusion criteria (non-contact ACL injury, study analyzed risk factors for contralateral ACL injury or graft rupture) were downloaded and read. Results: The initial search yielded 129 articles, of which 36 met inclusion criteria. After duplicates were removed, 23 articles remained. The reference lists of included articles were cross-referenced, and an additional 2 articles were included. Conclusion: Graft harvest site, allograft usage, return to sport, younger age, a positive family history, increased posterior tibial slope, and the number of previous ACL reconstructions are well-reported risk factors for second ACL injury. Recent studies suggest a patients who have negative psychological states in the perioperative periods have worse long-term functional outcomes.

scholarly journals Stiff Landings, Core Stability, and Dynamic Knee Valgus: A Systematic Review on Documented Anterior Cruciate Ligament Ruptures in Male and Female Athletes

2021 ◽  
Vol 18 (7) ◽  
pp. 3826
Author(s):  
Joseph Larwa ◽  
Conrad Stoy ◽  
Ross S. Chafetz ◽  
Michael Boniello ◽  
Corinna Franklin
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Core Stability ◽  
Knee Valgus ◽  
Acl Injuries ◽  
Male And Female ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injuries are the most common ligament injury of the knee, accounting for between 100,000 and 200,000 injuries among athletes per year. ACL injuries occur via contact and non-contact mechanisms, with the former being more common in males and the later being more common in females. These injuries typically require surgical repair and have relatively high re-rupture rates, resulting in a significant psychological burden for these individuals and long rehabilitation times. Numerous studies have attempted to determine risk factors for ACL rupture, including hormonal, biomechanical, and sport- and gender-specific factors. However, the incidence of ACL injuries continues to rise. Therefore, we performed a systematic review analyzing both ACL injury video analysis studies and studies on athletes who were pre-screened with eventual ACL injury. We investigated biomechanical mechanisms contributing to ACL injury and considered male and female differences. Factors such as hip angle and strength, knee movement, trunk stability, and ankle motion were considered to give a comprehensive, joint by joint analysis of injury risk and possible roles of prevention. Our review demonstrated that poor core stability, landing with heel strike, weak hip abduction strength, and increased knee valgus may contribute to increased ACL injury risk in young athletes.

scholarly journals Latest Trends in Neuromuscular Training to Prevent Anterior Cruciate Ligament Injury: A Literature Review

2021 ◽  
Vol 30 (4) ◽  
pp. 412-418
Author(s):  
Kwang-Jin Lee ◽  
Keun-Ok An
Keyword(s):  
Injury Prevention ◽  
Prevention Program ◽  
Training Programs ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Neuromuscular Training ◽  
Warm Up ◽  
Injury Prevention Program ◽  
Anterior Cruciate ◽  
Acl Injury Prevention

PURPOSE: Anterior cruciate ligament (ACL) injuries are the most common in sports and have doubled in the past 20 years. This study aimed to analyze the latest trends and changes in training programs for ACL injury prevention.METHODS: In this study, literature was searched using academic search sites, such as ‘PubMed’, ‘Google Scholar’, and ‘Wiley Online Library’. The literature published between 2015 and 2021 was used.RESULTS: Eleven papers were selected based on the literature selection criteria. Five warm-up exercise papers and six ACL injury prevention training program papers emphasized neuromuscular training.CONCLUSIONS: The ACL injury prevention program can be applied in warm-up exercises and training programs. It consists of an exercise form that includes multidimensional components such as plyometrics, muscle strength, balance, and agility. The key to the ACL injury prevention program is to reflect multidimensional components in neuromuscular training and to obtain a significant effect, and it is recommended to participate in regular training for 12-18 sessions and at least 6 months. In addition, it is suggested to utilize the ACL injury prevention program presented in this study until an individual study for ACL injury prevention by sports type is conducted.

scholarly journals Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification

2019 ◽  
Vol 54 (5) ◽  
pp. 472-482 ◽  
Author(s):  
Alicia M. Montalvo ◽  
Daniel K. Schneider ◽  
Kate E. Webster ◽  
Laura Yut ◽  
Marc T. Galloway ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Injury Incidence ◽  
Male Athletes ◽  
Acl Injuries ◽  
Sport Type ◽  
Anterior Cruciate

Objective To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact). Data Sources A systematic review was performed using the electronic databases PubMed (1969–January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969–January 20, 2017) and the search terms anterior cruciate ligament AND injury AND (incidence OR prevalence OR epidemiology). Study Selection Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English. Data Extraction Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis. Data Synthesis We conducted IR and IR ratio (IRR) meta-analyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10 000 versus 1.12/10 000 AEs, IRR = 1.14, P = .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21, P = .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49, P = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10 000 versus 0.87/10 000 AEs, IRR = 3.00, P &lt; .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10 000 versus 1.75/10 000 AEs, IRR = 5.51, P &lt; .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories. Conclusions Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports.

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