Meta-Analytic Driven Best Practices Guidelines for Anterior Cruciate Ligament Injury Prevention
Smith, Grace F.
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The anterior cruciate ligament (ACL) is one of the major stabilizing ligaments of the knee, but it is also the site of many extremely costly injuries in athletics. ACL tears are suffered approximately 3 times more often by female athletes than by males and each injury requires surgery and 6-9 months of rehabilitation in order to return to sports. In light of the significant impacts of this injury, ACL injury prevention should be a point of focus for coaches and athletes. A multitude of ACL injury prevention programs exist and, as a broad category, these injury prevention programs have been shown to reduce the risk of knee injury. The components of these programs, however, vary widely and no evidence-based best practice protocol or guidelines exist at this time, making it difficult to evaluate the effectiveness of individual programs or recommend injury prevention behaviors to coaches and athletes. In this study, we statistically analyze 14 programs which have been used in prospective randomized controlled trials to begin to determine what components should be included in an ACL injury prevention program. Through the use of odds ratios calculated from the reporting of injuries sustained in the trained and untrained groups of each study, we found that lower body strength, plyometric, and landing stabilization exercises increased protectiveness of programs compared to programs that did not include these components. Programs used in more than just the preseason and those which were implemented by coaches and/or trainers were also found to be more protective. This analysis is just the first step as there are a host of other program components that should also be analyzed, but using this approach and the current findings, we have created a checklist of ACL injury prevention best practices to help coaches and athletes assess injury prevention programs that they use or would like to implement. This checklist is a quick and easy way for coaches and athletes to improve their injury prevention behaviors. With further analysis, the best practices guidelines and checklist can continue to grow and refine ACL injury prevention practices in hopes of decreasing the prevalence of these devastating injuries.