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ACL Injuries

The following is an update on what we have learned about ACL injuries over the last few years:

1. The rate of ACL injury has not changed for the last 20 years.

2."Anterior cruciate ligament injury in athletic populations is more common than in the general population, and they more commonly occur in field and court sports than in snow sports."

3."Approximately, 50–80% of all ACL injuries in field and court sports are noncontact in nature."

4. Anatomical risk factors: "A number of anatomical risk factors were identified; NWI, knee joint laxity, hamstring flexibility and knee recurvatum, tibialis anterior cross-sectional area and volume, and the presence of relaxin receptors in human ACL. However, for most of those risk factors, no definitive conclusions should be reached."

5."Sidestep cutting was shown to be the change of direction maneuver most associated with ACL injury."

6."kinematic extremes and knee joint moments associated with ACL injury are more commonly reached when changes of direction are unplanned, highlighting skill as a risk factor."

7. "strength combined with appropriate neuromuscular control/landing skill" is critical to ACL injury prevention.

8. "fatigue impaired neuromuscular control"

9. Hormonal risk factors: "the increased likelihood of noncontact ACL injury during the luteal phase is most likely to be because of the combined effects of estrogen on procollagen I synthesis and relaxin concentration; during this phase, the tensile properties of the ligament are likely to alter."

10. "risk factors that are typically unavoidable such as genetic predisposition, high tibial plateau slope angle or high estrogen concentrations."

11. "a history of ACL injury was shown to be a significant risk factor for noncontact ACL injury."

12. "It was seen that noncontact ACL injuries were more likely to occur during attacking phases of play relative to playing position."

13. "Current literature suggests that this can be achieved through development of knee joint strength and neuromuscular training strategies that would ensure appropriate recruitment patterns. In particular, the preactivation of posterior chain muscles before footstrike appears important."

14. "Injury rates for ACL sprains and eversion ankle sprains for NFL games played on FieldTurf were higher than rates for those injuries in games played on grass, and the differences were statistically significant." (Source)

15. "Effective implementation of practical neuromuscular warm-up strategies can reduce lower extremity injury incidence in young, amateur, female athletes and male and female military recruits. This is typically a warm-up strategy that includes stretching, strengthening, balance exercises, sports-specific agility drills and landing techniques applied consistently for longer than three consecutive months." (Source)

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