ACL Prevention

 

As sports medicine professionals, we are always looking for a way to prevent injuries.  Working with coaches, we work to help our athletes train in ways to both avoid and minimize the impact of injuries.

Strength training, flexibility, and skills acquisition are all tools in the prevention tool chest. More recent techniques such as chaos training and training based on a variety of individualized metrics have made a difference. But there are still almost a quarter of a million ACL injuries per year in this country. 

Studies tell us that for every male that has an ACL injury, 8 females have one. That data can be argued, dissected, and defied, but the bottom line is still that more girls have ACL tears than boys.

I have two friends, Dr. Tim Hewett and Dr. Amy Arundale, who have dedicated their careers to injury prevention, particularly for the ACL.  Both have PhD’s in biomechanics and both have focused exhaustive studies on preventing ACL injuries.

Dr. Hewett created the original Cincinnati Jump Program, which did have some impact on ACL injury incidence, but even he admits that we have all had limited success in the prevention arena.

Dr. Arundale, who works for the NBA’s Washington Wizards, is most certainly considered one of the foremost authorities on preventing ACL injuries but she tore her own ACL, playing Australian Rules Football. 

I’m going to bring this story to a personal level.  Last year, I worked with a young athlete as she rehabbed her knee after ACL surgery.  It was nine grueling months of work. Along the way, we worked diligently on both legs, putting a lot of emphasis on preventing an injury to her other knee.

She got the benefit of everything that I know about ACL prevention--and I have dedicated a large part of my career to understanding the ACL. She returned to basketball in the fall and had no problem with the knee that she had surgery on—it performed at a very high level. Yet, you know the rest of the story.  A few weeks ago, she tore the ACL in her other knee.

So the bottom line is that we just don’t know how to truly prevent ACL injuries.  We can lessen the risk but we can’t stop it. That is frustrating for me.

Because of that frustration, I have engaged several of the leading authorities in the country in an ongoing discussion about what else we might do. One of the common denominators appears to be a narrowed intercondylar notch (you probably need your orthopedist or physical therapist to explain that one).  There isn’t a practical solution for that one.

What don’t we know?  The effect of the menstrual cycle on ACL injuries.  We know that adequate sleep is important but what role does fatigue play?  And how do you deal with that?

Are there training techniques that we just don’t understand yet? We know that how the foot interacts with the ground is important but how best to intervene?

What we do know and which I’ll preach for the rest of my life—it is essential that young kids play and run and move their bodies. Especially girls. And begin sports training by the time puberty hits. Not just playing a sport, but training for that sport.

I’ll admit that we don’t know what we don’t know right now—but we’re looking, searching for every ingredient to the ACL prevention our athletes so desperately need.