The Evidence
Why are we trying to prevent adolescent knee injuries?
What is the Impact of Knee Injuries in Youth Sport
Encouraging our adolescents to participate in grassroots sports reaps huge rewards in the form of physical health, mental health, team building and long-lasting friendships. Unfortunately injuries can occur and we want to minimize these. One of the more serious injuries affecting the knee is rupturing the anterior cruciate ligament (ACL). This ligament is a strong rope-like structure running through the centre of the knee joint providing stability and support to the knee. Sports that involve a lot of change of direction, jumping and twisting of the knee have a higher rate of injury of the ACL.
Unfortunately, ACL injuries in adolescents are increasing. While the body is still growing this injury is particularly difficult to treat. The recovery is prolonged with absence from sport for an average of 12 months, which can be hard to accept for a young person. In addition, surgical management in adolescents is more challenging with a higher risk of re-injury and joint arthritis further down the line than in adults.
Preventing these injuries occurring in the first place is therefore a worthwhile investment of time and effort on the part of everyone involved in youth sport.
What Can We Do To Prevent Knee Injuries in Youth Sport
Recently, a lot of interest has focused on prevention programmes with good evidence that regular use of an injury prevention warm-up can significantly reduce both first-time ACL ruptures as well as re-injury.
The way a person moves when they are changing direction or landing from a jump can put the ACL at risk of injury. The preventative warm-up programme targets movement patterns by incorporating, strength, plyometrics (springy-ness) and sport-specific agility training.
These programmes are easy to perform requiring no specific equipment. They can take the place of more traditional warm-ups and if performed regularly before each training session they can reduce injury rates by up to 50%. Adoption of correct knee positioning at landing and when performing cutting movements during these warm-up programmes is key to their success.
Further Reading
There is a large amount of published literature in this area. Here is a list of some of the key papers for those that want to delve deeper into the evidence:
ACL injury rates/ACL reconstruction rates
- Kooy CEVW et al. (2023)Major Increase in Incidence of Pediatric ACL Reconstructions From 2005 to 2021: A Study From the Norwegian Knee Ligament Register. Am J Sports Med.Sep;51(11):2891-2899
- Maniar, N. et al (2022). Trends in Australian knee injury rates: An epidemiological analysis of 228,344 knee injuries over 20 years. The Lancet Regional Health – Western Pacific, 21.
- Nogaro, M.-C. (2020). Paediatric and adolescent cruciate ligament reconstruction surgery. The Bone & Joint Journal, 239-245.
- Weitz FK et al. (2020) The incidence of paediatric ACL injury is increasing in Finland. Knee Surg Sports Traumatol Arthrosc. 28(2):363-368
Effectiveness of ACL injury prevention programmes
- Huang YL et al. (2020). A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by Injury Prevention Programs: A Systematic Review of Randomized Controlled Trials and Cluster-Randomized Controlled Trials With Meta-analysis. Am J Sports Med. 48(6):1505-1515.
- Ardern CL,et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Br J Sports Med. 2018 Apr;52(7):422-438
- Mandelbaum, B. et al. (2005). Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med, 33(7), 1003-10.
Positive impact of ACL Injury Prevention Programmes on Team Performance
- Silvers-Granelli, et al. (2023). High Compliance with the 11+ Injury Prevention Program Results in Better Win-Loss Records. International journal of sports physical therapy, 18(5), 1065–1075
Key Components of ACL Injury Prevention Programmes
- Sugimoto, D. et al (2016). Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis. British journal of sports medicine, 50(20), 1259–1266.
Cost-Effectiveness of ACL Injury Prevention Programmes
- Marshall, D. A. et al (2016). Economic impact study: neuromuscular training reduces the burden of injuries and costs compared to standard warm-up in youth soccer. British journal of sports medicine, 50(22), 1388–1393.
- Swart, E. et al. (2014) Prevention and screening programs for anterior cruciate ligament injuries in young athletes: a cost-effectiveness analysis. J Bone Joint Surg Am, 96(9), 705-11.
- Lewis, D. et al. (2018) Comparison of four alternative national universal anterior cruciate ligament injury prevention programme implementation strategies to reduce secondary future medical costs. Br J Sports Med, 52(4), 277-282.
Socio-economic costs of ACL injuries
- Herzog, M. et al. (2017). Cost of Outpatient Arthroscopic Anterior Cruciate Ligament Reconstruction Among Commercially Insured Patients in the United States, 2005-2013. Orthop J Sports Med, 5(1).
- Mather, R. et al. (2013). Societal and economic impact of anterior cruciate ligament tears. J Bone Joint Surg Am, 95(19), 1751-9.
Longterm risk of Osteoarthritis following ACL Rupture
- Magnussen, et al. (2013). Anterior Cruciate Ligament Reconstruction and Osteoarthritis: Evidence from Long-Term Follow-Up and Potential Solutions. Cartilage, 4(3 Suppl), 22S–6S
