With more than 200,000 athletes each year suffering injury to the
anterior cruciate ligament (ACL) of the knee, Understanding and
Preventing Noncontact ACL Injuries provides an authoritative
description of the biomechanical, clinical, and injury factors pertinent
to the athletes—primarily girls and young women—who experience this
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With more than 200,000 athletes each year suffering noncontact injury to the anterior cruciate ligament (ACL) of the knee, there is finally an up-to-date reference for professionals whose work involves developing and implementing programs to prevent such injuries. Understanding and Preventing Noncontact ACL Injuries provides an authoritative description of the biomechanical, clinical, and injury factors pertinent to the athletes—primarily girls and young women—who experience this problem.
To help readers understand how to incorporate targeted interventions, the book uses a preventive rather than strictly clinical approach to ACL injuries. It provides a thorough description of the current problem on an international scale, the rationale for developing prevention programs, the discrete risk factors for noncontact ACL injuries, and an analysis of current research data on the effects of interventions designed to prevent these injuries.
Understanding and Preventing Noncontact ACL Injuries will help readers
clearly understand the incidence, cost, and need to quantify risk factors related to the onset of noncontact ACL injuries;
compare various prevention programs and learn why prevention programs should be implemented—especially among young women—to reduce the potential for injury; and
understand the interplay between biomechanical and neuromuscular risk factors and become aware of the role hormones, bracing, and biofeedback play.
Understanding and Preventing Noncontact ACL Injuries is based on proceedings from a conference conducted by the American Orthopaedic Society for Sports Medicine and draws on the work of renowned experts in the field. The book logically progresses through four parts to help physicians, professionals, coaches, and other readers better understand the problem and how they may play a part in its prevention. Part I addresses the problem of ACL injuries, including the incidence of injury, risk factors, and costs associated with injuries. Part II examines injury prevention programs, their similarities and differences, and their relative effectiveness. Part III presents the latest information on biomechanical and neuromuscular mechanisms of ACL injuries. Part IV explores hormonal and anatomic risk factors and preventive bracing for ACL injuries.
To illustrate the preventive approaches that may be used, the book contains photographs of individuals actually performing the progressions involved in the programs. Other helpful resources include take-home messages and clinical notes that relate scientific findings to successful preventive efforts. By providing these tools, the authors hope to provide an easy-to-understand reference that appeals to a broad range of individuals, including athletic directors, coaches, parents, and athletes who would like to learn more about how to implement prevention programs in their schools or other organizations.
Understanding and Preventing Noncontact ACL Injuries is a current and unique resource that will be useful for all people affected by this global issue. By combining scientific factors with injury mechanisms, the book will provide readers with valuable knowledge of ACL injuries and help readers implement programs to prevent them.
An Introduction to Understanding and Preventing ACL Injury Timothy Edwin Hewett, PhD, FACSM
Part I. The Problem of ACL Injuries
Part Editor: Letha Y. Griffin, MD, PhD
Chapter 1. Incidence of ACL Injury Stephen W. Marshall, PhD; Darin Padua, PhD, ATC; and Melanie McGrath, MS, ATC
Human Movement and ACL Injury
What Is Incidence?
What Is the Average Incidence of ACL Injury in the General Population?
National Ambulatory Care Surveys
How Does ACL Injury Incidence Vary by Age and Gender?
How Does the Incidence of ACL Injury Vary By Sport and Gender?
Literature Review Methods
Abstraction of Incidence Data
Synthesis and Commentary
Recommendations for Future Research
Chapter 2. Does ACL Reconstruction Prevent Articular Degeneration? The ACL Risk Equation Paul H. Marks, MD; Kurt P. Droll, MD; and Michelle Cameron-Donaldson, MD
Summary and Future Work
Chapter 3. The Costs Associated With ACL Injury Timothy Edwin Hewett, PhD, FACSM; and Bohdanna T. Zazulak, DPT, MS, OCS
Who Pays for ACL Injury Prevention in the High-Risk Female Athlete?
Informing the High-Risk Female Athlete
Part II. ACL Injury Prevention Programs
Part Editor: Timothy E. Hewett, PhD, FACSM
Chapter 4. Components of Prevention Programs Holly J. Silvers, MPT
Chapter 5. Theories on How Interventions May Influence ACL Injury Rates:
The Biomechanical Effects of Plyometric, Balance, Strength, and Feedback Training Timothy Edwin Hewett, PhD, FACSM; Gregory D. Myer, MS, CSCS; and Kevin R. Ford, MS
Effects of a Comprehensive Program Combined With Either Plyometric or Balance Training Components
Conclusions and Future Directions
Chapter 6. Preventive Training Programs: Changing Strength Ratios Versus Positions of Muscular Efficiency Sandra J. Shultz, PhD, ATC, CSCS
Chapter 7. Effect of Prevention Programs on Performance Christopher M. Powers, PhD, PT; Christine D. Pollard, PhD, PT; and Susan M. Sigward, PhD, PT, ATC
Performance Measure: Vertical Jump Height
Performance Measures: Agility, Strength and Lunge Distance
Performance Measures: Vertical Jump Height, Single-Leg Hop, Speed, and Strength
Performance Measure: Single-Limb Stability
Performance Measures: Balance, Strength, Single-Leg Hop, Triple Jump, and Stair Hop
Chapter 8. Congruence Between Existing Prevention Programs and Research on Risk Factors and Mechanisms of Noncontact ACL Injury William E. Garrett, Jr., MD, PhD; and Bing Yu, PhD
ACL Loading Mechanisms and Risk Factors of Noncontact ACL Injury
Current Training Programs
Future Training Program Development
Chapter 9. Discussion, Summary, and Future Research Goals Lars Engebretsen, MD, PhD
Part III. Biomechanical and Neuromuscular Mechanisms of ACL Injuries
Part Editor: Timothy Edwin Hewett, PhD, FACSM
Chapter 10. Biomechanics Associated with Injury: Athlete Interviews and Review of Injury Tapes Tron Krosshaug and Roald Bahr, MD, PhD
Defining Injury Mechanisms
Describing the Inciting Event
Research Approaches to Describe the Injury Mechanisms
Chapter 11. Clinical Biomechanical Studies on ACL Injury Risk Factors Laura J. Huston, MS
Kinematic and Kinetic Differences
Sidestep and Cutting Maneuvers
Altered Muscle Activation Patterns
Chapter 12. Effects of Neuromuscular Training on Lower Extremity Motion Patterns Bing Yu, PhD; and Marlene DeMaio, MD
Combined Training Programs Including Plyometrics
Chapter 13. Sport-Specific Injury Mechanisms Associated With Pivoting, Cutting, and Landing Mary Lloyd Ireland, MD
Definitions of Mechanism of Injury
Chapter 14. Effects of Muscle Firing on Neuromuscular Control and ACL Injury Timothy Edwin Hewett, PhD, FACSM; Bohdanna T. Zazulak, DPT, MS, OCS; and Gregory D. Myer, MS, CSCS
Differences in EMG Activation Levels Between Males And Females
Summary and Conclusions
Chapter 15. Etiology and Mechanisms of ACL Injury in Alpine Skiing Bruce D. Beynnon, PhD; Carl F. Ettlinger, MSME; and Robert J. Johnson, MD
The Epidemiology of Alpine Skiing Injuries
ACL Injury Mechanisms Associated With Alpine Skiing
Chapter 16. Noncontact ACL Injuries in Dance and Skating Carol D. Teitz, MD
Center Of Gravity and Proprioception
What About Gymnasts?
Chapter 17. The Role of Biofeedback in Preventing Noncontact ACL Injuries Julie R. Steele, PhD; Bridget J. Munro, PhD
The Role of Biofeedback in ACL Injury Prevention
Biofeedback, Neuromuscular Activity and ACL Injury Prevention
Biofeedback, Knee Joint Motion and ACL Injury Prevention
The Role of Biofeedback in Preventing ACL Reinjury
Future Directions for Biofeedback and ACL Injury Prevention
Part IV. Hormonal and Anatomic Risk Factors and Preventive Bracing for ACL Injuries
Part Editor: Sandra J. Shultz, PhD, ATC, CSCS
Chapter 18. Ligament Biology and Its Relationship to Injury Forces James R. Slauterbeck, MD; John R. Hickox, MS; and Daniel M. Hardy, PhD
Relationships Among ACL Injury Factors
Effects of Tissue Remodeling
Sex, Hormones, and ACL Injury
Chapter 19. Hormonal Influences on Ligament Biology Sandra J. Shultz, PhD, ATC, CSCS
Sex Hormone Profiles: Not all Menstrual Cycles Are Created Equal
Sex Hormones Effects on Collagen Structure and Metabolism
Sex Hormones and Knee Joint Laxity and Stiffness
Menstrual Cycle and ACL Injury
Birth Control Hormones, Ligament Biology and ACL Injury
Chapter 20. Anatomical Factors in ACL Injury Risk Sandra J. Shultz, PhD, ATC, CSCS; Anh-Dung Nguyen, MS Ed, ATC; and Bruce D. Beynnon, PhD
Notch Size and Width
Generalized Joint Laxity
Anterior Knee Laxity
Chapter 21. Intrinsic and Extrinsic Forces Associated With ACL Injury: Can Functional Bracing Reduce the Risk of ACL Injury? Bruce D. Beynnon, PhD; and James R. Slauterbeck, MD
The Biomechanics of Knee Bracing
The Effectiveness of Braces in Preventing ACL, ACL Graft, and ACL-Deficient Knee Injuries
About the Editors
A reference for sports medicine physicians, physical therapists, athletic trainers, chiropractors, physiatrists, and coaches.
The American Orthopaedic Society for Sports Medicine (AOSSM) is a national organization of orthopaedic surgeons specializing in sports medicine, including national and international sports medicine leaders. The AOSSM works closely with many other sports medicine specialists and clinicians, including family physicians, emergency physicians, pediatricians, athletic trainers, and physical therapists, to improve the identification, prevention, treatment, and rehabilitation of sports injuries.
Formed in 1972 primarily as a forum for education and research, AOSSM has increased its membership from its modest initial membership of fewer than 100 to over 2,000. There are 67 Accreditation Council for Graduate Medical Education approved fellowships in orthopaedic sports medicine in the United States and Canada.
Members must demonstrate continuing active research and educational activities in the field of sports medicine. Such activities may include service as a team physician at any level of competition; educating persons involved with the health of athletes; service to local, regional, national, and international competitions; and the presentation of scientific research papers at sports medicine meetings. The unifying interest of the membership is their concern with the effects of exercise and the monitoring of its impact on active individuals of all ages, abilities, and levels of fitness.