ACL INJURY PREVENTION

JOSEPH NOAH, M.D.SUNCOAST ORTHOPAEDIC SURGERY AND SPORTS

MEDICINE

ACL ANATOMY

TWO BUNDLE LIGAMENT (ANTEROMEDIAL AND POSTEROLATERAL)

ORIGINATES FROM FEMUR AND INSERTS ONTO TIBIA

HIGHLY INNERVATED AND VASCULAR

ACL FUNCTION

ESSENTIAL FOR NORMAL KNEE FUNCTION

PREVENTS EXCESSIVE ANTERIOR TRANSLATION AND ROTATION OF THE TIBIA ON THE FEMUR

PREVENTS EXCESSIVE HYPEREXTENSION

SECONDARY RESTRAINT TO VALGUS/VARUS STRESS

ACL INJURIES AS MANY AS 200,000

INJURIES OCCUR ANNUALLY

CAN OCCUR IN BOTH WITH CONTACT AND NONCONTACT SPORTS

INJURY RATES SHOW A SIGNIFICANT GENDER DISPARITY ESPECIALLY IN NONCONTACT INJURY

ACL INJURIESCONTACT

HYPEREXTENSION INJURY

ASSOCIATED MORE WITH COLLISION SPORTS

REQUIRES A LOAD APPLIED TO A PLANTED FOOT

ASSOCIATED WITH A HIGHER RATE OF MULTIPLE STRUCTURE (LIGAMENT) DAMAGE

ACL INJURIESCONTACT

VALGUS COLLISION

NO EFFECTIVE BRACING TECHNIQUE

NO EFFECTIVE EXERCISE OR PREVENTATIVE PROGRAM ESTABLISHED

NOT PART OF THIS DISCUSSION

ACL INJURIESNONCONTACT

HYPEREXTENSION/ ROTATIONAL FORCE

VALGUS/ROTATIONAL FORCE

DECELERATION INJURY SEEN MORE IN

FEMALE ATHLETES

ACL INJURY STATS 46,000 GIRLS 19 YRS

AND YOUNGER IN 2006 (CDC).

GIRLS 8X AS LIKELY TO INJURE ACL

GIRLS UNDER 14 HAVE 5X RATES OF TEARS COMPARED TO BOYS

70% OF INJURIES WERE NONCONTACT

ACL INJURIESWHY SHOULD WE CARE?

SIGNIFICANT INJURY SURGICAL

RECONSTRUCTION OFTEN REQUIRED

LENGTHY REHABILITATION

POSSIBLE LONGTERM DAMAGE (POST TRAUMATIC ARTHRITIS)

ACL INJURYINTERNAL FACTORS

SMALLER FEMORAL NOTCH (SMALLER ACL)

WIDER PELVIS (INCREASE IN “Q” ANGLE)

HORMONAL FACTORS QUAD/HAMSTRING

RATIO NERVE AND MUSCLE

COORDINATION FOOT PRONATION

ACL INJURYEXTERNAL FACTORS

ATHLETE BEING DISTRACTED OR BUMPED JUST BEFORE DECELERATION OR LANDING

WOMEN RUN AND CUT IN A MORE ERECT POSTURE (KEEPS KNEE MORE EXTENDED)

HIPS BEHIND KNEES LANDING FROM A JUMP

ACL INJURYPREVENTION

ACL PREVENTION PROTOCOL ESSENTIAL FOR THE FEMALE ATHLETE EVEN AFTER INJURY

INCREASED RATE OF REINJURY AFTER RECONSTRUCTION

20% INJURY RATE TO THE CONTRALATERAL KNEE

CAN ALSO BE EFFECTIVE FOR MALE ATHLETES

HELPS PREVENT NONCONTACT INJURIES

NO IMPACT ON CONTACT INJURIES

ACL PREVENTIONGOALS OF PROGRAM

AVOIDING VULNERABLE POSITIONS

LEARNING HOW TO FALL INCREASING FLEXIBILITY INCREASING STRENGTH PLYOMETRIC EXERCISES

IN TRAINING INCREASING

PROPRIOCEPTION

ACL INJURY PREVENTION PROGRAM

PERFORMED 2-3/WK DURING SEASON

WARM UP STRETCHING STRENGTHENING PLYOMETRICS SPORTS SPECIFIC

AGILITY TRAINING COOL DOWN

ACL INJURY PREVENTION PROGRAM

WARM UPS STRETCHING

JOG LINE TO LINE SHUTTLE RUN (SIDE

TO SIDE) BACKWARDS RUN

CALF STRETCH QUAD STRETCH HAMSTRING STRETCH ADDUCTOR STRETCH HIP FLEXOR STRETCH

ACL INJURYPREVENTION PROGRAM

GENERAL EXERCISES

WALKING LUNGES RUSSIAN HAMSTRINGS SINGLE TOE RAISE LATERAL HOPS OVER

CONE OR BALL FORWARD/BACKWARD

HOPS SINGLE LEG HOPS

OVER CONE

ACL INJURYPREVENTION PROGRAM

PLYOMETRIC EXERCISES SHOULD BE INCLUDED IN WORK OUT.

EXPLOSIVE EXERCISES DESIGNED TO BUILD POWER, STRENGTH AND SPEED

IMPORTANCE IS ON LANDING TECHNIQUE

IT MUST BE SOFT

ACL INJURYPREVENTION PROGRAM

SPORTS SPECIFIC EXERCISES

VERTICAL JUMPS WITH SPORTS SPECIFIC ACTIVITY (HEADER, CATCHING A BALL)

SQUATTING (HIPS BACKWARDS AS IF SITTING)

SCISSOR JUMPS LUNGES DIAGONAL RUNS BOUNDING RUNS

ACL INJURY PREVENTION PROGRAM

COOL DOWN IMPORTANT, SO DON’T

SKIP ALLOWS MUSCLES TO

ELONGATE AND DETERS MUSCLE SORENESS

ACL INJURY PREVENTION PROGRAM

CAN SIGNIFICANTLY REDUCE RISK IN NONCONTACT ACL INJURIES (MORE IN WOMEN)

HELP PREVENT REINJURY AFTER ACL RECONSTRUCTION

REDUCE INJURY IN THE CONTRALATERAL LIMB

THANK YOU