Kerri Kaiser

Research Paper

ACL tears in Athletes: are athletes, coaches, and trainers thinking

enough about the future

Literature Review

In the early 1900’s women in North America barely participated in any physical

activity, and could not participate in an organized sport like soccer or basketball.

Title IX was passed in 1972 allowing equal opportunities for females to participate

in competitive, organized sports whether it is through the school or just through the

town they lived in. Since more and more females join the world of sports every year,

there has been an increase in the amount of injuries sustained by women every

year. 9,11

The anterior cruciate ligament, more commonly referred as the ACL, is one of

the most important ligaments found in the knee. It works together with other

ligaments like the posterior cruciate ligament

(PCL) to connect the femur and tibia. At the

same time it provides stability, movement, and

flexibility to the lower limbs, but essentially to

the whole body.3 The ACL plays a very

important role in cutting, pivoting, and landing

movements because it keeps both bones in the

leg stable and together, yet allows for fast,

intense movements. This is extremely important in sports like soccer and

basketball, which more and more women start to play each year, because athletes

are always moving side-to-side or stopping quickly and cutting to get away from

their opponent.

Female athletes have 6 times greater the risk of a non-contact ACL injury or

rupture compared to male athletes. 1,2,11 Non-contact simply means there was no

outside force imposing on the athletes ACL. For example, when a soccer player

pivots her body to turn the opposite direction to kick the ball, she could potentially

tear her ACL, but there was no outside

force or contact imposing her like

another player. Unlike when a goalie

dives for a soccer ball and ends up

coming in contact with the other

player’s knees causing extreme external

force on that player’s knees potentially

causing that player’s ACL to tear

because of the external force.

There are a few reasons why

researchers believe that females are more likely to tear their ACL’s than males: the

differences in female and male anatomy, hormones, but most importantly the

biomechanical and neuromuscular differences. 1,8,9 Researchers feel that the

anatomy and hormones of a woman could possibly have a small part in why they

have a greater risk of tearing their ACL, but more research needs to be done to

conclude the direct correlation.9 Almost all researchers agree that there is a direct

link between biomechanical movements and neuromuscular control of the knee and

tearing your ACL. The researchers believe the differences between females and

males biomechanical movements and neuromuscular control is the leading and

most prominent risk factor and why females tear their ACL’s much more than men

do. 1,5,6,9,10,11

To decrease the risk of female athletes tearing their ACL’s, researchers have

done studies to create the best prevention programs to benefit the areas that are

causing the biggest problems. Researches believe if females incorporate muscle

strengthening, agility, flexibility, muscle memory patterns, and proper mechanic

techniques, like jumping and landing, into one program it will decrease females risk

of tearing their ACL. 2,4,5,6,7,10,11 It would be most beneficial for the athletes to

participate in prevention program sessions during the preseason and actual

season.10 The preseason sessions could be used for teaching and learning of the

exercises and proper landing and planting techniques to keep the athletes the safest

and help instill good muscle memory habits. While the in-season programs can be

easily integrated into the warm-up because they are simple exercise that athletes do

not need any extra machines or equipment to do. For example dynamic stretching,

agility drills incorporated with the specific sport being played, and simple

strengthening exercises like lunges would be very beneficial to the athletes.2, 5,10

These studies have came to conclusions that prove prevention programs do

decrease the risk of female athletes tearing their ACL, yet not that many athletes

participate in them. My biggest question is why don’t athletes participate in

prevention programs and why don’t coaches and Athletic Trainers enforce

participation if it will only benefit their athlete.

Methods

I created a few questions to help find out the reasons why athletes, coaches,

and athletic trainers do or do not participate or have their athlete’s participate in

ACL prevention programs, if they are proven to decrease and athlete’s chances of an

ACL tear. I am going to collect this data by creating and giving out surveys to

athletes, specifically female soccer players, female soccer coaches, and athletic

trainers. The questions will be structured because it will allow a clearer focus when

analyzing the collected data. I feel collecting qualitative data is the best option for

this research; collecting very descriptive, rich thoughts, will hopefully help answer

my overall question, be a lead for other research to be created, and help spread

awareness about ACL injuries. At the end of the questions I am going to add an

additional comment section for the people I am interviewing to leave comments and

thoughts pertaining to the research I am conducting.

I chose to look at athletes, coaches, and athletic trainers because I believe

there is a link that ties them all in together and their relationships play a role in

reasons why an athlete would or would not participate in an ACL prevention

program. I contacted the people I am interviewing before giving them the actual

interview to see if it was something they were interested in participating in; if they

were interested I got there contact information so I could contact them via email

and telephone. I am going to administer the survey through email so they have the

link and can answer the questions whenever they have time. Also having their

answers in text form allows for no transcription errors and makes analyzing the

data more efficient rather than having to copy all their writing or words down if the

survey was given on a piece of paper or through phone. When analyzing the data, I

am going to use content analysis and typology. I will look for common themes

throughout the data and put them in common groups based on the themes. These

groups will hopefully show commonality in reasons why athletes do not participate

in ACL prevention programs.

I am going to ask a series of questions that include:

1. For Athletes

a. Have you ever heard about an ACL prevention program?

And if yes, what do you know about it?

b. Have you ever participated in an ACL prevention

program? If yes, how long did you participate in the

program for?

c. If yes to the second question, why did you stop

participating in the program?

d. If no to the second question, why did you never

participate in an ACL prevention program?

e. If you did not know about ACL prevention programs,

but learned that it does decrease your chances of

tearing your ACL, would you now participate in one?

2. For Coaches and Athletic Trainers

a. Have you ever heard about an ACL prevention program?

And if yes, what do you know about it?

b. Have one of your teams/athletes participated in an ACL

prevention program while you were the coach or

athletic trainer? If yes, how long did they do the

program for?

c. If yes to the second question, why did the team stop

participating the program?

d. If no to the second question, why did your team or

athletes never participate in an ACL prevention

program?

e. If you did not know about ACL prevention programs,

but learned that it does decrease an athlete’s chance of

tearing their ACL, would you have your team or athletes

participate in one now? Why or why not?

3. For Athletes, Coaches, and Athletic Trainers:

a. Addition Comments: What more would you like to tell

me pertaining to this issue?

I believe that most athletes, coaches, and athletic trainers have heard

about a type of ACL prevention program, whether they have participated in

one or not. I think a lot of people will actually have participated in one, but

stopped doing it for various reasons. I believe these questions and my

research will help find out these various reasons.

Results and Discussions

I collected surveys to find results in the matter of why female soccer players do or

do not participate in ACL prevention programs and why their coaches and athletic

trainers don’t push their athletes participation. I decided to have a fairly small group

of individuals participate in my research because this would help me collect very

rich, detailed data.

References

1. Mendiguchia J, Ford K, Quatman C, Alentorn-Geli E, Hewett T. Sex Differences in Proximal Control of the Knee Joint. Sports Medicine [serial online]. July 2011;41(7):541-557. Available from: Academic Search Complete, Ipswich, MA. Accessed February 11, 2013.

2. Alentorn-Geli E, Myer G, Cugat R, et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: A review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee Surgery, Sports Traumatology, Arthroscopy [serial online]. November 2009;17(8):859-879. Available from: Academic Search Complete, Ipswich, MA. Accessed February 11, 2013.

3. Ryder S, Johnson R. Prevention of ACL injuries. Journal Of Sport Rehabilitation [serial online]. May 1997;6(2):80. Available from: Academic Search Complete, Ipswich, MA. Accessed February 11, 2013.

4. Paszkewicz J, Webb T, Waters B, McCarty C, Van Lunen B. The Effectiveness of Injury-Prevention Programs in Reducing the Incidence of Anterior Cruciate Ligament Sprains in Adolescent Athletes. Journal Of Sport Rehabilitation [serial online]. November 2012;21(4):371-377. Available from: Academic Search Complete, Ipswich, MA. Accessed February 11, 2013.

5. McCann R, Cortes N, Van Lunen B, Greska E, Ringleb S, Onate J. Neuromuscular Changes following an Injury Prevention Program for ACL Injuries. International Journal Of Athletic Therapy & Training [serial online]. July 2011;16(4):16-20. Available from: Academic Search Complete, Ipswich, MA. Accessed February 11, 2013.

6. Vescovi J, VanHeest J. Effects of an anterior cruciate ligament injury prevention program on performance in adolescent female soccer players. Scandinavian Journal Of Medicine & Science In Sports [serial online]. June 2010;20(3):394-402. Available from: Academic Search Complete, Ipswich, MA. Accessed February 11, 2013.

7. Padua D, Marshall S. Evidence Supporting ACL-Injury-Prevention Exercise Programs: A Review of the Literature. Athletic Therapy Today [serial online]. March 2006;11(2):11-23. Available from: Academic Search Complete, Ipswich, MA. Accessed February 11, 2013.

8. Cooper, J. P., Negrete, R. J., & Schick, E. A. (2007). Lower-limb dominance as a possible etiologic factor in noncontact anterior cruciate ligament tears. Journal of Strength and Conditioning Research, 21(1), 270+. Retrieved from

9. Silvers H. Play at Your Own Risk: Sport, the Injury Epidemic, and ACL Injury Prevention in Female Athletes. Journal Of Intercollegiate Sport [serial online]. June 2009;2(1):81-98. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed February 19, 2013.

10. Barton, C., Herman, K., Malliaras, P., & Morrissey, D. (2012). The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic

review. BMC Medicine, 10, 75. 11. Hewett T, Ford K, Hoogenboom B, Myer G. UNDERSTANDING AND

PREVENTING ACL INJURIES: CURRENT BIOMECHANICAL AND EPIDEMIOLOGIC CONSIDERATIONS – UPDATE 2010. North American Journal Of Sports Physical Therapy [serial online]. December 2010;5(4):234-251. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed February 19, 2013.

12. Picture of Non-contact ACL: http://www.tucsonhoops.com/locker-room/strength-conditioning/reducing-acl-injuries

13. Picture of ACL: http://orthoinfo.aaos.org/topic.cfm?topic=a00297