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Document Title: Griffin-AJSM-Sep06.shtml
Article Title: Understanding and Preventing Noncontact Anterior Cruciate Ligament Injuries -- A Review of the Hunt Valley II Meeting, January 2005
Authors: Letha Y. Griffin, MD, PhD, Marjorie J. Albohm, MS, ATC, Elizabeth A. Arendt, MD, Roald Bahr, MD, PhD, Bruce D. Beynnon, PhD, Marlene DeMaio, CAPT, MC, USN, Randall W. Dick, MSc, Lars Engebretsen, MD, PhD, William E. Garrett, MD, PhD, Jr, Jo A. Hannafin, MD, PhD, Tim E. Hewett, PhD, Laura J. Huston, MSc, Mary Lloyd Ireland, MD, Robert J. Johnson, MD, Scott Lephart, PhD, ATC, Bert R. Mandelbaum, MD, Barton J. Mann, PhD, Paul H. Marks, MD, Stephen W. Marshall, PhD, Grethe Myklebust, PhD, Frank R. Noyes, MD, Christopher Powers, PhD, Clarence Shields, MD, Jr, Sandra J. Shultz, PhD, ATC, Holly Silvers, MPT, James Slauterbeck, MD, Dean C. Taylor, MD, Carol C. Teitz, MD, Edward M. Wojtys, MD, and Bing Yu, PhD.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: September 2006
Volume 34, pages 1512-1532
Keywords: ACL tearing, knee biomechanics, epidemiology, female athlete injury prevention
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: This article, a compilation of insights from dozens of knee experts from around the world, provides a comprehensive overview of noncontact (i.e. planting-and-twisting, also known as cutting-type or pivoting) ACL injuries. The authors note that degenerative changes continue to plague ACL-reconstructed knees, thus showing that top-notch reconstruction and rehabilition is not enough. They note that functional knee bracing does not prevent planting-and-twisting-type knee injuries. This is an obvious finding, given the presence of the easily sheared soft tissues surrounding the leg bones. (Although this article focuses on noncontact ACL injuries, the authors could have noted that bracing is ideal for protecting against sideways forcing and injurious hyperextension, two modes of forcing which also cause a lot of knee injuries. It should be kept in mind that sideways forcing and injurious hyperextension can occur in noncontact settings as well as in contact settings. In other words, noncontact ACL injuries are not always of the twisting type.) The authors do note that using a functional brace with an extension constraint (ideally either a spring in each hinge or a system of crossed straps behind the knee) results in more flexed knees during the landing of jumps -- a desirable situation for female athletes in particular. The authors discuss various training measures aimed at preventing ACL injuries, and also delve into the reasons why females are 2-8 times as likely to incur an ACL tear. They note that there is still a lot of research to be done.
Abstract
The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.
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