Download - Prevention of ACL Injuries
Prevention of Prevention of ACL InjuriesACL InjuriesKambiz Behzadi, M.DKambiz Behzadi, M.D
Sports Medicine Sports Medicine
andand
Reconstructive SurgeryReconstructive Surgery
Prevention of Prevention of ACL InjuriesACL Injuries
Anterior Cruciate Ligament Injuries: “ACL”Anterior Cruciate Ligament Injuries: “ACL” 100,000 ACL tears every year100,000 ACL tears every year Majority in 15 to 25 year oldsMajority in 15 to 25 year olds Cost to society 1.5 Billion dollars a yearCost to society 1.5 Billion dollars a year Short term, loss of participation and game Short term, loss of participation and game
timetime Long term, higher chance of arthritis in Long term, higher chance of arthritis in
futurefuture
Prevention of ACL Prevention of ACL injuriesinjuries
Common problem in young athleteCommon problem in young athlete Girls more susceptible to injuryGirls more susceptible to injury Incidence 2 to 8 times higher in girlsIncidence 2 to 8 times higher in girls Why?Why? Is there anything we can do to Is there anything we can do to
prevent it?prevent it?
AnatomyAnatomy
Patella, knee capPatella, knee cap Femur, thigh boneFemur, thigh bone Tibia, lower leg boneTibia, lower leg bone Fibula, small leg Fibula, small leg
bonebone Articular CartilageArticular Cartilage Meniscal CartilageMeniscal Cartilage Major LigamentsMajor Ligaments
ACL ACL PCLPCL
ACLPCL
Articular Cartilage
MeniscalCartilage
FunctionFunction
Load BearingLoad Bearing.articular cartilage.articular cartilage.meniscal cartilage.meniscal cartilage
LigamentsLigaments.tightness of the .tightness of the kneeknee.primary stabilizers.primary stabilizers
Muscles Muscles .control of the .control of the knee .secondary knee .secondary stabilizersstabilizers
Mechanism of InjuryMechanism of Injury
When the athlete When the athlete plants his/her leg plants his/her leg on the ground the on the ground the ACL is engaged ACL is engaged and the Knee is and the Knee is stablestable
Major function = Major function = restrict tibia from restrict tibia from moving to the frontmoving to the front
Neuromuscular control Neuromuscular control and Proprioceptionand Proprioception
A Complex array of nerves, muscles, A Complex array of nerves, muscles, bones, ligaments, and cartilages work bones, ligaments, and cartilages work together to optimize what we know as together to optimize what we know as sports performancesports performance
Neuromuscular ControlNeuromuscular Control: unconscious : unconscious control of our movements and control of our movements and muscles by our brain stemmuscles by our brain stem
ProprioceptionProprioception: our body’s ability to : our body’s ability to know where our knees and ankles are know where our knees and ankles are in spacein space
ACL InjuryACL Injury
What happens in What happens in that one in a that one in a million times that million times that the athlete pivots the athlete pivots and the ligament and the ligament tears?tears?
What causes ACL tearsWhat causes ACL tears 70% occur when 70% occur when
there is no contact there is no contact whatsoeverwhatsoever
Biomechanical Biomechanical factorsfactors
Body positionBody position associated with associated with increased risk of increased risk of injuryinjury
Body PositionBody Position ““Crouched Crouched
position”position”.hips and knees bent.hips and knees bent.center of gravity .center of gravity over feetover feet.on their toes.on their toes
““Upright position”Upright position”.center of gravity .center of gravity behind kneebehind knee.flat footed.flat footed.hips and knees .hips and knees straightstraight
Body PositionBody Position
Position of body Position of body during landing, during landing, cutting, pivotingcutting, pivoting
Hips and Knees are Hips and Knees are straightstraight
Landing on flat feetLanding on flat feet This puts ACL at This puts ACL at
riskrisk In contrast: when athlete has In contrast: when athlete has
hips and knees bent, and lands hips and knees bent, and lands on his/her toes, risk of ACL on his/her toes, risk of ACL injury is minimized injury is minimized
Balance of PowerBalance of Power Recruittment PatternRecruittment Pattern Quadriceps muscles Quadriceps muscles
antagonist-antagonist-stress stress ACLACL
Hamstring muscles Hamstring muscles agonist-agonist-protect ACLprotect ACL
Weak hamstringsWeak hamstrings and and strong quadriceps strong quadriceps puts ACL at riskputs ACL at risk
Female Female Quad. dominantQuad. dominant Male Male Hamstring dominantHamstring dominant Hamstrings 60% to Hamstrings 60% to
80% as strong as 80% as strong as Quadriceps Quadriceps
Quadricep
sHam
stri
ngs
Anatomic FactorsAnatomic Factors Intercondylar Intercondylar
NotchNotch Small notchSmall notch Small Ligament Small Ligament
sizesize Alignment of lower Alignment of lower
legleg
Intercondylar notchACL
ACL
Hormonal FactorsHormonal Factors
Estrogen and Estrogen and RelaxinRelaxin
Relax and soft Relax and soft tissuestissues
Does this Does this predispose female predispose female athlete to ACL athlete to ACL injury?injury?
Increased incidence of ACL tears Increased incidence of ACL tears during ovulatory phase?during ovulatory phase?
Moment of InjuryMoment of Injury
Loud PopLoud Pop Tibia subluxes Tibia subluxes
forward and pops forward and pops back inback in
PainPain Lie on turf, get Lie on turf, get
comfortablecomfortable Wait for coaches Wait for coaches
and trainersand trainers
ACL InjuriesACL Injuries Prevention--Biomechanical Factors Prevention--Biomechanical Factors
criticalcritical NeuromuscularNeuromuscular//ProprioceptiveProprioceptive
programsprograms Dramatic reduction in ACL tearsDramatic reduction in ACL tears Plyometric/jump training and Plyometric/jump training and
Balance drillsBalance drills Retrain mind on Retrain mind on body positionbody position
Major StudiesMajor Studies Mandelbaum, PEP Mandelbaum, PEP
program, 80% program, 80% reduction of ACL reduction of ACL injuires over 2 year in injuires over 2 year in girls playing soccer girls playing soccer ages 14 to 18ages 14 to 18
Carraffa, Balance drillsCarraffa, Balance drills Hewett, Jumping drillsHewett, Jumping drills Significant reduction Significant reduction
of ACL tearsof ACL tears in those in those who received who received Neuromuscular Neuromuscular trainingtraining
PEP programPEP program
PPrevent injury revent injury EEnhance nhance PPerformanceerformance Simple, no major equipment, soccer Simple, no major equipment, soccer
ball and coneball and cone 2 to 3 times a week2 to 3 times a week Incorporate into practice sessionsIncorporate into practice sessions Retrain your body positioning in spaceRetrain your body positioning in space It is all about prevention, more time It is all about prevention, more time
playing and less time on the benchplaying and less time on the bench