NEW ORLEANS, March 14, 2014 -- As youth participation in high-demand sports
such as football, basketball and soccer has increased over the past
decade, so has the number of anterior cruciate ligament (ACL) injuries in teens and young adults.
New research presented today at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons
(AAOS) found that universal neuromuscular training for adolescent
athletes—which focuses on the optimal way to bend, jump, land and pivot
the knee—is an effective and inexpensive way to avoid ACL sprains and
tears.
The
ACL is a critical ligament that stabilizes the knee joint. An ACL
injury, one of the most common sports injuries, often requires surgery
and a lengthy period of rehabilitation before an athlete can return to
sport and other activities. Recent research has found that screening
tools, such as "hop" or isokinetic (computer/video) tests to identify
neuromuscular deficits, as well as neuromuscular training programs, may
reduce ACL injuries.
"Use
of both preventative measures and screening tools sounds appealing, but
often there are significant financial, administrative and social
hurdles that have to be overcome before they can be implemented on a
widespread level," said lead study author Eric F. Swart, MD, an orthopaedic resident at Columbia University Medical Center in New York.
Researchers
evaluated three strategies for young athletes: no training or
screening, universal neuromuscular training, and universal screening
with neuromuscular training for identified high-risk athletes only. Risk
of injury, risk reduction from training and sensitivity and specificity
of screening were based on published data from clinical trials. Costs
of training and screening programs were estimated based on existing
literature.
The
research, a modeling study based on data from recent clinical trials,
evaluated a hypothetical cohort of student athletes ages 14 to 22, found
that, on average, universal training reduced the incidence of ACL
injury by 63 percent (from 3 to 1.1 percent per season), while the
screening program, on average, reduced the incidence rate by 40 percent
(from 3 to 1.8 percent).
Out of 10,000 athletes, the model predicted 300
ACL injuries in the no-screening group, 110 in the universal training
group, and 180 in the universal training/screening for "at risk"
athletes group.
Researchers estimated the cost of implementing a
universal training program, including coach and player instruction, at
approximately $1.25 per day. The study authors estimated that ACL reconstruction costs between $5,000 and $17,000. They concluded that universal training is the most cost-effective strategy for reducing ACL injury risk, saving an average of $275 per player per season.
"While
we were not surprised that training was more cost effective than no
intervention, we were impressed at the magnitude of the benefit," said
Dr. Swart. "According to our model, training was so much less expensive
and so much more effective than we anticipated. In addition, fewer
players injured mean fewer surgical reconstruction procedures, which
also saves money.
The research suggests that widely implementing a
universal training strategy could actually pay for itself in terms of
injuries prevented and surgeries avoided, which makes a very appealing
case for primary prevention."
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SOURCE American Academy of Orthopaedic Surgeons
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