Restricted accessResearch articleFirst published online 2009-3
Influence of Age,Sex,Technique,and Exercise Program on Movement Patterns After an Anterior Cruciate Ligament Injury Prevention Program in Youth Soccer Players
Background: Anterior cruciate ligament (ACL) injury prevention programs show promising results with changing movement; however, little information exists regarding whether a program designed for an individual’s movements may be effective or how baseline movements may affect outcomes.
Hypothesis: A program designed to change specific movements would be more effective than a “one-size-fits-all” program. Greatest improvement would be observed among individuals with the most baseline error. Subjects of different ages and sexes respond similarly.
Study Design: Randomized controlled trial; Level of evidence, 1.
Methods: One hundred seventy-three youth soccer players from 27 teams were randomly assigned to a generalized or stratified program. Subjects were videotaped during jump-landing trials before and after the program and were assessed using the Landing Error Scoring System (LESS), which is a valid clinical movement analysis tool. A high LESS score indicates more errors. Generalized players performed the same exercises, while the stratified players performed exercises to correct their initial movement errors. Change scores were compared between groups of varying baseline errors, ages, sexes, and programs.
Results: Subjects with the highest baseline LESS score improved the most (95% CI, —3.4 to —2.0). High school subjects (95% CI, —1.7 to —0.98) improved their technique more than pre—high school subjects (95% CI, —1.0 to —0.4). There was no difference between the programs or sexes.
Conclusions: Players with the greatest amount of movement errors experienced the most improvement. A program’s effectiveness may be enhanced if this population is targeted.
American Academy of Pediatrics.Injuries in youth soccer: a subject review. Pediatrics. 2000;105(3):659-661.
2.
Andrews JR, McLeod WD, Ward T., Howard K.The cutting mechanism. Am J Sports Med. 1977 ;5(3):111-121.
3.
Arendt E., Dick R.Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. Am J Sports Med. 1995;23(6):694-701.
4.
Arendt EA, Agel J., Dick R.Anterior cruciate ligament injury patterns among collegiate men and women . J Athl Train.1999;34(2):86-92.
5.
Arms SW, Pope MH, Johnson RJ, Fischer RA, Arvidsson I., Eriksson E.The biomechanics of anterior cruciate ligament rehabilitation and reconstruction . Am J Sports Med. 1984;12(1):8-18.
6.
Beynnon BD, Fleming BC, Johnson RJ, Nichols CE, Renstrom PA, Pope MHAnterior cruciate ligament strain behavior during rehabilitation exercises in vivo. Am J Sports Med. 1995;23(1):24-34.
7.
Beynnon BD, Johnson RJ, Fleming BC, Stankewich CJ, Renstrom PA, Nichols CEThe strain behavior of the anterior cruciate ligament during squatting and active flexion-extension: a comparison of an open and a closed kinetic chain exercise. Am J Sports Med. 1997;25(6):823-829.
8.
Bjordal JM, Arnly F., Hannestad B., Strand T.Epidemiology of anterior cruciate ligament injuries in soccer. Am J Sports Med. 1997;25(3):341-345.
9.
Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr.Mechanisms of anterior cruciate ligament injury. Orthopedics . 2000;23(6):573-578.
10.
Boling MC, Thigpen CA, Padua DAItem specific reliability analyses of the Landing Error Scoring System (LESS) . Med Sci Sports Exerc.2005;37(5):S124.
11.
Caraffa A., Cerulli G., Projetti M., Aisa G., Rizzo A.Prevention of anterior cruciate ligament injuries in soccer: a prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc. 1996;4(1):19-21.
12.
Cerulli G., Benoit DL, Lamontagne M., Caraffa A., Liti A.In vivo anterior cruciate ligament strain behaviour during a rapid deceleration movement: case report. Knee Surg Sports Traumatol Arthrosc.2003;11(5):307-311.
13.
Chappell JD , Creighton RA, Giuliani C., Yu B., Garrett WEKinematics and electromyography of landing preparation in vertical stop-jump: risks for noncontact anterior cruciate ligament injury. Am J Sports Med. 2007;35(2):235-241.
14.
Clark MA, Corn RJIntegrated fitness profile for the fitness professional. In: Clark MA, ed. NASM OPT: Optimum Performance Training for the Fitness Professional. Calabasas, CA: National Academy of Sports Medicine; 2001:115-186.
15.
Colby S., Francisco A., Yu B., Kirkendall D., Finch M., Garrett W. Jr.Electromyographic and kinematic analysis of cutting maneuvers: implications for anterior cruciate ligament injury. Am J Sports Med. 2000;28(2):234-240.
16.
de Loes M., Dahlstedt LJ, Thomee R.A 7-year study on risks and costs of knee injuries in male and female youth participants in 12 sports. Scand J Med Sci Sports. 2000;10(2):90-97.
17.
Decker MJ, Torry MR, Wyland DJ, Sterett WI, Richard Steadman J.Gender differences in lower extremity kinematics, kinetics and energy absorption during landing. Clin Biomech (Bristol, Avon). 2003;18(7):662-669.
18.
Devita P., Skelly WAEffect of landing stiffness on joint kinetics and energetics in the lower extremity. Med Sci Sports Exerc. 1992;24(1):108-115.
19.
DiStefano MJ , Padua DA, Prentice WE, Blackburn JT, Karas SGGender differences in trunk, hip, and knee kinematics during sidestep cutting between Division I soccer athletes. J Athl Train.2005;40:S59.
20.
Emery CA, Rose MS, McAllister JR, Meeuwisse WHA prevention strategy to reduce the incidence of injury in high school basketball: a cluster randomized controlled trial. Clin J Sport Med. 2007;17(1):17-24.
21.
Engstrom B, Johansson C, Tornkvist H. Soccer injuries among elite female players. Am J Sports Med.1991;19(4):372-375.
22.
Faigenbaum AD, Bellucci M., Bernieri A., Bakker B., Hoorens K.Acute effects of different warm-up protocols on fitness performance in children. J Strength Cond Res. 2005;19(2):376-381.
23.
Fleming BC, Renstrom PA, Ohlen G., et al. The gastrocnemius muscle is an antagonist of the anterior cruciate ligament. J Orthop Res. 2001;19(6):1178-1184.
24.
Gomez E., DeLee JC, Farney WCIncidence of injury in Texas girls’ high school basketball. Am J Sports Med. 1996;24(5):684-687.
25.
Granan LP, Bahr R., Steindal K., Furnes O., Engebretsen L.Development of a national cruciate ligament surgery registry: the Norwegian national knee ligament registry. Am J Sports Med. 2008;36(2):308-315.
26.
Granata KP, Padua DA, Wilson SEGender differences in active musculoskeletal stiffness. Part II: quantification of leg stiffness during functional hopping tasks. J Electromyogr Kinesiol. 2002;12(2):127-135.
27.
Granata KP, Wilson SE, Padua DAGender differences in active musculoskeletal stiffness. Part I: quantification in controlled measurements of knee joint dynamics. J Electromyogr Kinesiol. 2002;12(2):119-126.
28.
Grandstrand SL, Pfeiffer RP, Sabick MB, DeBeliso M., Shea KGThe effects of a commercially available warm-up program on landing mechanics in female youth soccer players. J Strength Cond Res. 2006;20(2):331-335.
29.
Griffin LY, Albohm MJ, Arendt EA, et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med.2006;34(9):1512-1532.
30.
Gwinn DE, Wilckens JH, McDevitt ER, Ross G., Kao TCThe relative incidence of anterior cruciate ligament injury in men and women at the United States Naval Academy. Am J Sports Med. 2000;28(1):98-102.
31.
Heidt RS Jr , Sweeterman LM, Carlonas RL, Traub JA, Tekulve FXAvoidance of soccer injuries with preseason conditioning. Am J Sports Med. 2000;28(5):659-662.
32.
Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FRThe effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study. Am J Sports Med. 1999;27(6):699-706.
33.
Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005 ;33(4):492-501.
34.
Hewett TE, Zazulak BT, Myer GD, Ford KRA review of electromyographic activation levels, timing differences, and increased anterior cruciate ligament injury incidence in female athletes. Br J Sports Med. 2005;39(6):347-350.
35.
Huston LJ, Vibert B., Ashton-Miller JA, Wojtys EMGender differences in knee angle when landing from a drop-jump. Am J Knee Surg.2001;14(4):215-219, discussion 219-220.
36.
Huston LJ, Wojtys EMNeuromuscular performance characteristics in elite female athletes. Am J Sports Med. 1996;24(4):427-436.
Junge A., Rosch D., Peterson L., Graf-Baumann T., Dvorak J.Prevention of soccer injuries: a prospective intervention study in youth amateur players. Am J Sports Med. 2002;30(5):652-659.
39.
Leininger RE, Knox CL, Comstock RDEpidemiology of 1.6 million pediatric soccer-related injuries presenting to US emergency departments from 1990 to 2003. Am J Sports Med.2007;35(2):288-293.
40.
Lindenfeld TN, Schmitt DJ, Hendy MP, Mangine RE, Noyes FRIncidence of injury in indoor soccer. Am J Sports Med. 1994;22(3):364-371.
41.
Lohmander LS , Ostenberg A., Englund M., Roos H.High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. 2004;50(10):3145-3152.
42.
Mandelbaum BR, Silvers HJ, Watanabe DS, et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med. 2005;33(7):1003-1010.
43.
Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GA, Slauterbeck JLCombined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res.1995;13(6): 930-935.
44.
Markolf KL, Gorek JF, Kabo JM, Shapiro MSDirect measurement of resultant forces in the anterior cruciate ligament: an in vitro study performed with a new experimental technique. J Bone Joint Surg Am. 1990;72(4):557-567.
45.
Marshall SW, Padua DA, McGrath MLIncidence of ACL injury. In: Hewett TE , Shultz SJ, Griffin LY, eds. Understanding and Preventing Noncontact ACL Injuries: American Orthopaedic Society for Sports Medicine. Champaign, IL: Human Kinetics;2007 :9.
46.
Messina DF, Farney WC, DeLee JCThe incidence of injury in Texas high school basketball: a prospective study among male and female athletes. Am J Sports Med. 1999;27(3):294-299.
47.
Myer GD, Ford KR, Brent JL, Hewett TEDifferential neuromuscular training effects on ACL injury risk factors in "high-risk" versus "lowrisk" athletes. BMC Musculoskelet Disord . 2007;8:39.
48.
Myer GD, Ford KR, Brent JL, Hewett TEThe effects of plyometric vs. dynamic stabilization and balance training on power, balance, and landing force in female athletes. J Strength Cond Res. 2006;20(2): 345-353.
49.
Myer GD, Ford KR, McLean SG, Hewett TEThe effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics. Am J Sports Med. 2006;34(3):445-455.
50.
Myklebust G. , Engebretsen L., Braekken IH, Skjolberg A., Olsen OE, Bahr R.Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med. 2003;13(2):71-78.
51.
Olsen OE, Myklebust G., Engebretsen L., Holme I., Bahr R.Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. BMJ. 2005;330(7489):449.
52.
Padua DAThe evaluation process in rehabilitation. In: Prentice WE, ed. Rehabilitation Techniques for Sports Medicine and Athletic Training. Vol 4. New York: McGraw-Hill; 2004:49-70.
53.
Padua DA, Marshall SWEvidence supporting ACL-injury-prevention exercise programs: a review of the literature. Athletic Therapy Today. 2006;11(2):11-23.
54.
Padua DA, Marshall SW, Beutler AI, Boling MC, Thigpen CADifferences in jump-landing technique between ACL injured and non-injured individuals: a prospective cohort study. J Athletic Train.2007;42(2):S85.
55.
Padua DA, Marshall SW, Onate JA, et al. Reliability and validity of the Landing Error Scoring System: implications on ACL injury risk assessment. J Ath Train.2004;39(2):S110.
56.
Pfeiffer RP , Shea KG, Roberts D., Grandstrand S., Bond L.Lack of effect of a knee ligament injury prevention program on the incidence of noncontact anterior cruciate ligament injury. J Bone Joint Surg Am. 2006;88(8):1769-1774.
57.
Powell JW, Barber-Foss KDSex-related injury patterns among selected high school sports. Am J Sports Med.2000;28(3):385-391.
58.
Prapavessis H., McNair PJ, Anderson K., Hohepa M.Decreasing landing forces in children: the effect of instructions. J Orthop Sports Phys Ther. 2003;33(4):204-207.
59.
Shea KG, Pfeiffer R., Wang JH, Curtin M., Apel PJAnterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop. 2004;24(6):623-628.
60.
Shelburne KB , Pandy MGDeterminants of cruciate-ligament loading during rehabilitation exercise. Clin Biomech (Bristol, Avon). 1998;13(6):403-413.
61.
Soderman K. , Werner S., Pietila T., Engstrom B., Alfredson H.Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surg Sports Traumatol Arthrosc.2000;8(6):356-363.
62.
Strickland LJ, Padua DA, DiStefano MJ, Marshall SWPre-participation evaluation of jump-landing technique in youth soccer athletes: effects of age, skill level and sex. J Athletic Train. 2007;42(2):S83-84.
63.
Wang JB, Rubin RM, Marshall JLA mechanism of isolated anterior cruciate ligament rupture: case report. J Bone Joint Surg Am. 1975;57(3):411-413.
64.
Wedderkopp N., Kaltoft M., Lundgaard B., Rosendahl M., Froberg K.Prevention of injuries in young female players in European team handball: a prospective intervention study. Scand J Med Sci Sports.1999;9(1):41-47.
65.
Yu B., McClure SB, Onate JA, Guskiewicz KM, Kirkendall DT, Garrett WEAge and gender effects on lower extremity kinematics of youth soccer players in a stop-jump task. Am J Sports Med. 2005 ;33(9):1356-1364.
66.
Zarins B., Nemeth VAAcute knee injuries in athletes. Orthop Clin North Am. 1985;16(2):285-302.
67.
Zarins B., Rowe CR, Harris BA, Watkins MPRotational motion of the knee. Am J Sports Med. 1983;11(3):152-156.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
