Preventing a Second ACL Injury

Preventing a Second ACL Injury

I was happy to find this research.

I know, I try to do these research blog posts once a week.  I like them and I learn a lot.  I hope you do as well.

I know, it ends up being once every two weeks.

Here we go.

What Increases Your Risk of Another ACL Injury?

One piece of information that was missing was details when it comes to having a second ACL injury.  This piece of research that I found filled in that hole.

I am so happy, this has been bugging me for some time.

Here are a few details that I got out of the introduction that I found very interesting.

Anterior cruciate ligament (ACL) rupture is linked to:

  • short-term functional deficits (affects what you can do)
  • premature development of osteoarthritis
  • significant progressive disability
These results can occur despite surgical or nonsurgical intervention.

Looking at what is the likelihood that an athlete will have a second ACL injury of the same leg or other leg after returning to sport after having ACL surgery is:

  • 1 in 4 (25%) to 1 in 17 (6%)
  • Often occurs within the first two years
  • 12% sustained a second ACL injury within 5 years
  • 1 in 3.7 individuals have a second ACL injury within 10 years
  • The risk of a second ACL injury is a lot higher than the initial ACL injury

Younger athletes were at higher risk:

  • 17% of patients under the age of 18 years sustained a second ACL injury
  • 4% over the age of 25 years sustained a second injury
Risk of second ACL injury is greatest in individuals with a history of an initial ACL injury caused by contact with another player and with return to cutting and pivoting sport activities.

Now let’s get to the research.

What They Looked at

They looked at what factors demonstrate an increased risk of a second ACL injury.

What They Did

They assessed 56 athletes (35 female, 21 male) by looking at three things.  They tested:

  1. Using 3 dimensional motion during a drop vertical jump (Jump off a 31 cm box, land on the ground, and jump straight up.)
  2. Anterior-posterior knee laxity (How much movement is in the knee forward and back.)
  3. Postural stability assessment (Sanding on one leg with arms crossed on an unstable platform.)

This was done before going back to pivoting and cutting sports.  Over the next 12 months they followed the athletes to see if they had a second ACL injury and 13 did.

What They Found

The study findings indicate:

  • Increase in net hip rotation moment impulse (Knee rotating in) – Greater hip external rotator moment may act to restrain internal rotation motion during landing phase.  Participants with less external rotation were 8 times more likely to re-injury their ACL.
  • Frontal plane knee range of motion during landing (Knee collapsing in) – Increased frontal plane motion were 3 times more likely to re-injury.
  • Asymmetries in sagittal plane knee moments at initial contact (Knee moving forwards) – Lead to 4.1 times re-injury rate.
  • Postural stability are collectively (single leg standing) – Increases risk 2 times.
are all strong predictor of a second ACL

Where to get more information – Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE. (2010). Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med. 2010 Oct;38(10):1968-78. Epub 2010 Aug 11.

I have put together an exercise program that people can do to prevent an ACL injury from occurring.  It is an easy program that can be done anywhere.  Here it is:
Another article that I thought was good but did not review was:

Laudner KG, Moline MT, Meister K. (2010). The relationship between forward scapular posture and posterior shoulder tightness among baseball players. Am J Sports Med. 2010 Oct;38(10):2106-12. Epub 2010 Jul 1.

I know it is baseball players but the research is interesting.

A definition that may help when reading is:

What is Scapular dyskinesis?
Scapular dyskinesis is an alteration in the normal position or motion of the scapula during coupled scapulohumeral movements. – Kibler 2003)
Here is one more that was interesting.

Myer GD, Ford KR, Khoury J, Succop P, Hewett TE. (2010). Development and validation of a clinic-based prediction tool to identify female athletes at high risk for anterior cruciate ligament injury. Am J Sports Med. 2010 Oct;38(10):2025-33. Epub 2010 Jul 1.

It was interesting to see which laboratory and clinical test you used to determine high risk.

I think that is it.

Have a great day!

Rick Kaselj, MS