Minimising ACL ruptures in female athletes Jacinta Horan & Jess - - PowerPoint PPT Presentation

Minimising ACL ruptures in female athletes Jacinta Horan & Jess Meyer

WHISPA

• Multidisciplinary group
• HPSNZ & external
• Evidence based guideline production and dissemination
• Physio focus on ACL injuries
• Website and resources available

Statistics

2013

• >5000 ACL ruptures/year
• 15 - 29 years largest incidence
• Sport breakdown – 24% of all ACL ruptures across rugby, netball and soccer
• 2948 ACL reconstructions in NZ
• 68% ACL reconstructions = rugby, netball and soccer
• Surgery = $29.5 million
• $8 million other costs
• $3-5 million additional healthcare costs ie physio
• total costs > $40 million per year

Costs

• Individuals, healthcare systems and teams
• Financial
• Time
• Social – ie isolation, decreased self esteem
• Psychological aspects of missed athletic performance
• Long term disability – OA
• 20 – 50% never return to same level of sport
• Team performance – teams with the least injuries win the most

Research

• ACL rupture rates are 4 – 8 x higher in females than their corresponding male

counterparts in the same sports (Arendt et al, Bjordal et al, Engstrom et al, Gray et al)

• Female and male rates equivalent pre puberty
• ACL ruptures are predominantly non contact in nature:
• deceleration
• change of direction manoeuvre
• landing injury
• Increasing frequency of ACL injuries in our female athletic population

Risk factors

• There are a large number of potential intrinsic and extrinsic risk factors including but

not limited to:

• Genetics
• Gender
• Neuromuscular control
• Anatomic
• Biomechanical
• Hormone

Research and risk factors

• ACL rupture is greater during the pre-ovulatory phase
• The effects are on the active restraints of the knee:
• neuromuscular control – modifiable risk
• Post puberty females:
• strength, power and control doesn’t increase as it does in males
• reduced neuromuscular control

Neuromuscular control

MODIFIABLE RISK FACTOR – ACL ruptures

• Neuromuscular control deficits in jump

landing, cutting and deceleration.

• Valgus knee collapse characteristic of

female ACL injury

Prevention programmes

• Neuromuscular retraining reduces the number of ACL injuries in young

female athletes in team sports

• Positive effects on those with and without history of ACL ruptures
• Greatest effects on athletes 14 – 18 yrs age
• Power, strength and neuromuscular control are poorer in this age group

Particulars of ACL Prevention Programmes

• Frequency and length of time required is unknown
• Higher the volume of prevention training the greater the reductions in

ACL injuries

• >1 x per week to be effective
• Must start in the preseason
• Must include neuromuscular control, plyometrics and sports specific

skills such as cutting

• Multifaceted programme

Particulars cont.

• Team warm up ideal situation
• Coach led
• Supervised
• Feedback given on technique in order to be most effective
• Higher compliance = greater results
• Ideally starts pre puberty ie 11 – 12 yrs age for best results

Research results on “Prevention Programmes”

• Reduction in ALL ACL injury rates up to 50%
• Contact and non contact
• Male and female
• Reduction ACL injury rates up to 70% (non contact)
• Reduction in ACL injury rates = male baseline rates
• (Webster & Hewitt, 2018)

Current NZ Warmup prevention programmes

• http://netballnz.co.nz/useful-info/netball-smart
• https://www.rugbysmart.co.nz/sportsmart-warm-up
• http://fit4football.co.nz/the-11plus/11plus
• http://fit4football.co.nz/the-11plus/11plus-kids

Comparison of NZ ACC sports smart warmups to research findings

✔ Multifaceted programmes ✔ Time appropriate ✔ Warmup based ✔ Frequency recommended appropriate ✔ Online resources identify importance of correct technique What is needed?

• Education and buy in:
• sports, schools, clubs, coaches, managers, parents and athletes particularly from

young ages

• Netball and football currently in process of rolling out regionalised programmes of

their sportsmart warmups

ACLs and Performance

• Teams and individual athletes with least number of injuries WIN the

most

• Ability to complete >80% of full training over the year results in 7 x

higher chance of athletes achieving their performance goals

• Reduced injury rates -> Maximised training potential - > Increased

success

WHISPA recommendations