Does Previous Knee Injury Impact Performance & What Can We Do About It? - Part V

Over the course of the last several weeks, we have been looking at the impact that previous knee injury has on future performance.  Knowing that previous knee injury does impact performance this led us along the logical progression of how do we assess this risk factor and more importantly is there anything we can do about it.  The Johnson et al study guided us on what we should be assessing and the Lopes et al study let us know that we can change these biomechanical factors with the right program. 

Knowing that we can impact injury rates with the right program and that we are assessing athletes for ability to stabilize their lower kinetic chain in frontal plane, it would make sense that programs that focus and train these principles would be more effective.  That led us to the Omi et al Am J Sport Med2018 study.

Effect of Hip-Focused Injury Prevention Training for Anterior Cruciate Ligament Injury Reduction in Female Basketball Players: A 12-Year Prospective Intervention Study.

Purpose: The purpose of this study was to determine the effectiveness of hip focused ACL injury prevention program in female basketball players.

Methods:  This was a prospective intervention study conducted for 12 years.  During the 4 year observation period, incident rates of ACL injuries were collected from female college basketball players.  Following the observation period, a hip focused ACL injury prevention program was implemented for 8 years (the intervention period).  A total of 309 players (age 19.6 years ± 1.2 years, height 163.7 cm ± 5.6 cm, weight 59.1 kg ± 5.1 kg) were tracked and compared with 448 players (age 19.6 years ± 1.1 years, height 162.6 cm ± 5.8 cm, weight 58.0 kg ± 5.7 kg) who participated in the intervention period.  Athletic exposures, ACL numbers and mechanisms of injury, relative risk and absolute risk reduction, numbers need to treat and compliance were analyzed.

Results:

ACL Injuries during the 4 year observation period

• 16 ACL injuries
• 13 of which were non-contact in orientation (81.3%)
• Avg. 4 ACLs/year
• Incident rate = .25/1000 AEs

ACL injuries during the 8 year intervention period

• 9 ACL Injuries
• 8 of which were non-contact in orientation (88.9%)
• Avg. 1.1 ACL/year
• Incident rate = .10/1000 AEs

Discussion:  The hip focused injury prevention program demonstrated significant reduction in the incidence of ACL injury in female collegiate basketball players.  This particular program has a significant focus on hip strengthening and single limb performance.  In addition, there is a fair amount of focus placed on technique and control of the knee in the frontal plane. 

Considering the Lopes et al study and the Omi et al study, one might conclude that assessing an athlete prior to performance of a program like this would not only allow us to measure the pre/post impact to the intervention but also may assist us in progressing an athlete through the series of the exercises to a higher level once stability in the frontal plane is obtained. 

So now that we know what to do about it, we now have some ways we can assess and based on that assessment drive a corrective program.  The final question we need to look at is what we do with those athletes who have had an injury.  Is there anything we can do to help them return to play without increasing risk for reinjure and reducing the impact there is on performance?  To close out this series next week, we will look at the Wren et al study looking at hop test and whether or not this this a good test for return to play.  Next week we will look at the Wren et al J Orth Sport Phy Ther 2018 study.

Also, please make sure to check out our new website at www.iceperform.com where our goal is to help you help others.  #ViPerformAMI

Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment.  He is the founder | developer of the ViPerform AMI, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent is also a competitive athlete in Brazilian Jiu Jitsu.