0
Commentary and Perspective   |    
An Ounce of Prevention Beats a Pound of ReconstructionCommentary on an article by Patrick Sadoghi, MD, et al.: “Effectiveness of Anterior Cruciate Ligament Injury Prevention Training Programs”
Rick W. Wright, MD
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

This article was chosen to appear electronically on March 28, 2012, in advance of publication in a regularly scheduled issue.



Disclosure: The author did not receive payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. He, or his institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. The author has not had any other relationships, or engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 May 02;94(9):e60 1-1. doi: 10.2106/JBJS.L.00224
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case
Vavken and coauthors have performed a systematic literature review and meta-analysis of a timely topic. The issue of anterior cruciate ligament (ACL) injury prevention strategies continues to become increasingly important. One of the first questions that patients ask once they have been diagnosed with an ACL tear is, “Could I have prevented this?” The importance of prevention continues to be borne out in the ACL literature. Our recent systematic review in JBJS demonstrated that, at a minimum follow-up of five years after ACL reconstruction, the risk of sustaining an ACL tear in the contralateral knee is 11.8% compared with a 5.8% risk of a repeat ACL tear in the reconstructed knee1. Obviously, preventing these injuries would decrease health-care costs and decrease these patients’ risk of future osteoarthritis and limited activity.
The authors’ stated goals for the present literature review were to determine whether currently practiced prevention therapies decrease the risk of ACL injuries, to identify the best prevention program, and to assess the validity of the review's findings. As is the case in many areas of orthopaedics, the included studies were not homogeneous and had a variety of levels of evidence.
The effectiveness of the injury prevention programs was reported by a variety of methods in the included studies. The authors of the review pooled the ACL injury rates and calculated an overall risk ratio of 0.38, corresponding to a 62% decrease in the risk of ACL injury in the treated groups. The decrease in risk was noted to be 85% for male subjects but only 52% for female subjects. Some of the included trials included both contact and noncontact ACL injuries, which further complicated determining a true risk reduction.
The heterogeneity precluded the authors from determining the best set of activities for ACL injury prevention. However, the successful programs typically focused on neuromuscular training performed for a minimum of ten minutes three times a week.
The scientific quality of many of the included studies was low, and this represented a limitation of the review. The heterogeneity in the design and outcome measures of the included studies was a further limitation but was well handled by the authors of the review. They have demonstrated that these training programs have a definite impact in decreasing the risk of ACL injury. They have demonstrated the need for additional research to determine the most effective exercises to reduce this risk. There is a critical need for additional research in this area to improve the safety of active individuals who are at risk for ACL injuries.

Reference

Wright  RW;  Magnussen  RA;  Dunn  WR;  Spindler  KP. Ipsilateral graft and contralateral ACL rupture at five years of more following ACL reconstruction: a systematic review. J Bone Joint Surg Am.  2011;93:1159-65.
 

Submit a comment

References

Reference

Wright  RW;  Magnussen  RA;  Dunn  WR;  Spindler  KP. Ipsilateral graft and contralateral ACL rupture at five years of more following ACL reconstruction: a systematic review. J Bone Joint Surg Am.  2011;93:1159-65.
 
Accreditation Statement
These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
CME Activities Associated with This Article
Submit a Comment
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe





Related Content
The Journal of Bone & Joint Surgery
JBJS Case Connector
Related Audio and Videos
PubMed Articles
Clinical Trials
Readers of This Also Read...
JBJS Jobs
03/19/2014
MA - The University of Massachusetts Medical School
03/17/2014
CT - Orthopaedic Foundation
04/16/2014
CT - Yale University School of Medicine
04/02/2014
IL - Hinsdale Orthopaedics