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Lack of Effect of a Knee Ligament Injury Prevention Program on the Incidence of Noncontact Anterior Cruciate Ligament Injury
Ronald P. Pfeiffer, EdD, LAT, ATC1; Kevin G. Shea, MD2; Dana Roberts, MS, ATC3; Sara Grandstrand, MS, ATC4; Laura Bond, MS5
1 Department of Kinesiology, K-209, Boise State University, 1910 University Drive, Boise, ID 83725-1710. E-mail address: rpfeiff@boisestate.edu
2 Intermountain Orthopaedics, 600 North Robbins Road, Suite 401, Boise, ID 83702
3 St. Martin's University, 5300 Pacific Avenue S.E., Lacey, WA 98503
4 8100 129th Place S.E., Newcastle, WA 98056
5 Office of Institutional Assessment, Boise State University, 1023 Denver Street, Boise, ID 83725-1515
View Disclosures and Other Information
Note: The authors acknowledge the contributions of Linda Hammann, MS, PT, SCS, LAT, ATC, and Jim Moore, MS, of the Idaho Sports Medicine Institute, Boise, Idaho, and Bill Hirai, PT, St. Luke's Idaho Elks Rehabilitation Services, Boise, Idaho, for their contributions to the development and implementation of the KLIP training program. They also acknowledge the contribution of Peter J. Apel, MD, Winston-Salem, North Carolina, for the production of the KLIP program instructional videotape.
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from St. Alphonsus Orthopaedic Institute, Boise, Idaho. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Center for Orthopaedic and Biomechanics Research (COBR), Boise State University, and Intermountain Orthopaedics, Boise, Idaho

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 Aug 01;88(8):1769-1774. doi: 10.2106/JBJS.E.00616
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Background: Studies have suggested that exercise programs can reduce the incidence of noncontact injuries of the anterior cruciate ligament in female athletes. We conducted a two-year prospective study to assess the effects of a knee ligament injury prevention exercise program on the incidence of noncontact anterior cruciate ligament injuries in high-school female athletes.

Methods: A prospective cohort design was used to study high-school female athletes (playing soccer, basketball, and volleyball) from fifteen schools (112 teams) for two consecutive seasons. The schools were divided into treatment and control groups. The treatment group participated in a plyometric-based exercise program twice a week throughout the season. Practice and game exposures and compliance with the exercise program were recorded on a weekly basis. Suspected noncontact anterior cruciate ligament injuries were confirmed on the basis of the history as well as at the time of surgery and/or with magnetic resonance imaging.

Results: A total of 1439 athletes (862 in the control group and 577 in the treatment group) were monitored. There were six confirmed noncontact anterior cruciate ligament injuries: three in the treatment group, and three in the control group. The incidence of noncontact anterior cruciate ligament injuries per 1000 exposures was 0.167 in the treatment group and 0.078 in the control group, yielding an odds ratio of 2.05, which was not significant (p > 0.05).

Conclusions: Our results suggest that a twenty-minute plyometric-based exercise program that focuses on the mechanics of landing from a jump and deceleration when running performed twice a week throughout the season will not reduce the rate of noncontact anterior cruciate ligament injuries in high-school female athletes.

Level of Evidence: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    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.
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