Overall, despite much scientific research, the incidence and prevalence of ACL injuries still remains high. I do not believe ACL injuries can be completely mitigated as they are so multi-factorial and involve both contact and non-contact situations. And although preventative programs have been found to reduce the incidence of ACL injuries by up to 90% in some cases, I still believe a lot more research needs to be conducted in regards to how much training stimulus is required to produce a protective effect. I understand that many coaches may be sceptical in regards to employing a preventative program, but the research indicates even something as simple as plyometric training can help train neuromuscular control and improve lower leg strength. Overall, I believe something is better than nothing, and if more often than not intervention programs are producing positive outcomes, the coaches really have nothing to lose. The key is to achieve widespread awareness and widespread use; so spread this presentation and message so we can achieve this and help reduce the debilitating consequences this injury has on so many young athletes.

1. Can anterior cruciate ligament
injuries be mitigated?
Ella Ward

2. Overview of presentation
• Background
• Importance of study
• Role of the coach
– Knee valgus
– Jump landing technique
– Strength
– Plyometrics
• Practical applications and further research
• Summary

3. Learning objectives
1. Be aware of the coaches role in reducing the
incidence of ACL injuries.
2. Describe what factors contribute to an
increased risk of injury.
3. Identify different components that can be
incorporated into a preventative program.

4. “ACL injury incidence has been generally
steady over the past few seasons”
(Brent et al 2012; Orchard, Orchard & Seward 2013)

5. In Australia from 2003-2008, there were
50,187 ACL reconstructions, resulting in
75 million dollars being spent on
reconstructive surgery annually.
(Driscoll et al 2011)

6. After an ACL injury, you are
10 times more likely to develop
early-onset of knee osteoarthritis.
(Chu & Friel 2013)

7. (Driscoll et al 2011; Dai et al 2012; Garrett et al 2005; Mandelbaum & Silvers 2011), image sourced from ClipArt

8. Role of the coach
Hormonal
Anatomical
Environmental Neuromuscular
(Myers & Hawkins 2010; Mandelbaum & Silvers 2011), images sourced from Clip Art

9. Female athletes are up to 8 times more
likely to sustain an ACL injury than male
athletes.
(Elliot, Goldberg & Kuehl 2010)

10. Undiagnosed ACL injuries
Diagnosed ACL injuries
50,187 ACL
reconstructions
Diagram modified from: (Driscoll et al 2011)

11. (Driscoll et al 2011), image sourced from: http://flic.kr/p/b6Su8k

12. (McLean, Lipfert & van den Bogert 2004)

13. Knee valgus
LOW risk HIGH risk
(Celebrini et al 2009), image sourced from Clip Art

14. “While our approach to screening might be
viewed as over simplistic, its
straightforwardness is aimed at
optimising screening compliance
among clinicians and coaches.”
(Celebrini et al 2009)

15. Landing technique
Baseline Modified
(Myers & Hawkins 2010), image sourced from Clip Art

16. (Tsang & Dipasquale 2011)

17. Practical applications
• Awareness of risk-factors
• Implement in high-risk sports and
populations
• Observational screening
• Multi-component programs

18. Further research
• Can we modify other risk factors?
• How much training stimulus is required?
• What are the implications of detraining?
(Aldous et al 2005; Orchard, Orchard & Seward 2013)

19. Discussion
Overuse injuries?
• FIFA 11+
• Prevent injury and
Enhance Performance
(PEP)
• HarmoKnee
• SportsMetrics
Image sourced from Clip Art

20. Conclusion
1. Coaches play a pivotal role in reducing the
incidence of ACL injuries.
2. Neuromuscular factors can be targeted to
decrease risk of ACL injuries.
3. Programs should incorporate multi-
components.

21. Can anterior cruciate ligament
injuries be mitigated?

22. References
• Aldous D, Bennell K, Chivers I, Orchard JW & Seward H. (2005). Rye grass is associated with fewer non-
contact anterior cruciate ligament injuries than bermuda grass. British Journal of Sports
Medicine, 39, 704-709.
• Brent JL, Ford KR, Hewett TE & Myer GD (2012). An integrated approach to change the outcome part I:
neuromuscular screening methods to identify high ACL injury risk athletes. Journal of Strength and
Conditioning Research, 26(8), 2265–2271.
• Celebrini RG, Ekegren CL, Eng JJ, Macintyre DL & Miller WC. (2009). Reliability and validity of
observational risk screening in evaluating dynamic knee valgus. Journal of Orthopeadic Sports Physical
Therapy, 39(9), 665-674.
• Chu CR & Friel NA. (2013). The role of ACL injury in the development of post-traumatic knee
osteoarthritis. Journal of Clinical Sports Medicine, 32, 1-12.
• Driscoll T, Janssen K, Orchard J, & van Mechelen W. (2011). High incidence and costs for anterior
cruciate ligament reconstructions performed in Australia from 2003–2004 to 2007–2008. Scandinavian
Journal of Medicine & Science in Sports.
• Mandelbaum BR & Silvers HJ. (2011). ACL Injury Prevention in the Athlete. Sports Orthopaedics and
Traumatology, 27(1), 18-26.
• McLean SG, Lipfert SQ, & Bogert VJ. (2004). Effect of gender and defensive opponent on the
biomechanics of sidestep cutting. Med Sci Sports Exerc, 36(6), 1008-1016.
• Orchard J, Orchard J & Seward H. (2013). 21st annual AFL injury report: 2012.
• Tsang KK, & Dipasquale AA. (2011). Improving the H:Q ratio in women using plyometric exercises.
Journal of Strength and Conditioning Research, 25(10), 2740–2745.

23. Images
• Sourced from Clip Art
• Skier sourced from Flickr Creative
Commons: http://flic.kr/p/b6Su8k
• Pictures of knee valgus and landing
technique were photographed by Ella Ward