Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors |
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Authors: | Eduard Alentorn-Geli Gregory D Myer Holly J Silvers Gonzalo Samitier Daniel Romero Cristina Lázaro-Haro Ramón Cugat |
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Institution: | 1. Artroscopia G.C., Hospital Quirón, Barcelona, Spain 6. Dr. Ramon Cugat’s Office, Hospital Quirón, Plaza Alfonso Comín 5-7, 08023, Barcelona, Spain 2. Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA 3. Rocky Mountain University of Health Professions, Provo, UT, USA 4. Santa Monica Orthopaedic Sports Medicine/Research Foundation, Santa Monica, CA, USA 5. Physical Therapy School, Blanquerna University, Barcelona, Spain
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Abstract: | Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent
to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes
the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for
injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable
risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature
that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer
players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction
or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near
full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high
knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted
over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact
ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported
intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio
of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not
using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering
neuromuscular control, decreased “core” strength and proprioception, low trunk, hip, and knee flexion angles, and high dorsiflexion
of the ankle when performing sport tasks, lateral trunk displacement and hip adduction combined with increased knee abduction
moments (dynamic knee valgus), and increased hip internal rotation and tibial external rotation with or without foot pronation.
The identified mechanisms and risk factors for non-contact ACL injuries have been mainly studied in female soccer players;
thus, further research in male players is warranted. Non-contact ACL injuries in soccer players likely has a multi-factorial
etiology. The identification of those athletes at increased risk may be a salient first step before designing and implementing
specific pre-season and in-season training programs aimed to modify the identified risk factors and to decrease ACL injury
rates. Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the
sequelae of osteoarthritis associated with this traumatic injury. |
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Keywords: | Prevention Non-contact ACL injury Soccer |
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