Monday, April 28, 2014 AAP Says Neuromuscular Training Could Lower Risk of ACL Injury in Adolescent Athletes A new clinical report from the American Academy of Pediatrics (AAP) asserts that the continued rise in anterior cruciate ligament (ACL) injuries in adolescent athletes could be partially countered by neuromuscular training to "preprogram" safer movement patterns before an injury occurs. Better training could be of particular benefit to female adolescent athletes, who could see their rates of ACL injury risk drop by as much as 72%. The recommendation was part of the conclusions and guidance presented in a report (.pdf full text available for free) published in the April 28 edition of Pediatrics. The report addressed diagnosis, treatment, and prevention of ACL injuries in adolescent athletes, which have been on the rise over the past 2 decades due to growing numbers of children participating in sports and more intensive training programs, among other reasons. Intrinsic risk factors include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of the trunk and lower extremities, according to the report. While incidence rates among adolescent athletes are still lower than among college athletes (5.5 vs 15 per 100,000 athlete-exposures), the rates are increasing and rise more dramatically during puberty—particularly for girls. Authors of the report write that female athletes between the ages of 15 and 20 account for the largest numbers of ACL injuries among adolescent athletes, and that, overall, girls suffer ACL injuries at a rate 2.5–6.2 times higher than boys in gender-comparable sports. The report cautions against surgical interventions for adolescent ACL injuries, particularly when the surgery may cause growth disturbances, but authors also acknowledge the role patient and parent cooperation play in this consideration. While nonoperative treatments such as braces, rehabilitation, and sports restriction are often recommended until skeletal maturity is reached, authors write that "many … athletes and their parents are less inclined to agree to restrict the athlete's activity," which can lead to additional injuries and early-onset arthritis. "Therefore, most recent literature now supports early surgery for pediatric athletes with an ACL-deficient knee and recurrent episodes of instability," they write. Certain techniques minimize the risk of growth plate injury. More certain results can be achieved in prevention, where neuromuscular training can have an impact, according to the report. More so than bracing (which authors say is "unlikely" to reduce risk of ACL injury), the training has a preventive effect by helping athletes to "'preprogram' safer movement patterns that reduce injury risk during landing, pivoting, or unexpected loads or perturbations during sports movements," authors write. Adolescent female athletes could see the biggest risk reduction, if this training is introduced in their mid-teens. Training that "incorporates plyometric and strengthening exercises, combined with feedback to athletes on proper technique, appears to be most effective," authors write. "Pediatricians and orthopedic surgeons who work with schools and sports organizations are encouraged to educate athletes, parents, coaches, and sports administrators about the benefits of neuromuscular training in reducing ACL injuries and direct them to appropriate resources." Research-related stories featured in News Now are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.