ACL Tears- Soccer Players’ Nemesis

: how does it happen, can it be prevented, and how to best do so?

ACL tears are an unfortunately common injury for athletes, especially youth athletes, and especially soccer players.

FACTS:

-Soccer has the highest risk of ACL injuries of all sports.

-ACL injuries cause the most time lost from competition in soccer.

-Thousands of ACL tears occur in the United States annually.

-Females are 6x more likely to suffer an ACL injury.

-ACL injuries on a soccer team make up 1.3% of male injuries and 3.7% of female injuries. (1)

So- what factors are more likely to lead to ACL tears? A 2017 review of research found “Faulty mechanics” (less than ideal mechanics) during dynamic movements that cause extra valgus force at the knee (knee collapses inward toward the opposite leg; inside the foot and hip if viewed from the front) increases risk of ACL injury. These faulty mechanics can be due to sideways displacement of the trunk, unequal limb loading, and lack of neuromuscular control in the muscles that prevent valgus. This is all made more likely when an athlete is tired. (2)

Fortunately, these movement patterns can be recognized and worked on with an injury prevention program. Although there is no ‘gold standard’ prevention program, it is shown that multi-component programs have promising results to reduce the risk and incidence of non-contact ACL injuries in soccer players. Interventions should be provided in the off- and pre-season and be combined with an in-season maintenance program to prevent injury. (3)

These programs include multiple modes of exercise such as plyometrics (jump training), neuromuscular training (balance and response to movement), and strength training. The review concluded that programs that utilize neuromuscular training and strength training at a young age show the most promise in reducing ACL injuries and thorough dynamic examination is necessary for the athletes while adjusting the program to fit the athlete. (4)

A second review of research in 2017, this time by the German Knee Society, (5) also concluded that there are modifiable and non-modifiable risk factors for knee injuries (including ACL injuries). The most important modifiable risk factor being training to prevent dynamic valgus of the knee (that inward collapse of the leg). Their review concludes that simple tests can be effective to screen athletes for injury risk and programs can be performed to decrease risk of injury. They recommend similar training: standard warm up exercises, focusing on muscle strength, balance, proprioception (a person’s sense of where their body is in space), as well as running and flexibility. Programs that include these aspects can reduce incidence of knee injuries by up to 27% and ACL injuries by up to 51%.

Injury screening should be performed and programs should have multiple components, they do not have to be complicated or highly time consuming. Screening should include movement mechanics testing and general strength testing. Prevention activities should include a proper warm up before intensive activities, jump and landing training, balance, neuromuscular, strength, and proprioception training. All of which can be performed on the field. Interventions and exercises can be found online, but risk factors vary by person and individualized programs top cookie-cutter every time.

If you are interested in having a trained and experienced professional perform personalized evaluation and prevention programming- contact us at 458-215-1915 or through the contact box to discuss options to help you, your child, or team from getting caught wrong footed. Packages available for individuals, with discounted packages available for small groups and teams.

1) Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc. 2009 Jul;17(7):705-29. doi: 10.1007/s00167-009-0813-1. Epub 2009 May 19. PMID: 19452139.

2) Nessler T, Denney L, Sampley J. ACL Injury Prevention: What Does Research Tell Us? Curr Rev Musculoskelet Med. 2017 Sep;10(3):281-288. doi: 10.1007/s12178-017-9416-5. PMID: 28656531; PMCID: PMC5577417.

3) Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lázaro-Haro C, Cugat R. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates. Knee Surg Sports Traumatol Arthrosc. 2009 Aug;17(8):859-79. doi: 10.1007/s00167-009-0823-z. Epub 2009 Jun 9. PMID: 19506834.

4) Nessler T, Denney L, Sampley J. ACL Injury Prevention: What Does Research Tell Us? Curr Rev Musculoskelet Med. 2017 Sep;10(3):281-288. doi: 10.1007/s12178-017-9416-5. PMID: 28656531; PMCID: PMC5577417.

5) Mehl J, Diermeier T, Herbst E, Imhoff AB, Stoffels T, Zantop T, Petersen W, Achtnich A. Evidence-based concepts for prevention of knee and ACL injuries. 2017 guidelines of the ligament committee of the German Knee Society (DKG). Arch Orthop Trauma Surg. 2018 Jan;138(1):51-61. doi: 10.1007/s00402-017-2809-5. Epub 2017 Oct 5. PMID: 28983841.