Abstract
Objectives:
Injury to the anterior cruciate ligament (ACL) is one of the most common knee injuries, with an annual incidence of 100,000 to 200,000 in the U.S, and 70% of these injuries occurring due to sports activities. To reduce injury rates, several ACL Injury Prevention Programs (AIPPs) have been developed, focusing on strengthening of the hamstrings, hips, core, and trunk, while also reducing landing forces and knee abduction during sports movements. These programs have shown to reduce the risk of non-contact ACL injuries by up to 50% in all athletes, and up to 67% specifically in female athletes. Despite their effectiveness, it is unclear if these programs are widely adopted, particularly at the high school level.
The current study aims to collect data on the usage of AIPPs across male and female high school sports teams, including details on specific programs used, frequency of use, time and resources needed for implementation, and barriers to implementation. Authors hypothesize that increased use of AIPPs will be correlated with increased awareness of their existence amongst athletic trainer/coaching staff, increased number of past ACL injuries on the team, and girl’s teams.
Methods:
Male and female high school sports teams covered by a large regional orthopedic group were identified. Athletic directors, athletic trainers, and/or coaching staff were contacted for completion of a standardized survey through RedCap. The survey included items comprising (a) the gender, level, size, and size of coaching/training team of each sports team available at the school, (b) estimated incidence of ACL injuries for players over the past 5 years and use of AIPP for each sports team, and (c) motivations, interest, and perceived barriers related to using an AIPP. Representatives from teams that reported not currently implementing AIPPs were further asked to rate their interest in implementing AIPPs in the future as well as their interest in undergoing coach/athletic trainer education of AIPPs. Representatives for each team were contacted a total of 3 times via phone and/or email for completion of the survey, and non-responsive teams were not included in the results of this study.
Results:
A total of 428 sports teams across 20 unique high schools responded to the survey. Of these teams, 242 teams (56.5%) were boy’s teams, and 186 teams (43.5%) were girl’s teams. 207 teams (48.4%) were Junior Varsity (JV) teams, while 221 teams (51.6%) were Varsity teams. Further stratification of the teams by JV/Varsity, sport, and gender, are shown in Tables 1A-B.
Eighty-four teams (19.6%) across all sports reported an ACL injury on their team within the past 5 years. However, only 11 teams (2.57%) reported implementing an AIPP for their athletes (Tables 2A-B). Among the 11 teams implementing AIPP programs, 4 were female teams across 3 unique high schools and 7 were male teams all from 1 high school. Seven of these teams reported at least one ACL injury in the past 5 years. Eight of these 11 teams were Varsity teams, and 3 were Junior Varsity teams. The majority of the teams who reported using AIPPs were soccer teams (5 out of 11 teams). The most commonly used AIPPs include Prevention Injury and Enhance Performance Program (PEP) (45%), Knee Injury Prevention Program (18%), and FIFA11+ (18%).
226 teams (52.8%) reported not currently implementing AIPPs despite being aware of the programs and their potential benefits. However, 80% of representatives from these teams reported interest in undergoing education of AIPPs and 65% were interested in implementing AIPPs into their athletes’ training/practices. The two primary barriers that representatives reported as contributing to AIPP non-use were: (1) inadequate training and cooperation amongst coaching staff and (2) perceived time constraints. All responses are shown in Table 3.
Conclusions:
Results from this study revealed that while staff from a majority of high school athletic teams acknowledged awareness of ACL Injury Prevention Programs, utilization of such programs is extremely low. Among participating schools, more boy’s teams implemented AIPPs than female teams, despite higher risk of female athletes having a non-contact ACL injury. Furthermore, the majority of the teams implementing AIPPs did have a history of ACL injury on their team, but further analysis is needed to elucidate this relationship due to small sample size of teams using these programs in this study.
Barriers identified in this study included resistance from coaches, time constraints, and lack of adequate training. Overall, these findings suggest that targeted efforts should focus on advocating for AIPP usage to coaches, education on increased risk of ACL injury in female athletes, and tailoring of programs to better fit team resources.
