Factors influencing the implementation of anterior cruciate ligament injury prevention strategies by girls soccer coaches.

Women are 3 times more likely to injure their anterior cruciate ligament (ACL) while playing soccer than men. ACL injury prevention programs (IPPs) involving stretching and strengthening drills can reduce the incidence of ACL injury when incorporated into routine training. The rate of implementation among coaches is largely unknown. The purpose of this study was to determine the rate of implementation of ACL IPP, to identify factors that influence implementation, and to acquire information to assist in design dissemination and implementation strategies. Study subjects were coaches of woman soccer players aged 11-22 years in Utah (n = 756). Data were gathered using a Web-based survey followed by a qualitative study in which "best practice coaches"-coaches who met criteria for successful implementation of ACL IPP-were interviewed via telephone. A minority of survey respondents, 19.8% (27/136), have implemented ACL IPP. Factors associated with successful implementation include length of coaching experience and presence of additional support staff such as a strength and conditioning coach or athletic trainer. Best practice coaches (14/136) unanimously agreed on the following: (a) there are performance-enhancing benefits of ACL IPP, (b) education on ACL injury prevention should be required for licensure, and (c) dissemination and implementation will require soccer associations to enact policies that require IPPs. In conclusion, a minority of girls soccer coaches have implemented ACL IPP and those that have do so because they believe that prevention improves performance and that soccer organizations should enact policies requiring ACL injury prevention education and implementation. Efforts to implement ACL IPP should be driven by soccer organizations, emphasize performance-enhancing benefits, and engage additional coaching staff.

Clinical outcomes following osteochondral autologous transplantation (OATS).

This study evaluated the clinical outcome in 21 patients (22 knees) undergoing osteochondral autologous transplantation (OATS) in the knee over a 5-year period. Sixteen knees in 15 patients were available for follow-up at an average of 40 months after the procedure. The clinical outcome was analyzed using the IKDC and Knee and Osteoarthritis Outcome Score (KOOS) evaluation forms, a subjective questionnaire, and a clinical examination. At final follow-up, the average KOOS result for pain was 80.6 (range: 56-94), symptoms 53.6 (range: 25-71), function of activities of daily living 93.4 (range: 79-100), function of sports and recreational activities 65.3 (range: 20-100), and quality of life 51.0 (range: 6-88). The average IKDC score was 68.2. On our subjective questionnaire, the average preoperative grade given was 3.1 (range: 1-7) with an improvement at the most recent follow-up to a grade of 8.0 (range: 5-10) (P < .00001). Thirteen (86%) patients reported that they would have the surgery again if they had to make the decision a second time. Age did not correlate with subjective results on the IKDC evaluation (P = .7048) or score difference on our questionnaire (P = .9175). This procedure provides an option for articular resurfacing of the femoral condyles for focal areas of chondral defects with promising results regarding subjective improvement.

The effects of semitendinosus and gracilis harvest in anterior cruciate ligament reconstruction.

PURPOSE: There is significant debate concerning the morbidity of hamstring harvest for use during anterior cruciate ligament (ACL) reconstruction. We hypothesized that harvest of the semitendinosus and gracilis tendons for ACL reconstruction would result in no measurable hamstring weakness, but that abnormalities of the semitendinosus and gracilis muscle would be observed on magnetic resonance imaging (MRI) scans. TYPE OF STUDY: Case series. METHODS: Nine patients undergoing ACL reconstruction with doubled semitendinosus and gracilis tendons had MRI cross-sectional area measurements of both limbs made from axial images and muscle contour was studied on coronal images at 3 and 12 months. The semitendinosus, semimembranosus, gracilis, sartorius, and biceps muscles were evaluated. Isokinetic testing was performed on the operative and nonoperative legs at 60 degrees and 180 degrees per second at 6 and 12 months postoperatively. RESULTS: The gracilis cross-sectional area at 1 year averaged 2 cm2 on the operative side and 3.7 cm2 on the contralateral side. The semitendinosus averaged 2.1 cm2 on the operative side and 6.6 cm2 on the contralateral side at 1 year. Both of these differences were statistically significant (P < .05). In most cases, the semitendinosus muscle was retracted. Distally, the gracilis and occasionally the semitendinosus were blending with the gastrocnemius or sartorial fascia. The gracilis and semitendinosus in 1 case extended to near the original attachment site. Hamstring strength testing revealed a 26% deficit on the operative side at 60 degrees/second at 6 months and 16% at 180 degrees/second. At 12 months the mean 60 degrees/second deficit was 21% and the deficit at 180 degrees/second was 13%. CONCLUSIONS: At 1 year, the semitendinosus and gracilis muscles showed significant and persistent atrophy on the operative side and frequent retraction of the semitendinosus muscle belly. There were also hamstring strength deficits persisting at 1 year after the use of the tendons for ACL reconstruction. LEVEL OF EVIDENCE: Level IV.