Sports injuries in women: sex- and gender-based differences in etiology and prevention.

There has been a significant increase in the participation of women in sports at all levels, especially after the enactment of the Title IX Education Amendment in 1972. This increased participation at all levels has resulted in more women sustaining sports injuries. Data on sex- and gender-based differences in all organ systems, including the musculoskeletal system, are beign gathered. It is important to review some of the areas of sex- and gender-based differences in sports injuries for which there is significant research, such as osteoporosis, the female athlete triad, and anterior cruciate ligament injuries. It is also necessary to examine those areas in which more information is needed, such as injuries to the shoulder, foot, and ankle.

Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005.

The incidence of noncontact anterior cruciate ligament injuries in young to middle-aged athletes remains high. Despite early diagnosis and appropriate operative and nonoperative treatments, posttraumatic degenerative arthritis may develop. In a meeting in Atlanta, Georgia (January 2005), sponsored by the American Orthopaedic Society for Sports Medicine, a group of physicians, physical therapists, athletic trainers, biomechanists, epidemiologists, and other scientists interested in this area of research met to review current knowledge on risk factors associated with noncontact anterior cruciate ligament injuries, anterior cruciate ligament injury biomechanics, and existing anterior cruciate ligament prevention programs. This article reports on the presentations, discussions, and recommendations of this group.

Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up.

BACKGROUND: Among female athletes it has not been established whether a neuromuscular and proprioceptive sports-specific training program will consistently reduce the incidence of anterior cruciate ligament injuries. PURPOSE: To determine whether a neuromuscular and proprioceptive performance program was effective in decreasing the incidence of anterior cruciate ligament injury within a select population of competitive female youth soccer players. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: In 2000, 1041 female subjects from 52 teams received a sports-specific training intervention in a prospective non-randomized trial. The control group consisted of the remaining 1905 female soccer players from 95 teams participating in the same league who were age and skill matched. In the 2001 season, 844 female athletes from 45 teams were enrolled in the study, with 1913 female athletes (from 112 teams) serving as the age- and skill-matched controls. All subjects were female soccer players between the ages of 14 and 18 and participated in either their traditional warm-up or a sports-specific training intervention before athletic activity over a 2-year period. The intervention consisted of education, stretching, strengthening, plyometrics, and sports-specific agility drills designed to replace the traditional warm-up. RESULTS: During the 2000 season, there was an 88% decrease in anterior cruciate ligament injury in the enrolled subjects compared to the control group. In year 2, during the 2001 season, there was a 74% reduction in anterior cruciate ligament tears in the intervention group compared to the age- and skill-matched controls. CONCLUSION: Using a neuromuscular training program may have a direct benefit in decreasing the number of anterior cruciate ligament injuries in female soccer players.

A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players.

BACKGROUND: Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large. HYPOTHESIS: A simple on-field alternative warm-up program can reduce noncontact ACL injuries. STUDY DESIGN: Randomized controlled trial (clustered); Level of evidence, 1. METHODS: Participating National Collegiate Athletic Association Division I women's soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes' participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons. RESULTS: Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41% decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries). CONCLUSION: This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.

Neuromuscular training and injury prevention in sports.

Exercises that help develop neuromuscular control and increase functional joint stability are critical in conditioning and rehabilitation programs designed for injury prevention in sports. Information regarding joint movement and joint position provided by mechanoreceptors in the skin, muscles, tendons, ligaments, and joints combine with input from the vestibular and visual systems to maintain balance. Insufficient neurologic input or improperly processing that input at the spinal, brain stem, or cognitive centers can lead to an inadequate response by the motor system resulting in an injury. Therefore, it is important to include drills that enhance neuromuscular control into traditional training, conditioning, and rehabilitation programs for sports.

Appearance of previously injured posterior cruciate ligaments on magnetic resonance imaging.

BACKGROUND: The appearance of normal and injured cruciate ligaments on magnetic resonance imaging (MRI) has been well described in the literature. Few studies have reported on changes found on sequential imaging of injured posterior cruciate ligaments (PCLs) during the healing process, however. METHODS: Ten consecutive patients with isolated injuries to the PCL were evaluated with an initial clinical examination, x-rays, and MRI of the injured knee. Clinical examination and imaging studies were repeated at a minimum of 6 months after the initial injury. These studies were interpreted by radiologists blinded to the study design. RESULTS: Seven of the 10 patients were found to have PCL continuity on repeat MRI. One patient continued to demonstrate an abnormal appearance of the PCL on MRI, and 2 patients were lost to follow-up. CONCLUSIONS: Despite the healed appearance of their PCLs on imaging studies, 6 of 7 patients continued to demonstrate laxity on clinical examination. All returned to their preinjury occupations and to recreational sports, however. Our results are consistent with previously reported data.