Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons.
OBJECTIVE
To assess the effect of a neuromuscular training program on the incidence of anterior cruciate ligament injuries in female team handball players.


METHODS
Prospective intervention study.


METHODS
Female team handball: Division I-III in Norway.


METHODS
Players from the three top divisions: control season (1998-1999), 60 teams (942 players); first intervention season (1999-2000), 58 teams (855 players); second intervention season (2000-2001), 52 teams (850 players).


METHODS
A five-phase program (duration, 15 min) with three different balance exercises focusing on neuromuscular control and planting/landing skills was developed and introduced to the players in the autumn of 1999 and revised before the start of the season in 2000. The teams were instructed in the program and supplied with an instructional video, poster, six balance mats, and six wobble boards. Additionally, a physical therapist was attached to each team to follow up with the intervention program during the second intervention period.


METHODS
The number of anterior cruciate ligament injuries during the three seasons and compliance with the program.


RESULTS
There were 29 anterior cruciate ligament injuries during the control season, 23 injuries during the first intervention season (OR, 0.87; CI, 0.50-1.52; p = 0.62), and 17 injuries during the second intervention season (OR, 0.64; CI, 0.35-1.18; p = 0.15). In the elite division, there were 13 injuries during the control season, six injuries during the first intervention season (OR, 0.51; CI, 0.19-1.35; p = 0.17), and five injuries in the second intervention season (OR, 0.37; CI, 0.13-1.05; p = 0.06). For the entire cohort, there was no difference in injury rates during the second intervention season between those who complied and those who did not comply (OR, 0.52; CI, 0.15-1.82; p = 0.31). In the elite division, the risk of injury was reduced among those who completed the anterior cruciate ligament injury prevention program (OR, 0.06; CI, 0.01-0.54; p = 0.01) compared with those who did not.


CONCLUSIONS
This study shows that it is possible to prevent anterior cruciate ligament injuries with specific neuromuscular training.
Myklebust
Grethe
G
Oslo Sports Trauma Research Center, Norwegian University of Sport and Physical Education, Norway. grethem@nih.no
Engebretsen
Lars
L
Braekken
Ingeborg Hoff
IH
Skjølberg
Arnhild
A
Olsen
Odd-Egil
OE
Bahr
Roald
R
D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000453:epidemiology / Q000517:prevention & control*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000517:prevention & control*; D008597:Menstrual Cycle; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies