title: 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.
abstract: Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players participating in the game as on 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes a significant loss of time from competition in soccer, which has served as the strong impetus to conduct research that focuses to determine the risk factors for injury, and more importantly, to identify and teach techniques to reduce this injury in the sport. This research emphasis has afforded a rapid influx of literature aimed to report the effects of neuromuscular training on the risk factors and the incidence of non-contact ACL injury in high-risk soccer populations. The purpose of the current review is to sequence the most recent literature relating the effects of prevention programs that were developed to alter risk factors associated with non-contact ACL injuries and to reduce the rate of non-contact ACL injuries in soccer players. To date there is no standardized intervention program established for soccer to prevent non-contact ACL injuries. Multi-component programs show better results than single-component preventive programs to reduce the risk and incidence of non-contact ACL injuries in soccer players. Lower extremity plyometrics, dynamic balance and strength, stretching, body awareness and decision-making, and targeted core and trunk control appear to be successful training components to reduce non-contact ACL injury risk factors (decrease landing forces, decrease varus/valgus moments, and increase effective muscle activation) and prevent non-contact ACL injuries in soccer players, especially in female athletes. Pre-season injury prevention combined with an in-season maintenance program may be advocated to prevent injury. Compliance may in fact be the limiting factor to the overall success of ACL injury interventions targeted to soccer players regardless of gender. Thus, interventional research must also consider techniques to improve compliance especially at the elite levels which will likely influence trickle down effects to sub-elite levels. Future research is also needed for male soccer athletes to help determine the most effective intervention to reduce the non-contact ACL injury risk factors and to prevent non-contact ACL injuries.
authors.affiliation: Artroscopia GC, Dr Ramón Cugat's Office, Hospital Quirón, Plaza Alfonso Comín 5-7, 08023 Barcelona, Spain. ealentorngeli@gmail.com
authors.forename: Eduard
authors.initials: E
authors.lastname: Alentorn-Geli
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Myer
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Silvers
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Samitier
authors.forename: Daniel
authors.initials: D
authors.lastname: Romero
authors.forename: Cristina
authors.initials: C
authors.lastname: Lázaro-Haro
authors.forename: Ramón
authors.initials: R
authors.lastname: Cugat
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000517:prevention & control*; D006801:Humans; D007718:Knee Injuries / Q000517:prevention & control*; D010806:Physical Education and Training / Q000379:methods*; D012307:Risk Factors; D012916:Soccer / Q000293:injuries*