Preventing knee injuries in adolescent female football players - design of a cluster randomized controlled trial [NCT00894595].
BACKGROUND
Knee injuries in football are common regardless of age, gender or playing level, but adolescent females seem to have the highest risk. The consequences after severe knee injury, for example anterior cruciate ligament (ACL) injury, are well-known, but less is known about knee injury prevention. We have designed a cluster randomized controlled trial (RCT) to evaluate the effect of a warm-up program aimed at preventing acute knee injury in adolescent female football.


METHODS
In this cluster randomized trial 516 teams (309 clusters) in eight regional football districts in Sweden with female players aged 13-17 years were randomized into an intervention group (260 teams) or a control group (256 teams). The teams in the intervention group were instructed to do a structured warm-up program at two training sessions per week throughout the 2009 competitive season (April to October) and those in the control group were informed to train and play as usual. Sixty-eight sports physical therapists are assigned to the clubs to assist both groups in data collection and to examine the players' acute knee injuries during the study period. Three different forms are used in the trial: (1) baseline player data form collected at the start of the trial, (2) computer-based registration form collected every month, on which one of the coaches/team leaders documents individual player exposure, and (3) injury report form on which the study therapists report acute knee injuries resulting in time loss from training or match play. The primary outcome is the incidence of ACL injury and the secondary outcomes are the incidence of any acute knee injury (except contusion) and incidence of severe knee injury (defined as injury resulting in absence of more than 4 weeks). Outcome measures are assessed after the end of the 2009 season.


CONCLUSIONS
Prevention of knee injury is beneficial for players, clubs, insurance companies, and society. If the warm-up program is proven to be effective in reducing the incidence of knee injury, it can have a major impact by reducing the future knee injury burden in female football as well as the negative long-term disabilities associated with knee injury.


BACKGROUND
NCT00894595.
Hägglund
Martin
M
Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden. martin.hagglund@liu.se
Waldén
Markus
M
Atroshi
Isam
I
D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D001265:Athletic Injuries / Q000453:epidemiology / Q000517:prevention & control*; D016000:Cluster Analysis; D015444:Exercise / Q000502:physiology; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000453:epidemiology / Q000517:prevention & control*; D007719:Knee Joint / Q000033:anatomy & histology / Q000502:physiology; D018482:Muscle, Skeletal / Q000033:anatomy & histology / Q000502:physiology; D017063:Outcome Assessment, Health Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012107:Research Design / Q000592:standards; D012727:Sex Characteristics; D017678:Sex Distribution; D012737:Sex Factors; D012916:Soccer / Q000592:standards*; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome