title: The 2012 ABJS Nicolas Andry Award: The sequence of prevention: a systematic approach to prevent anterior cruciate ligament injury.
abstract: BACKGROUND
  ACL injuries are common, often devastating injuries that lead to short-term disability and long-term sequelae, many of which lack effective treatment, such as osteoarthritis. Therefore, prevention of ACL injury is currently the only effective intervention for these life-altering sequelae, while much of the literature has a rehabilitative focus.
  
  
  OBJECTIVE
  The primary long-term purpose of our multidisciplinary collaborative research team has been to develop ACL injury prevention programs by determining which factors related to ACL injury should be altered, followed by how and when they should be altered.
  
  
  METHODS
  Our primary study objectives were to determine: (1) modifiable risk factors; (2) how these factors can best be modified; and (3) when is the best time to diminish these risk factors. Throughout the course of various studies, we determined the modifiable factors related to increased ACL injury risk. Our research team then focused on exploring numerous ways to augment these factors to maximize prevention efforts. We developed a sequence of prevention models that provide a framework to monitor progress toward the ultimate goal of preventing ACL injuries.
  
  
  RESULTS
  The modifiable factors shown in our work include biomechanical and neuromuscular functionality. When targeted in physical training, we have determined that these factors can be enhanced to effectively aid in the prevention of ACL injuries. Preliminary data have shown that childhood and early adolescence may be valuable periods to implement such training.
  
  
  CONCLUSIONS
  Current evidence has led to the evolution of clinical assessment tools for high-risk athletes and interventions for large populations and specific high-risk individuals. Targeted intervention implemented at the specified developmental stage of highest risk may be the final step toward the maximal reduction of ACL injury risk in young athletes.
authors: Department of Physiology & Cell Biology, The Ohio State University Sports Medicine Sports Health & Performance Institute, 2050 Kenny Road, Suite 3100, Columbus, OH 43221-3502, USA. Timothy.Hewett@osumc.edu
authors: Timothy E
authors: TE
authors: Hewett
authors: Gregory D
authors: GD
authors: Myer
authors: Kevin R
authors: KR
authors: Ford
authors: Mark V
authors: MV
authors: Paterno
authors: Carmen E
authors: CE
authors: Quatman
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries; D001363:Awards and Prizes; D006801:Humans; D007718:Knee Injuries / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods; D018570:Risk Assessment; D012307:Risk Factors