title: Effects of evidence-based prevention training on neuromuscular and biomechanical risk factors for ACL injury in adolescent female athletes: a randomised controlled trial.
abstract: BACKGROUND
  Adolescent female football and handball players are among the athletes with the highest risk of sustaining anterior cruciate ligament (ACL) injuries.
  
  
  OBJECTIVE
  This study evaluated the effects of evidence-based lower extremity injury prevention training on neuromuscular and biomechanical risk factors for non-contact ACL injury.
  
  
  METHODS
  40 adolescent female football and handball players (15-16 years) were randomly allocated to a control group (CON, n=20) or neuromuscular training group (NMT, n=20). The NMT group performed an injury prevention programme as a warm-up before their usual training 3 times weekly for 12 weeks. The CON group completed their regular warm-up exercise programme before training. Players were tested while performing a side cutting movement at baseline and 12-week follow-up, using surface electromyography (EMG) and three-dimensional movement analysis. We calculated: (1) EMG amplitude from vastus lateralis (VL), semitendinosus (ST) and biceps femoris 10 ms prior to initial contact (IC) normalised to peak EMG amplitude recorded during maximal voluntary isometric contraction and (2) VL-ST EMG preactivity difference during the 10 ms prior to foot contact (primary outcome). We measured maximal knee joint valgus moment and knee valgus angle at IC.
  
  
  RESULTS
  There was a difference between groups at follow-up in VL-ST preactivity (43% between-group difference; 95% CI 32% to 55%). No between-group differences were observed for kinematic and kinetic variables.
  
  
  CONCLUSIONS
  A 12-week injury prevention programme in addition to training and match play in adolescent females altered the pattern of agonist-antagonist muscle preactivity during side cutting. This may represent a more ACL-protective motor strategy.
authors.affiliation: Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, Metropolitan University College, Copenhagen, Denmark Gait Analysis Laboratory, Department of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Mette K
authors.initials: MK
authors.lastname: Zebis
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark Human Performance group, SMI, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
authors.forename: Lars L
authors.initials: LL
authors.lastname: Andersen
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark.
authors.forename: Mikkel
authors.initials: M
authors.lastname: Brandt
authors.affiliation: Oslo Sport Trauma Research Centre, Norwegian School of Sports Sciences, Norway Physical Activity, Oslo, Norway.
authors.forename: Grethe
authors.initials: G
authors.lastname: Myklebust
authors.affiliation: Gait Analysis Laboratory, Department of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Bencke
authors.affiliation: Gait Analysis Laboratory, Department of Orthopaedic Surgery and Physical Therapy, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Hanne Bloch
authors.initials: HB
authors.lastname: Lauridsen
authors.affiliation: Clinical Research Centre, Copenhagen University Hospital, Amager-Hvidovre, Denmark Department of Orthopaedic Surgery and Physical Therapy, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bandholm
authors.affiliation: Sports Orthopaedic Research Centre-Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Thorborg
authors.affiliation: Sports Orthopaedic Research Centre-Copenhagen (SORC-C), Arthroscopic Centre Amager, Copenhagen University Hospital, Amager-Hvidovre, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Hölmich
authors.affiliation: Institute of Sports Sciences and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Aagaard
mesh_terms: D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries; D056352:Athletes; D001265:Athletic Injuries / Q000517:prevention & control*; D001696:Biomechanical Phenomena; D004576:Electromyography; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000517:prevention & control*; D007719:Knee Joint / Q000502:physiology; D009068:Movement; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000502:physiology; D064797:Physical Conditioning, Human / Q000379:methods*; D012307:Risk Factors; D012916:Soccer; D063996:Warm-Up Exercise
keywords: ACL; Adolescent; Athlete; Biomechanics; Training