JOSEPH NOAH, M.D. SUNCOAST ORTHOPAEDIC SURGERY AND SPORTS MEDICINE

 TWO BUNDLE LIGAMENT (ANTEROMEDIAL AND POSTEROLATERAL)  ORIGINATES FROM FEMUR AND INSERTS ONTO TIBIA  HIGHLY INNERVATED AND VASCULAR

 ESSENTIAL FOR NORMAL KNEE FUNCTION  PREVENTS EXCESSIVE ANTERIOR TRANSLATION AND ROTATION OF THE TIBIA ON THE FEMUR  PREVENTS EXCESSIVE HYPEREXTENSION  SECONDARY RESTRAINT TO VALGUS/VARUS STRESS

 AS MANY AS 200,000 INJURIES OCCUR ANNUALLY  CAN OCCUR IN BOTH WITH CONTACT AND NONCONTACT SPORTS  INJURY RATES SHOW A SIGNIFICANT GENDER DISPARITY ESPECIALLY IN NONCONTACT INJURY

HYPEREXTENSION INJURY  ASSOCIATED MORE WITH COLLISION SPORTS  REQUIRES A LOAD APPLIED TO A PLANTED FOOT  ASSOCIATED WITH A HIGHER RATE OF MULTIPLE STRUCTURE (LIGAMENT) DAMAGE

VALGUS COLLISION  NO EFFECTIVE BRACING TECHNIQUE  NO EFFECTIVE EXERCISE OR PREVENTATIVE PROGRAM ESTABLISHED  NOT PART OF THIS DISCUSSION

 HYPEREXTENSION/ ROTATIONAL FORCE  VALGUS/ROTATIONAL FORCE  DECELERATION INJURY  SEEN MORE IN FEMALE ATHLETES

 46,000 GIRLS 19 YRS AND YOUNGER IN 2006 (CDC).  GIRLS 8X AS LIKELY TO INJURE ACL  GIRLS UNDER 14 HAVE 5X RATES OF TEARS COMPARED TO BOYS  70% OF INJURIES WERE NONCONTACT

 SIGNIFICANT INJURY  SURGICAL RECONSTRUCTION OFTEN REQUIRED  LENGTHY REHABILITATION  POSSIBLE LONGTERM DAMAGE (POST TRAUMATIC ARTHRITIS)

 SMALLER FEMORAL NOTCH (SMALLER ACL)  WIDER PELVIS (INCREASE IN “Q” ANGLE)  HORMONAL FACTORS  QUAD/HAMSTRING RATIO  NERVE AND MUSCLE COORDINATION  FOOT PRONATION

 ATHLETE BEING DISTRACTED OR BUMPED JUST BEFORE DECELERATION OR LANDING  WOMEN RUN AND CUT IN A MORE ERECT POSTURE (KEEPS KNEE MORE EXTENDED)  HIPS BEHIND KNEES LANDING FROM A JUMP

 ACL PREVENTION PROTOCOL ESSENTIAL FOR THE FEMALE ATHLETE EVEN AFTER INJURY  INCREASED RATE OF REINJURY AFTER RECONSTRUCTION  20% INJURY RATE TO THE CONTRALATERAL KNEE  CAN ALSO BE EFFECTIVE FOR MALE ATHLETES  HELPS PREVENT NONCONTACT INJURIES  NO IMPACT ON CONTACT INJURIES

 AVOIDING VULNERABLE POSITIONS  LEARNING HOW TO FALL  INCREASING FLEXIBILITY  INCREASING STRENGTH  PLYOMETRIC EXERCISES IN TRAINING  INCREASING PROPRIOCEPTION

 PERFORMED 2-3/WK DURING SEASON  WARM UP  STRETCHING  STRENGTHENING  PLYOMETRICS  SPORTS SPECIFIC AGILITY TRAINING  COOL DOWN

WARM UPSSTRETCHING  JOG LINE TO LINE  SHUTTLE RUN (SIDE TO SIDE)  BACKWARDS RUN  CALF STRETCH  QUAD STRETCH  HAMSTRING STRETCH  ADDUCTOR STRETCH  HIP FLEXOR STRETCH

GENERALEXERCISES  WALKING LUNGES  RUSSIAN HAMSTRINGS  SINGLE TOE RAISE  LATERAL HOPS OVER CONE OR BALL  FORWARD/BACKWARD HOPS  SINGLE LEG HOPS OVER CONE

 PLYOMETRIC EXERCISES SHOULD BE INCLUDED IN WORK OUT.  EXPLOSIVE EXERCISES DESIGNED TO BUILD POWER, STRENGTH AND SPEED  IMPORTANCE IS ON LANDING TECHNIQUE  IT MUST BE SOFT

SPORTS SPECIFICEXERCISES  VERTICAL JUMPS WITH SPORTS SPECIFIC ACTIVITY (HEADER, CATCHING A BALL)  SQUATTING (HIPS BACKWARDS AS IF SITTING)  SCISSOR JUMPS  LUNGES  DIAGONAL RUNS  BOUNDING RUNS

 COOL DOWN  IMPORTANT, SO DON’T SKIP  ALLOWS MUSCLES TO ELONGATE AND DETERS MUSCLE SORENESS

 CAN SIGNIFICANTLY REDUCE RISK IN NONCONTACT ACL INJURIES (MORE IN WOMEN)  HELP PREVENT REINJURY AFTER ACL RECONSTRUCTION  REDUCE INJURY IN THE CONTRALATERAL LIMB