Lesion Del Acl

i52

SUPPLEMENT

Prevention of anterior cruciate ligament injury in the female athlete
Holly Jacinda Silvers, Bert R Mandelbaum
................................................................................................................................... See end of article for authors’ affiliations ........................ Correspondence to: Ms H J Silvers, Santa Monica OrthopaedicSports Medicine/Research Foundation, Suite 350, 1919 Santa Monica Boulevard, Santa Monica, CA 90404, USA; hollysilverspt@aol.com Accepted 13 March 2007 Published Online First 3 July 2007 ........................ Br J Sports Med 2007;41(Suppl I):i52–i59. doi: 10.1136/bjsm.2007.037200

The relationships of gender, age and training to the incidence of anterior cruciate ligament (ACL) injury arepivotal to developing a comprehensive neuromuscular and proprioceptive training programme to decrease ACL injuries in female athletes. A prophylactic neuromuscular and proprioceptive training programme may have direct benefit in decreasing the number of ACL injuries in female athletes. This research foundation endorses further epidemiological and biomechanical studies to determine the exact mechanism ofACL injury and the most effective intervention for decreasing ACL injuries in this high-risk population.

he anterior cruciate ligament (ACL) is one of the major stabilising intracapsular ligaments in the knee joint. It prevents excessive anterior translation of the tibia on the femur. In addition, it plays a secondary role of limiting internal rotation of the tibia. It is housed in theintercondylar notch of the femur. The proximal attachment is the posterior medial surface of the lateral femoral condyle, with distal attachment to the anterior portion of the intercondylar eminence of the tibia. There are two distinct bundles in the ACL joint: (1) the anteromedial portion, which is taut in knee flexion; (2) the posterolateral portion, which is taut in knee extension. The ACL workscollectively with the posterior cruciate ligament to stabilise the knee during dynamic movement. The latter is attached to the posterior portion of the intercondylar eminence of the tibia and passes forward to attach to the medial condyle of the femur. The medial collateral ligament is attached to the medial femoral condyle and the medial surface of the tibia. The lateral collateral ligament isattached to the lateral femoral condyle and the lateral portion of the head of the fibula. These two ligaments are extracapsular and provide stability to the knee joint in the frontal plane during varus and valgus loads.

T

HOW IS THE ACL RUPTURED?
Injuries to the knee joint are common. Ligamentous or meniscal structures are typically damaged during knee injury. Ligaments are usually torn when anexcessive external force is applied to the limb, whereas meniscal injuries usually occur as the result of forces generated within the limb (torsional). However, unlike most ligamentous structures in the body, the ACL can be injured without external force being applied to the knee joint. In the USA alone, about 250 000 ACL injuries occur annually. This translates into a 1 in 3000 chance that amember of the general population will sustain an ACL injury. The fiscal burden of such an injury is quite large; when the costs of MRI, reconstructive surgery, postoperative bracing and rehabilitation are considered, the average annual cost exceeds 2 billion dollars. In addition, the psychological impact of such an injury can be quite devastating. Typically, an athlete will miss 6–9 months ofcompetitive play as a result of the injury itself
www.bjsportmed.com

and reconstructive surgery and rehabilitation. However, this estimate does not reflect the large dichotomy that exists when the epidemiological data are stratified with respect to gender. Since Title IX of the Education Amendments of 1972 was passed, allowing equal opportunity for female participation in sport, there has been an...