To Screen or Not to Screen for ACL Injury Risk: That is the Question

Youth sport participation is on the rise, particularly among female athletes. Approximately three quarters of American households have a child who plays organized sports.1 ACL injuries are of particular concern because adolescents with major knee injuries are more prone to functional deficits, poorer quality of life, and increased risk of obesity in the decade following injury.2 Screening programs may help to identify youth athletes at higher risk of ACL tear. Targeted injury prevention strategies may help reduce the incidence of ACL injury.

Targeted injury prevention strategies may help reduce the incidence of ACL injury. Any sport that requires running, jumping, cutting, pivoting, or landing— such as basketball, football, or soccer— creates a higher risk of ACL tear.2 The vast majority of athletes require surgery to restore stability and function. Surgery mandates a 6- to 12-month minimum recovery period, mic knee valgus, stiff landing, and others) may be detected prior to injury using landing and cutting maneuvers. Accurate detection of movement patterns can be accomplished using “gold standard” 3D marker based systems.5 Limitations of widespread screening using this technique include the requirement of a laboratory setting, increased cost, and the need for highly trained professionals carries a real risk of inability to return to pre-injury level of activity, a risk of recurrent ACL tear, and increases the chance of progressive arthritis over time.3,4 Because of these consequences, it makes sense to try and avoid all of this trouble by focusing on reducing the rate of ACL injuries in the first place.

While some ACL tears caused by physical contact or collision may be unavoidable, roughly 70% of ACL injuries are non-contact and possibly preventable. Young females are at a 2 to 6 times increased risk of non-contact ACL injury compared to males.3 While there are many contributing factors that increase the injury risk profile in young females, researchers have identified a few key faulty movement patterns that may put them at higher risk.2,5,6 These faulty patterns (i.e., dynanmic knee valgus, stiff landing and others may be detected prior to injury using landing and cutting maneuvers. Accurate detection of movement patterns can be accomplished using “gold standard” 3D markerbased systems.5 Limitations of widespread screening using this technique include the requirement of a laboratorysetting, increased cost, and the need for highly trained technicians. 2D camcorder based systems are mobile and less expensive, but there are issues regarding their efficiency and accuracy. Research is now focusing on the development and validation of ACL injury risk screening tools using that use the Microsoft Kinect.8

Collaborative researchers are working toward the goal of developing portable, low risk, inexpensive, accurate, and efficient means to screen for ACL injury risk. There is no perfect screening test or tool for ACL injury risk detection. Understanding the magnitude of the problem is a critical first step. Clinicians and researchers must team up with players, parents, coaches, and athletic trainers to identify high-risk athletes. The goal of ACL injury reduction may not be far out of reach if we can use safe, efficient, and low cost injury screening methods along with targeted injury prevention programs.

References 1. Swart E, Redler L, Fabricant FD, Mandelbaum BR, Ahmad CS, Wang YC. Prevention and screening programs for anterior cruciate ligament injuries in young athletes: A cost-effectiveness analysis. J Bone Joint Surg Am. 2014.96:705-11. 2. Leppänen M, Pasanen K, Kulmala P, et al. Knee control and jumplanding technique in young basketball and floorball players. Int J Sports Med. 2016.37:334-8. 3. Mok KM, Leow RS. Measurement of movement patterns to enhance ACL injury prevention—a dead end? Asia-Pacific J Sports Med, Arthrosc, Rehab & Tech. 2016.5:13-16. 4. Zaffagnini S, Grassi A, Serra M, Marcacci M. Return to sport after ACL reconstruction: How, when and why? A narrative review of current evidence. Joints. 3:25-30. 5. Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: A prospective study. Am J Sports Med. 2005.33:492-501. 6. Krosshaug T, Steffen K, Kristianslund E, et al. The vertical drop jump is a poor screening test for ACL injuries: Response. Am J Sports Med. 2016.44:NP24-5. 7. McLean SG, Walker K, Ford KR, Myer GD, Hewett TE, van den Bogert AJ. Evaluation of a two dimensional analysis method as a screening and evaluation tool for anterior cruciate ligament injury. Br J Sports Med. 2005.39:355-62. 8. Gray AD, Marks JM, Stone EE, Butler MC, Skubic M, Sherman SL. Validation of the Microsoft Kinect as a portable and inexpensive screening tool for identifying ACL injury risk. Orthop J Sports Med. 2014:2(2).