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Pediatrics Academy Offers Suggestions to Reduce Youth-Athlete ACL Injuries

With the rate of anterior cruciate ligament (ACL) injuries on the rise among youth-athletes over the past two decades, a new report from the American Academy of Pediatrics offers recommendations on how to prevent such maladies.

The report, published online today in the journal Pediatrics, dives into the details of youth ACL injuries before exploring possible preventative mechanisms. The ACL, which is one of the four major ligaments in the knee, is responsible for stabilizing the knee joint during actions that involve turning or pivoting.

According to the report, about 70 percent of ACL injuries are noncontact in nature, although the definition of noncontact varies by study. Some define it as a complete lack of player-to-player (or knee-to-knee) contact, while others define a noncontact ACL injury as one that occurs without a direct blow to a student-athlete's knee.

In high school sports, ACL injuries comprise a higher proportion of all injuries in female athletes compared to males (4.6 percent versus 2.5 percent), with girls' basketball leading the way (6 percent), followed by girls' soccer, girls' gymnastics, and girls' volleyball (5 percent each). Compared to boys, girls are more likely to undergo surgery and less likely to return to sports following an ACL injury, according to the report.

A study published last November in the Journal of Athletic Training found no significant gender difference in ACL injury rates among high school athletes, but did find girls suffering far more ACL injuries in gender-comparable sports. The AAP report confirms the latter finding, as ACL injury rates at the high school level were 2.5 to 6.2 times higher in girls compared with boys in gender-comparable sports (soccer, basketball, baseball/softball, track, and volleyball).

Once pre-teens enter puberty—beginning at age 12 for girls and age 14 for boys—they're at a higher risk for ACL injuries. After puberty, girls are at higher risk of ACL injuries than boys, according to the report, because they typically do not develop more muscle power despite their body size increasing.

"After puberty, girls have a 'machine motor mismatch,' " said Timothy Hewett, a co-author of the report and the director of research at Ohio State University Sports Medicine, in a statement. "In contrast, boys get even more powerful relative to their body size after their growth spurt. The good news is that we've shown that with neuromuscular training, we can boost the power of girls' neuromuscular engine, and reduce their risk of ACL injuries."

As Hewett alluded to, specific types of physical training—most notably plyometric and strengthening exercises—can reduce the risk of ACL injury as much as 72 percent for young female athletes, according to the report. Thus, the report authors recommend that pediatricians and orthopedic surgeons who work with schools to educate athletes, parents, coaches, and sports administrators about the benefits of neuromuscular training in terms of preventing ACL injuries.

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