Jenny Giampalmo

Independent Research
2016-2017
Title: ACL Prevention Program
Introduction and Overview of Research:
Tearing or injuring of the Anterior Cruciate Ligament is a very common injury. This
ligament is a crucial part of knee stabilization and when injured a person loses much of their knee
function. For athletes this injury limits athletic participation and can cause lifelong discomfort.
This lead to research into what exercises and training could be done to limit the risk of injury.
Throughout this research meta analysis was used to analyze current ACL injury prevention
protocols and reach a conclusion about the most effective aspects of current programs. It was
found that the most effective exercises that should make up a majority of the program focus on
co-activation of the quadriceps and hamstrings, while static stretching should be avoided or at
least very limited. Overall a trained professional to give the participants real-time feedback to
correct as many errors as possible.

Background and Rationale

Every year there are about 150,000 ACL tears in the United States, and over 70% of these
injuries occur in noncontact situations such as pivoting and landing jumps. For those who tear
their ACLs, they must have reconstructive surgery followed by an average of nine months of
physical therapy before they can return to sports. The ACL is one of four major ligaments in the
knee. It runs from the anterior of the tibia to the posterior of the femur and is responsible for
stabilizing the shin and preventing it from moving forward.
There are several factors that lead to an increased risk for ACL tears. The first is the way
in which a person strikes the ground with their foot. Those who land on their rear foot put a much
higher rate of stress on their ACLs than those who absorb impact with their forefoot. The next is
valgus knee rotation during pivoting movements. Valgus rotation is when the knee twists inward.
This movement puts a heavy amount of stress ACL and overall on the knee.
For female athletes in particular there are many areas in which they face an even higher
risk of ACL tear. This is due to their increased joint laxity, neuromuscular factors, and the size of
their intercondylar groove. In general females have higher joint laxity than males which simply
means that their ligaments are looser overall. They have increased mobility which increases the
risk of hyperextension. The intercondylar groove is located at the base of the femur and is the
region where the patella rests. This is also the region of the knee which the ACL runs through and
because females are more likely to have small intercondylar grooves this directly decreases the
size of the ACL which in turn makes it weaker.
While there are some uncontrollable factors including growth and gender that can
increase the risk of ACL tears, many are controllable to some extent. This project and research
hopes to change foot strike during landing, promote knee stabilization through muscle
development and proper form during change of direction and pivoting movements.
Research Methodology:
Research Question:
How might I design the most effective neuromuscular training program to decrease the risk of
ACL tears in female athletes?
Research Thesis:
If a small group of collegiate/ high school aged female lacrosse players participate in a strength-
training program (I still need to research specifics about weight and lifting programs) then they
will develop balanced leg muscles that decrease the risk of an ACL tear.
Research Design Model:
This research utilized mixed method data collected through meta analysis. This method
of data collection was used because this topic is an area of science research that relies on raw data
but the researcher does not have the access to resources for conducting a firsthand experiment. By
using meta analysis the researcher is able to use statistics from professional systematic reviews
about areas of ACL prevention programs including balancing the length of time with user
compliance, instructional feedback and effectiveness of exercises used in order to complete the
project.
Data Collection:
This research utilized meta analysis to gather data for developing the most effective anterior
cruciate ligament (ACL) prevention program for female lacrosse players. The meta analysis
mainly focused on systematic reviews of particular parts of current ACL prevention programs and
other studies related to ACL prevention protocols. All sources found training protocols to be
effective but to varying degrees depending on a few factors. When all the strengths and
weaknesses of the systematic reviews are compared it is found that the time of the protocol is not
very important in terms of effectiveness; however, in order to have a higher in season compliance
rate, training programs need to have a time limit. Also, it is going to be important to have a
trained professional running the program so that errors in movement can be corrected early on.
The most effective exercises that should make up a majority of the program should strengthen the
quadriceps and hamstrings and their co-activation. Static stretching should be avoided or at least
very limited. Overall a main weakness in the data that should be researched further is the
effectiveness of individual exercises on general knee strength and ACL tear prevention.
Product Objectives:
The final product of this research will be a sample exercise program with the focus of reducing
ACL tear risks in female athletes. The program will consist of a short list of exercises with
specific instruction about duration and technique. Exercises that target the quadriceps and the
hamstrings as they work together are found to be the most effective for developing strength and
stability. Particular exercises that target the co-activation of the hamstring and the quadriceps
include lunging, single leg squat, depth jumps and tuck jumps. The co-activation of muscle has
been found to be the most effective due to the more even and gradual distribution of force. The
main group that will be targeting by the product is players and coaches. The goal is for the
coaches to add the small workout program created to their practices as a way to help strengthen
their players.
Logistical Considerations:
This product is based off of data that is gathered in systematic reviews of current ACL
injury prevention programs. There is not always sufficient data about how doing an exercise in a
controlled and monitored environment compares to an unpredictable situation. This creates some
problems with level of effectiveness of the programs. Also, fatigue is known to increase the
number of errors in exercises. The broad effects of several factors are known, but the specific
effects of several exercises and fatigue are not well understood.

References
AAOS. (2014, March). Common knee injuries. Retrieved from American Academy of
Orthopaedic
Surgeons website: http://orthoinfo.aaos.org/topic.cfm?topic=a00325
Herman, D. C., Weinhold, P. S., Guskiewicz, K. M., Garrett, W. E., Bing Yu, & Padua, D. A.
(2008,
April). The Effects of Strength Training on the Lower Extremity Biomechanics of
Female Recreational Athletes During a Stop-Jump Task. The American Journal of Sports
Medicine, 36(4), 733+. Retrieved from
http://go.galegroup.com/ps/i.do?p=GPS&sw=w&u=glen20233&v=2.1&it=r&id=GALE
%7CA178525192&asid=a53b7e9552afc03caf7ed4ef43051ca2