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Ross A, Kim J, McKay M, Pappas E, Hardaker N, Whalan M, Peek K. The economics of a national anterior cruciate ligament injury prevention program for amateur football players: a Markov model analysis. Med J Aust 2024; 221:149-155. [PMID: 38992929 DOI: 10.5694/mja2.52385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/15/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES To estimate the long term cost savings, return on investment, and gain in quality-adjusted life years (QALYs) that could be achieved by a national anterior cruciate ligament (ACL) injury prevention program for amateur football (soccer) players in Australia. STUDY DESIGN Markov model decision analysis. SETTING, PARTICIPANTS Two hypothetical scenarios including all amateur football players in Australia (340 253 players): no intervention, and a national ACL injury prevention program. Transitions between health states, including ACL rupture, meniscal injury, knee osteoarthritis, and total knee replacement were made in one-year cycles over 35 years from a societal perspective. MAIN OUTCOME MEASURES Cost savings, return on investment, and QALY gain achieved in the prevention program scenario relative to control scenario, by age group (10-17, 18-34, 35 years or older) and gender. SECONDARY OUTCOMES incidence of ACL rupture, knee osteoarthritis, total knee replacement, and total knee replacement revision. RESULTS The total mean cost of an ACL injury was estimated to be $30 665. The national injury prevention program was projected to save $52 539 751 in medical and societal costs caused by ACL ruptures in amateur footballers over 35 years; the estimated return on each dollar invested in the program was $3.51. Over this period, the number of players with ruptured ACLs could be reduced by 4385 (9%), the number of knee osteoarthritis cases by 780 (8.1%), and the number of total knee replacements by 121 (8.1%); 445 QALYs were gained. CONCLUSION Our findings support investing in a national, evidence-based program for the primary prevention of ACL injuries in amateur football players.
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Affiliation(s)
- Andrew Ross
- The University of Sydney, Sydney, NSW
- Victoria University, Melbourne, VIC
| | - Joosup Kim
- Southern Clinical School, Monash University, Melbourne, VIC
| | - Marnee McKay
- Sydney School of Health Sciences, University of Sydney, Sydney, NSW
| | - Evangelos Pappas
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW
| | - Natalie Hardaker
- Sports Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
- Accident Compensation Corporation, Wellington, New Zealand
| | - Matt Whalan
- Centre of Medical and Exercise Physiology, University of Wollongong, Wollongong, NSW
- Football Australia, Sydney, NSW
| | - Kerry Peek
- Sydney School of Health Sciences, University of Sydney, Sydney, NSW
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Guilfoyle L, Kenny IC, O'Sullivan K, Campbell MJ, Warrington GD, Glynn LG, Comyns T. Coaches of youth field sports as delivery agents of injury prevention programmes: how are we training the trainers? A scoping review. Br J Sports Med 2024; 58:144-153. [PMID: 38216323 PMCID: PMC10894822 DOI: 10.1136/bjsports-2023-106934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE To systematically map the coach education (CE) component of injury prevention programmes (IPPs) for youth field sports by identifying and synthesising the design, content and facilitation strategies used to address competency drivers and behaviour change. DESIGN Scoping review. DATA SOURCES PubMed, PsycInfo, EMBASE, CINAHL, SportDiscus and Google Scholar electronic databases were searched using keywords related to IPPs and youth field sports. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies of IPPs in youth field sports, that provided 'train-the-trainer' education to coaches as designated delivery agents. RESULTS 20 studies from two field sports (soccer/football; n=17, Rugby Union; n=3) fulfilled the eligibility criteria. Eleven CE interventions occurred in the preseason and 18 occurred at one time-point (single day). Five studies cited use of a behavioural change theory or model in the design of their CE, most frequently the Health Action Process Approach model (n=5); and use of behavioural change techniques varied. Twelve of twenty studies (60%) reported some form of ongoing support to coaches following the CE primary intervention concurrent with IPP implementation. CONCLUSION CE that occurs on 1 day (one time-point) is most popular for preparing coaches as delivery agents of IPPs in youth field sports. While recognising pragmatic barriers, more expansive in-service training, support and feedback may enhance the effective implementation of IPPs. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/FMHGD.
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Affiliation(s)
- Lauren Guilfoyle
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ian C Kenny
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Kieran O'Sullivan
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, University of Limerick, Limerick, Ireland
- Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Mark J Campbell
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Lero, The Science Foundation Ireland Centre for Software Research, University of Limerick, Limerick, Ireland
| | - Giles D Warrington
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Liam G Glynn
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Tom Comyns
- Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
- Sport and Human Performance Research Centre, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Ross AG, Agresta B, McKay M, Pappas E, Cheng T, Peek K. Financial burden of anterior cruciate ligament reconstructions in football (soccer) players: an Australian cost of injury study. Inj Prev 2023; 29:474-481. [PMID: 37666517 DOI: 10.1136/ip-2023-044885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES To estimate the financial burden of anterior cruciate ligament (ACL) reconstructions in amateur football (soccer) players in Australia over a single year, including both direct and indirect cost. METHODS Available national direct and indirect cost data were applied to the annual incidence of ACL reconstructions in Australia. Age-adjusted and sex-adjusted total and mean costs (ACL and osteoarthritis (OA)) were calculated for amateur football (soccer) players in Australia using an incidence-based approach. RESULTS The estimated cost of ACL reconstructions for amateur football players is $A69 623 211 with a mean total cost of $A34 079. The mean indirect costs are 19.8% higher than the mean direct costs. The mean indirect costs are lower in female (11.5%, $A28 628) and junior (15.3%, $A29 077) football players. The mean ACL costs are 3-4-fold greater than the mean OA costs ($A27 099 vs $A6450, respectively), remaining consistent when stratified by sex and age group. Our model suggests that for every 10% increase in adherence to injury prevention programmes, which equates to approximately 102 less ACL injuries per year, $A9 460 224 in ACL costs could be saved. CONCLUSION While the number of ACL reconstructions per year among football players in Australia is relatively small, the annual financial burden is high. Our study suggests that if injury prevention exercises programmes are prioritised by stakeholders in football, significant cost-savings are possible.
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Affiliation(s)
- Andrew George Ross
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Blaise Agresta
- Health Economics and Health Technology Assessment, NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marnee McKay
- Discipline of Physiotherapy, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Tegan Cheng
- Faculty of Medicine and Health & Children's Hospital at Westmead, University of Sydney School of Health Sciences, Sydney, New South Wales, Australia
| | - Kerry Peek
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Ross AG, McKay MJ, Pappas E, Peek K. Insurance cost and injury characteristics of anterior cruciate ligament injuries in sub-elite football: A population analysis involving 3 years of Australian insurance data. J Sci Med Sport 2023:S1440-2440(23)00129-9. [PMID: 37349252 DOI: 10.1016/j.jsams.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/22/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVES To investigate the injury characteristics and insurance cost of anterior cruciate ligament injuries in sub-elite football players in New South Wales, Australia. DESIGN Descriptive epidemiological study. METHODS Three years of insurance records (2018-2020) was used to describe anterior cruciate ligament injury costs and characteristics. Concomitant injuries and the mechanism of injury were determined by analysing the injury descriptions. Claim characteristics and costs are presented by age group (junior = 7-17 years, senior = 18-34 years, and veteran = 35 + years) and sex. Categorical data (including age-groups and sex) are presented as counts and percentages and analysed using a Chi squared or Fisher's exact test. Cost data are reported as means ± standard deviation with 95 % confidence intervals. RESULTS Over the course of three football seasons (2018-2020), 786 anterior cruciate ligament injuries were reported to the injury insurance company. The total insurance cost was AU$3,614,742 with direct injury insurance costs accounting for 36.3 % of the total costs. The mean indirect insurance costs were six-fold higher than direct insurance costs (AU$11,458 vs AU$1914). Isolated injuries had an average cost of $4466 whilst concomitant injuries had an average cost of $4951. Surgical costs are excluded from direct cost calculations. The peak injury count occurred in the first month of all three football seasons, immediately after the pre-season. CONCLUSIONS Anterior cruciate ligament injuries represent a substantial economic burden to the insurer and individual. The cost data provided can be used for future economic and modelling studies.
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Affiliation(s)
- Andrew G Ross
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Marnee J McKay
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Evangelos Pappas
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia; Faculty of Science, Medicine and Health, Illawarra Health and Medical Research Institute, University of Wollongong, Australia
| | - Kerry Peek
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Australia
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Huntington L, Griffith A, Spiers L, Pile R, Batty L, Tulloch S, Tran P. Suture-tape augmentation of anterior cruciate ligament reconstruction: a prospective, randomised controlled trial (STACLR). Trials 2023; 24:224. [PMID: 36964584 PMCID: PMC10037835 DOI: 10.1186/s13063-023-07127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/30/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction aims to restore anteroposterior and rotatory stability to the knee following ACL injury. This requires the graft to withstand the forces applied during the process of ligamentisation and the rehabilitative period. We hypothesise that the use of suture tape augmentation of single bundle ACL reconstruction (ACLR) will reduce residual knee laxity and improve patient-reported outcomes at 2-year follow-up. We will conduct a 1:1 parallel arm single-centre randomised controlled trial comparing suture tape augmented ACLR to standard ACLR technique. METHODS The study design will be a parallel arm 1:1 allocation ratio randomised controlled trial. Sixty-six patients aged 18 and over waitlisted for primary ACLR will be randomised. Patients requiring osteotomy and extra-articular tenodesis and who have had previous contralateral ACL rupture or repair of meniscal or cartilage pathology that modifies the post-operative rehabilitation will be excluded. The primary outcome measure will be the side-to-side difference in anterior tibial translation (measured on the GNRB arthrometer) at 24 months post-surgery. GNRB arthrometer measures will also be taken preoperatively, at 3 months and 12 months post-surgery. Secondary outcomes will include patient-reported outcome measures (PROMs) collected online, including quality of life, activity and readiness to return to sport, complication rates (return to theatre, graft failure and rates of sterile effusion), examination findings and return to sport outcomes. Participants will be seen preoperatively, at 6 weeks, 3 months, 12 months and 24 months post-surgery. Participants and those taking arthrometer measures will be blinded to allocation. DISCUSSION This will be the first randomised trial to investigate the effect of suture-tape augmentation of ACLR on either objective or subjective outcome measures. The use of suture-tape augmentation in ACLR has been associated with promising biomechanical and animal-level studies, exhibiting equivalent complication profiles to the standard technique, with initial non-comparative clinical studies establishing possible areas of advantage for the technique. The successful completion of this trial will allow for an improved understanding of the in situ validity of tape augmentation whilst potentially providing a further platform for surgical stabilisation of the ACL graft. TRIAL REGISTRATION Australia New Zealand Clinical Trial Registry ACTRN12621001162808. Universal Trial Number (UTN): U1111-1268-1487. Registered prospectively on 27 August 2021.
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Affiliation(s)
- Lachlan Huntington
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia.
| | - Andrew Griffith
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Libby Spiers
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Rebecca Pile
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Lachlan Batty
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Scott Tulloch
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
| | - Phong Tran
- Department of Orthopaedic Surgery, Western Health, Footscray Hospital, Level 1 South, Gordon St, Footscray, Melbourne, VIC, 3011, Australia
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Wu XD, Kang L, Tian J, Wu Y, Huang Y, Liu J, Wang H, Qiu G, Wu Z. Exosomes derived from magnetically actuated bone mesenchymal stem cells promote tendon-bone healing through the miR-21-5p/SMAD7 pathway. Mater Today Bio 2022; 15:100319. [PMID: 35757032 PMCID: PMC9218580 DOI: 10.1016/j.mtbio.2022.100319] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 12/15/2022] Open
Abstract
Graft healing after anterior cruciate ligament reconstruction (ACLR) involves slow biological processes, and various types of biological modulations have been explored to promote tendon-to-bone integration. Exosomes have been extensively studied as a promising new cell-free strategy for tissue regeneration, but few studies have reported their potential in tendon-to-bone healing. In this study, a novel type of exosome derived from magnetically actuated (iron oxide nanoparticles (IONPs) combined with a magnetic field) bone mesenchymal stem cells (BMSCs) (IONP-Exos) was developed, and the primary purpose of this study was to determine whether IONP-Exos exert more significant effects on tendon-to-bone healing than normal BMSC-derived exosomes (BMSC-Exos). Here, we isolated and characterized the two types of exosomes, conducted in vitro experiments to measure their effects on fibroblasts (NIH3T3), and performed in vivo experiments to compare the effects on tendon-to-bone integration. Moreover, functional exploration of exosomal miRNAs was further performed by utilizing a series of gain- and loss-of-function experiments. Experimental results showed that both BMSC-Exos and IONP-Exos could be shuttled intercellularly into NIH3T3 fibroblasts and enhanced fibroblast activity, including proliferation, migration, and fibrogenesis. In vivo, we found that IONP-Exos significantly prevented peri-tunnel bone loss, promoted more osseous ingrowth into the tendon graft, increased fibrocartilage formation at the tendon-bone tunnel interface, and induced a higher maximum load to failure than BMSC-Exos. Furthermore, overexpression of miR-21-5p remarkably enhanced fibrogenesis in vitro, and SMAD7 was shown to be involved in the promotive effect of IONP-Exos on tendon-to-bone healing. Our findings may provide new insights into the regulatory roles of IONPs in IONP-Exos communication via stimulating exosomal miR-21-5p secretion and the SMAD7 signaling pathway in the fibrogenic process of tendon-to-bone integration. This work could provide a new strategy to promote tendon-to-bone healing for tissue engineering in the future.
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Affiliation(s)
- Xiang-Dong Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Lin Kang
- Medical Science Research Center (MRC), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jingjing Tian
- Medical Science Research Center (MRC), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yuanhao Wu
- Medical Science Research Center (MRC), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yue Huang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Jieying Liu
- Medical Science Research Center (MRC), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Hai Wang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Guixing Qiu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Zhihong Wu
- Medical Science Research Center (MRC), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
- Beijing Key Laboratory for Genetic Research of Skeletal Deformity, Beijing, 100730, China
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Mattu AT, Ghali B, Linton V, Zheng A, Pike I. Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084648. [PMID: 35457516 PMCID: PMC9027388 DOI: 10.3390/ijerph19084648] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/06/2022] [Accepted: 04/09/2022] [Indexed: 02/01/2023]
Abstract
Anterior cruciate ligament (ACL) injuries account for a large percentage of knee injuries, disproportionately affecting female athletes. To help health professionals stay current, we performed an umbrella review to evaluate the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates, determine the effective components within interventions, and provide clinical recommendations. Twelve databases (Medline, Embase, Cochrane Database of Systematic Reviews, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched in May 2021 to identify relevant systematic reviews and meta-analyses. Four databases were searched again in September 2021 to identify recent primary literature. Non-contact ACL injury data were extracted to calculate incidence rate ratios (IRRs) and these were combined using an inverse variance random-effects model. A qualitative assessment of included reviews was performed. The methodological quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) or Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Sixteen reviews and two primary studies met the inclusion criteria. Across 11 primary studies, prevention programs were effective in reducing non-contact ACL injuries by 64% (IRR = 0.36 (95% CI: 0.18–0.70)). A multi-faceted exercise program, beginning in the pre-season and containing at least three exercise types, may be beneficial in reducing ACL injury risk.
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Affiliation(s)
- Anmol T. Mattu
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence:
| | - Brianna Ghali
- Undergraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada;
| | - Vanessa Linton
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children’s Hospital Research Institute, Vancouver, BC V6H 3V4, Canada; (V.L.); (A.Z.); (I.P.)
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC V6H 3V4, Canada
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Maniar N, Verhagen E, Bryant AL, Opar DA. Trends in Australian knee injury rates: An epidemiological analysis of 228,344 knee injuries over 20 years. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 21:100409. [PMID: 35345847 PMCID: PMC8956823 DOI: 10.1016/j.lanwpc.2022.100409] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Acute knee injuries are a key predisposing risk factor for knee osteoarthritis. Public health interventions require in-depth epidemiological evidence to determine which knee injuries are problematic in critical age and sex demographics. METHODS Descriptive epidemiological analysis of longitudinal data on knee injuries (July 1998 - June 2018) from the National Hospital Morbidity Database in Australia were studied. The main outcomes where the population-related knee injury frequency, incidence per 100,000 and annual growth rate (%) over the 20-year observation period. Age-group and sex differences were also studied to determine demographic-specific trends. FINDINGS 228,344 knee injuries were diagnosed over the 20-year analysis period. Significantly rising annual incidences were observed for total knee injuries, anterior cruciate ligament (ACL) injuries and knee contusions in males and females. Posterior cruciate ligament (PCL) injuries and knee dislocations were also rising in females, but not males. Greater annual growth rates were observed for females compared to males for total knee injuries, knee contusions, PCL injuries and knee dislocations. Demographic analysis revealed that the highest annual growth rate in injury incidence (10.4%) was observed for ACL injuries in females aged 5-14 years old. INTERPRETATION Increasing annual incidence of knee injuries was observed over the 20-year period. Males have a higher incidence of knee injury per capita than females, but the gap appears to have narrowed over the 20-year analysis period. Younger Australians show a precipitous rise in the annual number of ACL injuries, particularly for females aged 5-14 years. These trends warrant urgent intervention. FUNDING None.
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Affiliation(s)
- Nirav Maniar
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam UMC and Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Adam Leigh Bryant
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Parkville, Victoria, Australia
| | - David Andrew Opar
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
- Sports Performance, Recovery, Injury and New Technologies (SPRINT) Research Centre, Australian Catholic University, Fitzroy, Victoria, Australia
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9
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Truong AP, Pérez-Prieto D, Byrnes J, Monllau JC, Vertullo CJ. Vancomycin Soaking Is Highly Cost-Effective in Primary ACLR Infection Prevention: A Cost-Effectiveness Study. Am J Sports Med 2022; 50:922-931. [PMID: 35180008 DOI: 10.1177/03635465211073338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although presoaking grafts in vancomycin has been demonstrated to be effective in observational studies for anterior cruciate ligament reconstruction (ACLR) infection prevention, the economic benefit of the technique is uncertain. PURPOSE To 1) determine the cost-effectiveness of vancomycin presoaking during primary ACLR to prevent postoperative joint infections and 2) to establish the break-even cost-effectiveness threshold of the technique and determine its cost-effectiveness across various international health care settings. STUDY DESIGN Economic and decision analysis; Level of evidence, 2. METHODS A Markov model was used to determine cost-effectiveness and the incremental cost-effectiveness ratio of additional vancomycin presoaking compared with intravenous antibiotic prophylaxis alone. A repeated search of the PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials databases, using the same criteria as a recent meta-analysis, was completed. A repeated meta-analysis of 9 cohort studies (level 3 evidence) was completed to determine the odds ratio of infection with vancomycin presoaking compared with intravenous antibiotics alone. Estimated costs of the vancomycin technique, treatment of infection, and further surgery were sourced from local hospitals and literature. Transitional probabilities for further surgery, including revision reconstruction and primary arthroplasty, were obtained from the literature. Probabilistic sensitivity analyses and a 1-way sensitivity analysis were performed to evaluate the ACLR infection rate break-even threshold for which the vancomycin technique would be no longer cost-effective. RESULTS The vancomycin soaking technique provides expected cost savings of $660 (USA), A$581 (Australia), and €226 (Spain) per patient. There was an improvement in the quality-adjusted life-years of 0.007 compared with intravenous antibiotic prophylaxis alone (4.297 vs 4.290). If the infection rate is below 0.014% with intravenous antibiotics alone, the vancomycin wrap would no longer be cost-effective. CONCLUSION The vancomycin presoaking technique is a highly cost-effective method to prevent postoperative septic arthritis after primary ACLR.
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Affiliation(s)
- Anthony P Truong
- Department of Orthopaedics, Toowoomba Base Hospital & Gold Coast University Hospital, Toowoomba, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Daniel Pérez-Prieto
- ICATKNEE, Hospital Universitari Dexeus, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Joan C Monllau
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Department of Orthopaedic Surgery and Traumatology, Hospital del Mar ICATKNEE, Hospital Universitari Dexeus, Barcelona, Spain
| | - Christopher J Vertullo
- Orthopaedic Surgery & Sports Medicine Centre, Gold Coast, Queensland, Australia.,Knee Research Australia, Gold Coast, Queensland, Australia.,Menzies Health, Griffith University, Brisbane, Queensland, Australia.,Australian Knee Society.,Australian Orthopaedic Association.,AOA Continuing Orthopaedic Education
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10
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Arundale AJH, Silvers-Granelli HJ, Myklebust G. ACL injury prevention: Where have we come from and where are we going? J Orthop Res 2022; 40:43-54. [PMID: 33913532 DOI: 10.1002/jor.25058] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are one of the most common and severe knee injuries across sports. As such, ACL injury prevention has been a focus of research and sports medicine practice for the past three-plus decades. Examining the current research and identifying both clinical strategies and research gaps, the aim of this review is to empower clinicians and researchers with knowledge of where the ACL injury prevention literature is currently and where it is going in the future. This paper examines the mechanism of ACL injury prevention, screening, implementation, compliance, adherence, coronavirus, and areas of future research. Clinical significance: The time lag between research and practical implementation in general healthcare settings can be as long as 17 years; however, athletes playing sports today are unable to wait that long. With effective programs already established, implementation and adherence to these programs is essential. Strategies such as coaching education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaboration are just a few ways that could help improve both ACL injury prevention implementation and adherence.
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Affiliation(s)
- Amelia J H Arundale
- Department of Rehabilitation, Icahn School of Medicine, Mount Sinai Health System, New York, New York, USA.,Red Bull Athlete Performance Center, Red Bull GmBH, Thalgua, Austria
| | - Holly J Silvers-Granelli
- Velocity Physical Therapy, Santa Monica, California, USA.,Major League Soccer, Medical Research Committee, New York, New York, USA
| | - Grethe Myklebust
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
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11
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Primeau CA, Zomar BO, Somerville LE, Joshi I, Giffin JR, Marsh JD. Health Economic Evaluations of Hip and Knee Interventions in Orthopaedic Sports Medicine: A Systematic Review and Quality Assessment. Orthop J Sports Med 2021; 9:2325967120987241. [PMID: 34262974 PMCID: PMC8243245 DOI: 10.1177/2325967120987241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The economic burden of musculoskeletal diseases is substantial and growing. Economic evaluations compare costs and health benefits of interventions simultaneously to help inform value-based care; thus, it is crucial to ensure that studies are using appropriate methodology to provide valid evidence on the cost-effectiveness of interventions. This is particularly the case in orthopaedic sports medicine, where several interventions of varying costs are available to treat common hip and knee conditions. PURPOSE To summarize and evaluate the quality of economic evaluations in orthopaedic sports medicine for knee and hip interventions and identify areas for quality improvement. STUDY DESIGN Systematic review; Level of evidence, 3. METHODS The Medline, AMED, OVID Health Star, and EMBASE databases were searched from inception to March 1, 2020, to identify economic evaluations that compared ≥2 interventions for hip and/or knee conditions in orthopaedic sports medicine. We assessed the quality of full economic evaluations using the Quality of Health Economic Studies (QHES) tool, which consists of 16 questions for a total score of 100. We classified studies into quartiles based on QHES score (extremely poor quality to high quality) and we evaluated the frequency of studies that addressed each of the 16 QHES questions. RESULTS A total of 93 studies were included in the systematic review. There were 41 (44%) cost analyses, of which 21 (51%) inappropriately concluded interventions were cost-effective. Only 52 (56%) of the included studies were full economic evaluations, although 40 of these (77%) fell in the high-quality quartile. The mean QHES score was 83.2 ± 19. Authors consistently addressed 12 of the QHES questions; questions that were missed or unclear were related to statistical uncertainty, appropriateness of costing methodology, and discussion of potential biases. The most frequently missed question was whether the cost perspective of the analysis was stated and justified. CONCLUSION The number of studies in orthopaedic sports medicine is small, despite their overall good quality. Yet, there are still many highly cited studies based on low-quality or partial economic evaluations that are being used to influence clinical decision-making. Investigators should follow international health economic guidelines for study design and critical appraisal of studies to further improve quality.
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Affiliation(s)
- Codie A. Primeau
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Bryn O. Zomar
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | | | - Ishita Joshi
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - J. Robert Giffin
- Bone and Joint Institute, Western University, London, Ontario, Canada
- London Health Sciences
Centre, University Hospital, London, Ontario, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jacquelyn D. Marsh
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
- London Health Sciences
Centre, University Hospital, London, Ontario, Canada
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12
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Ross AG, Donaldson A, Poulos RG. Nationwide sports injury prevention strategies: A scoping review. Scand J Med Sci Sports 2020; 31:246-264. [PMID: 33080079 DOI: 10.1111/sms.13858] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/19/2020] [Accepted: 10/13/2020] [Indexed: 12/26/2022]
Abstract
National strategies to prevent sports injuries can potentially improve health outcomes at a population level and reduce medical costs. To date, a compilation of the strategies that countries have attempted, and their effectiveness, does not exist. This scoping review sets out to: identify nationwide attempts at implementing sports injury prevention strategies; examine the impact of these strategies; and map them onto the Translating Research into Injury Prevention Practice (TRIPP) framework. Using Levac's scoping review method, we: (a) identified the research questions, (b) identified relevant studies, (c) identified the study selection criteria, (d) charted the data, and (e) reported the results. A search of MEDLINE, Scopus, SPORTDiscus, CINAHL, and Web of Science databases for articles published pre-June 2019 was conducted. We identified 1794 studies and included 33 studies (of 24 strategies). The USA (n = 7), New Zealand (n = 4), Canada (n = 3), the Netherlands (n = 3), Switzerland (n = 2), Belgium (n = 1), France (n = 1), Ireland (n = 1), South Africa (n = 1), and Sweden (n = 1) have implemented nationwide sports injury prevention strategies with 29 (88%) of the included studies demonstrating positive results. Mapping the strategies onto the TRIPP framework highlighted that only four (17%) of the 24 included strategies reported on the implementation context (TRIPP Stage 5), suggesting an important reporting gap. Nationwide sports injury prevention efforts are complex, requiring a multidimensional approach. Future research should report intervention implementation data; examine the implementation context early in the research process to increase the likelihood of real-world implementation success; and could benefit from incorporating qualitative or mixed research methods.
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Affiliation(s)
- Andrew G Ross
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Alex Donaldson
- Centre for Sport and Social Impact, La Trobe University, Melbourne, Vic., Australia
| | - Roslyn G Poulos
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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Petushek EJ, Sugimoto D, Stoolmiller M, Smith G, Myer GD. Evidence-Based Best-Practice Guidelines for Preventing Anterior Cruciate Ligament Injuries in Young Female Athletes: A Systematic Review and Meta-analysis. Am J Sports Med 2019; 47:1744-1753. [PMID: 30001501 PMCID: PMC6592422 DOI: 10.1177/0363546518782460] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injury prevention neuromuscular training (NMT) programs reduce the risk for anterior cruciate ligament (ACL) injury. However, variation in program characteristics limits the potential to delineate the most effective practices to optimize injury risk reduction. PURPOSE To evaluate the common and effective components included in ACL NMT programs and develop an efficient, user-friendly tool to assess the quality of ACL NMT programs. STUDY DESIGN Systematic review and meta-analysis. METHODS Study inclusion required (1) a prospective controlled trial study design, (2) an NMT intervention aimed to reduce incidence of ACL injury, (3) a comparison group, (4) ACL injury incidence, and (5) female participants. The following data were extracted: year of publication, study design, sample size and characteristics, and NMT characteristics including exercise type and number per session, volume, duration, training time, and implementer training. Analysis entailed both univariate subgroup and meta-regression techniques using random-effects models. RESULTS Eighteen studies were included in the meta-analyses, with a total of 27,231 participants, 347 sustaining an ACL injury. NMT reduced the risk for ACL injury from 1 in 54 to 1 in 111 (odds ratio [OR], 0.51; 95% CI, 0.37-0.69]). The overall mean training volume was 18.17 hours for the entire NMT (24.1 minutes per session, 2.51 times per week). Interventions targeting middle school or high school-aged athletes reduced injury risk (OR, 0.38; 95% CI, 0.24-0.60) to a greater degree than did interventions for college- or professional-aged athletes (OR, 0.65; 95% CI, 0.48-0.89). All interventions included some form of implementer training. Increased landing stabilization and lower body strength exercises during each session improved prophylactic benefits. A meta-regression model and simple checklist based on the aforementioned effective components (slope = -0.15, P = .0008; intercept = 0.04, P = .51) were developed to allow practitioners to evaluate the potential efficacy of their ACL NMT and optimize injury prevention effects. CONCLUSION Considering the aggregated evidence, we recommend that ACL NMT programs target younger athletes and use trained implementers who incorporate lower body strength exercises (ie, Nordic hamstrings, lunges, and heel-calf raises) with a specific focus on landing stabilization (jump/hop and hold) throughout their sport seasons. CLINICAL RELEVANCE Clinicians, coaches, athletes, parents, and practitioners can use the developed checklist to gain insight into the quality of their current ACL NMT practices and can use the tool to optimize programming for future ACL NMT to reduce ACL injury risk.
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Affiliation(s)
- Erich J. Petushek
- Department of Radiology, College of Human Medicine,
Michigan State University, East Lansing, Michigan, USA.,School of Health and Human Performance, Northern
Michigan University, Marquette, Michigan, USA.,Address correspondence to Erich J. Petushek, PhD,
Department of Radiology, College of Human Medicine, Michigan State University,
846 Service Rd, East Lansing, MI 48824, USA
()
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention,
Waltham, Massachusetts, USA.,Department of Orthopaedic Surgery, Harvard Medical
School, Boston, Massachusetts, USA.,Division of Sports Medicine, Department of
Orthopaedics, Boston Children’s Hospital, Boston, Massachusetts, USA
| | - Michael Stoolmiller
- Department of Pediatrics, College of Human Medicine,
Michigan State University, East Lansing, Michigan, USA
| | - Grace Smith
- Kalamazoo College, Kalamazoo, Michigan, USA.,Department of Physical Therapy, Grand Valley
State University, Grand Rapids, Michigan, USA
| | - Gregory D. Myer
- The Micheli Center for Sports Injury Prevention,
Waltham, Massachusetts, USA.,The SPORT Center, Division of Sports
Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,
USA.,Departments of Pediatrics and Orthopaedic
Surgery, University of Cincinnati, Cincinnati, Ohio, USA
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14
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Somthavil S. Altered kinematics after anterior cruciate ligament reconstruction, and their role in the prevention of osteoarthritis. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.10.529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims: Anterior cruciate ligament injury is common, and anterior cruciate ligament reconstruction has become the standard of care that aims to restore knee stability, return to activity, and prevent secondary injury. Methods: A literature review was carried out using PubMed and Science Direct databases from 1998 through 2017. Search terms included: anterior cruciate ligament reconstruction and knee osteoarthritis; kinematics after anterior cruciate ligament reconstruction; and prevention of knee osteoarthritis. A total of 356 studies matched the search terms. After removing duplicates and any studies that were not relevant, 73 studies remained. Findings: Individuals usually have impaired neuromuscular control after reconstruction, and abnormal biomechanical patterns may lead to loading of cartilage areas that are not commonly loaded and that, longitudinally, can lead to osteoarthritis. The knee adduction moment indicates loading of the knee joint and has been associated with the development of osteoarthritis and altered gait mechanics have also been implicated in the increased rate of osteoarthritis after anterior cruciate ligament reconstruction, including differences in tibial rotation during walking. Furthermore, altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. It is clear that abnormal mechanical stimulation may cause dysfunction of articular chondrocytes and breakdown of cartilage extracellular matrix, leading to articular cartilage degradation and chondrocyte death. The affected joint will progress to post-traumatic osteoarthritis. Conclusions: The restoration of normal knee anatomy and mechanics, such as returning the joint to normal function, improving muscle strength, functional movement prevention programmes, restoring gait symmetry and weight management are recommended.
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Affiliation(s)
- Sompiya Somthavil
- Lecturer Faculty of Sports Science, Kasetsart University, Nakhon Pathom, Thailand
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15
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Abstract
The Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy have an ongoing effort to create evidence-based clinical practice guidelines (CPGs) for orthopaedic and sports physical therapy management and prevention of musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability and Health (ICF). This particular guideline focuses on the exercise-based prevention of knee injuries. J Orthop Sports Phys Ther. 2018;48(9):A1-A42. doi:10.2519/jospt.2018.0303.
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16
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Zbrojkiewicz D, Vertullo C, Grayson JE. Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. Med J Aust 2018; 208:354-358. [DOI: 10.5694/mja17.00974] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/12/2017] [Indexed: 01/14/2023]
Affiliation(s)
- David Zbrojkiewicz
- Knee Research Australia, Gold Coast, QLD
- Griffith University, Gold Coast, QLD
| | - Christopher Vertullo
- Knee Research Australia, Gold Coast, QLD
- Gold Coast Orthopaedic Research and Education Alliance, Griffith University, Gold Coast, QLD
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17
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Trojian T, Driban J, Nuti R, Distefano L, Root H, Nistler C, LaBella C. Osteoarthritis action alliance consensus opinion - best practice features of anterior cruciate ligament and lower limb injury prevention programs. World J Orthop 2017; 8:726-734. [PMID: 28979857 PMCID: PMC5605359 DOI: 10.5312/wjo.v8.i9.726] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 07/04/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To identify best practice features of an anterior cruciate ligament (ACL) and lower limb injury prevention programs (IPPs) to reduce osteoarthritis (OA).
METHODS This consensus statement started with us performing a systematic literature search for all relevant articles from 1960 through January 2017 in PubMed, Web of Science and CINAHL. The search strategy combined the Medical Subject Heading (MeSH) and keywords for terms: (1) ACL OR “knee injury” OR “anterior cruciate ligament”; (2) “prevention and control” OR “risk reduction” OR “injury prevention” OR “neuromuscular training”; and (3) meta-analysis OR “systematic review” OR “cohort study” OR randomized. We found 166 different titles. The abstracts were reviewed for pertinent papers. The papers were reviewed by at least two authors and consensus of best practice for IPP to prevent OA was obtained by conference calls and e-mail discussions. All authors participated in the discussion.
RESULTS The best practice features of an IPP have the following six components: (1) lower extremity and core strengthening; (2) plyometrics; (3) continual feedback to athletes regarding proper technique; (4) sufficient dosage; (5) minimal-to-no additional equipment; and (6) balance training to help prevent injuries. Exercises focused on preventing ankle sprains, hamstring injuries and lateral trunk movements are important. Plyometric exercises should focus on correcting knee valgus movement. Exercises should focus on optimizing the hamstring to quadriceps strength ratio. In order for IPP to be successful, there should be increased education and verbal feedback along with increased athletic compliance. Additional equipment is not necessary. Balance training alone does not significantly reduce injuries, but is beneficial with other exercises. Not enough evidence to recommend stretching and agility exercises, with no ill effects identified. Therefore, we suggest making these optional features.
CONCLUSION Best practice features for ACL and lower limb IPPs to help prevent OA contain six key components along with two optional.
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Affiliation(s)
- Thomas Trojian
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Jeffrey Driban
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Rathna Nuti
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Lindsay Distefano
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Hayley Root
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Cristina Nistler
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
| | - Cynthia LaBella
- Division of Sports Medicine, Drexel University College of Medicine, Philadelphia, PA 19127, United States
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18
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Shaw L, Finch CF. Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005-2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E599. [PMID: 28587262 PMCID: PMC5486285 DOI: 10.3390/ijerph14060599] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 02/01/2023]
Abstract
Anterior cruciate ligament (ACL) injuries in children and adolescents have been the focus of recent media attention and parental concern, given their potential for adverse long-term health outcomes and healthcare costs. However, there is limited formal evidence on trends in the incidence of ACL injuries in children. This study utilizes the Victorian Admitted Episodes Dataset (VAED) to characterize epidemiologic trends of hospital-admitted ACL injuries in those aged 5 to 14 years over a period of 10 years from 2005 to 2015. There was a total of 320 cases and the overall annual rate of ACL injuries increased by 147.8% from 2.74 per 100,000 population in 2005/2006 to 6.79 per 100,000 in 2014/2015. The majority (96.9%) of these injuries were in 10- to 14-year-olds. The main in-hospital procedure provided to over 80% of the hospitalized cases involved ACL reconstruction. Sporting activities accounted for 56.6% of ACL injuries. For females, over half (52.4%) of ACL injuries occurred whilst playing ball sports, compared to 35.4% of males. The large increase in ACL injuries in 5- to 14-year-olds in the state of Victoria, Australia over a 10-year period indicates they are a significant and emerging health burden. Population-wide ACL prevention policies are required to halt these trends. Cost effective prevention programs that involve neuromuscular training must be implemented in schools and junior sports teams.
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Affiliation(s)
- Louise Shaw
- Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat 3353, Victoria, Australia.
| | - Caroline F Finch
- Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University Australia, Ballarat 3353, Victoria, Australia.
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