Injury Prevention Protocols


Sport-specific injury prevention training programs are used across the country as an aid to increase performance and decrease injury rates. Two common areas of injury include the athletic shoulder and knee. Among the athletic population, injuries to the throwing shoulder are becoming more apparent as a result of overuse and poor conditioning. Likewise, anterior cruciate ligament (ACL) knee injuries continue to rise each year among the athletic population. The focus of this chapter is aimed at specific prevention protocols for reducing the likelihood of injury in the athletic knee, specific to ACL pathology, and in the throwing shoulder of the youth and elite athlete.

ACL Injury Prevention

Epidemiology and Injury Statistics

  • Injury to the ACL can be functionally debilitating and often requires surgical intervention.

  • ACL injuries are common in sports and strenuous work activities.

  • Approximately 200,000 ACL injuries occur annually in the United States (Fu: AJSM 1999).

  • Over a 20-year period, ACL surgery procedures have increased by 58%, with 148,714 ACL surgeries performed in 2013 (PearlDiver Technologies. PearlDiver supercomputer database. Available at: ).

  • One in 3500 people will sustain an ACL injury (Baer, Harner: Clin Sports Med 2007).

  • Sixty-two to sixty-six percent of ACL injuries are sports related, often in a noncontact manner (i.e., running, cutting, or landing from a jump).

  • The incidence of ACL injury and reconstruction seems to be increasing because of an increasing number of youth engaging in high-level athletics and older individuals remaining active longer (Mall et al: AJSM 2014).

  • Females are four to six times more likely to sustain an ACL injury compared with their male counterparts.

  • There are 43,125 ACL injuries annually in high school–aged athletes (Joseph et al: J Athl Train 2013).

  • High school–aged athletes, especially the female high school athlete, appear to be at the highest risk. The rank order for high school–aged athletes at highest risk are as follows (Yard et al: J Athl Train 2009):

    • Girls’ soccer—11.7 per 100,000 athletic exposures (AEs)

    • Boys’ football—11.4 per 100,000 AEs

    • Girls’ basketball—11.2 per 100,000 AEs

    • Girls’ gymnastics—9.9 per 100,000 AEs

    • Boys’ lacrosse—7.4 per 100,000 AEs

  • Ten times greater risk of developing osteoarthritis in an injured ACL knee (Fleming et al: JOSPT 2003).

  • By 7–11 years after ACL injury, a cohort study reported a 50 times increased risk of radiographic changes on the lateral femoral condyle, 30 times increased risk on the retropatellar surface, and 19 times on the medical femoral condyle (Potter et al: AJSM 2012).

  • Sixty-seven percent of ACL injuries occur in individuals between 15 and 29 years of age.

  • At an increased risk of contralateral ACL injury after first-time ACL injury.

  • Young, active athletes have high second-injury rates for the ACL, with the range of one-quarter to one-third. Most of these occur within 2 years after the first injury (Webster, Feller: AJSM 2016).

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