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A brief summary of every document (one paragraph per assignment) within the files. Should be under 2 pages in APA 7th edition. The assignment name should be the header for the paragraph used for each summary.

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Literature review
Anterior cruciate ligament (ACL) injuries are prevalent in young athletes and can have
serious consequences. The ACL accounts for almost all knee injuries in young athletes. ACL
injuries have a financial and emotional toll on the athletes who suffer them, including time away
from the games, emotional distress, and lasting fitness and health issues. One component of these
costs is the considerable financial impact of surgical intervention and prolonged recovery. ACL
injuries also have a financial impact on the individual who sustains them. ACL injuries nearly
invariably harm to the adjacent nerves. Injuries of this nature increase the likelihood of recurring
knee injuries and chronic knee complications, as well as the beginning of osteoarthritis earlier in
life (Noyes & Barber-Westin, 2018). Several ways can be considered to minimize the long-term
health, emotional and financial costs associated with such traumatic events. Around 70% of all
ACL tears result from anything other than a direct physical impact. Many of these rips may be
avoided if prophylactic measures were taken. With the hope of lowering the number of noncontact ACL injuries, several injury deterrence plans for high-risk groups, such as female
athletes, have been developed. Preventing ACL injuries may be done in various ways, depending
on the program. Neuromuscular and biomechanical training has been emphasized heavily in
these preventive programs to improve knee muscle support and change movement patterns.
Significance and Innovation
This project aims to highlight ways to prevent female athletes from ACL injury. Proactive
measures that might prevent future ACL injuries in female athletes can be caused by a diversity
of aims, including the usage of specific equipment, hormonal levels, the environment in which
the sport is played, dietary habits, strength training regimens, and anatomical variances between
genders (Noyes & Barber-Westin, 2018). The research will document extrinsic and intrinsic
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factors that may be linked to ACL injuries.
Does the field of play or equipment affect the possibility of injury in athletes?
Beynnon et al. depicts that ACL induce persistent impairment and early osteoarthritis in
those who have had a catastrophic injury (Beynnon et al., 2014). First-time noncontact ACL
injuries in fit actions are studied, as is the influence of level of race, type of sport, and gender on
the prevalence of these injuries. An athlete’s threat ACL harm is not affected by any interactions
among the various variables. According to Beynnon et al. and Howard et al. the level of
competition, the gender of the player, and the sort of sport they participate in are the only factors
that influence this risk (Howard et al., 20220). Female collegiate athletes had the highest danger
of filling a non-contact ACL hurt compared to other groups.
According to Beynnon et al., first-time noncontact ACL injuries remained twice more
prevalent in girls than boys, irrespective levels of competitiveness. Athletes had a far greater
injury danger than high school players, even after adjusting for variations in sport and gender.
After correcting for variables such as gender and skill level, Beynnon et al. states that athletes
who played soccer or rugby had a significantly higher danger of a first-time noncontact ACL
injury than those who played lacrosse. Only lacrosse had a statistically significant risk of injury
among the other sports. Beynnon et al. findings depict that the projected number of injuries for
high school male players in soccer was lower than the actual number of injuries seen in lacrosse
(Beynnon et al. 2014). However, the statistical significance of these inconsistencies was not high
enough to warrant further investigation.
According to Howard et al., training on natural grass rather than artificial grounds in the
NCAA increases the chance of tearing the ACL, regardless of gender or division in which the
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athlete participates (Howard et al., 2020). There was no noticeable improvement in the risk of
ACL damage during the sessions. A number of other factors must be considered when
calculating the possibility of a player injuring their ACL. Despite the slight difference in risk,
Howard et al. indicated that the total threat of tearing an ACL in NCAA football players was
considerably greater throughout training on natural grass than throughout exercise on artificial
turf. The risk of damaging ACL was much greater for NCAA athletes who practiced on natural
grass than on artificial turf. Division III athletes were more probable to withstand an ACL injury
on synthetic turf, but Division II athletes were more likely to sustain an ACL injury on natural
grass throughout competition (Howard et al.2020). The revelation that women trained on natural
grass instead of artificial turf was an interesting side note.
Natural grass was 3.03 times more likely to injure male athletes during practice than
artificial turf. During sports and exercise on two different types of field surfaces, Howard et al.
observed at the occurrence of ACL injuries. Division III athletes are further vulnerable to ACL
damage on synthetic turf (Howard et al. 2020). Likely, participants in Division II were more
probable to develop an injury while playing on natural grass. In Divisions, I and III, athletes who
exercised on natural grass had a greater chance of damaging their ACL than those who practiced
on synthetic turf. For athletes playing in Division II, no injuries were documented while
practicing on artificial grass, which may have influenced our sub analyses of injury rates.
According to the NCAA, ACL injuries are more probable to happen on natural grass than on
artificial turf. This might be due to a player’s experience level, which is difficult to account for.
According to Howard et al., there was no association between “talent level” as evaluated by the
NCAA division and the danger of ACL injuries in female basketball players. This might be
because the players are more exhausted in practice than in games, which could upsurge the risk
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of ACL injuries on natural grass during training but not in actual sports. Likely, it is probable
that the natural grass on training grounds is not as well kept as on game fields (Howard et al.
2020). When it comes to game fields, the upkeep of natural grass could be preferable if the fields
are being kept in top condition for the athletes that use them.
Since vertical drop jumps (VDJ) test is still widely used in clinical screening, Krosshaug et
al., administered preseason screening checks to the best female soccer and handball players
(Krosshaug et al., 2016). A three-dimensional motion study of a landing from a drop leap was
carried out by Krosshaug et al., throughout the testing. Only 710 of the 782 people who took the
test were included in the analysis, out of 782. Noncontact ACL injuries were documented in 42
athletes, 12 of whom had already suffered an ACL injury. Krosshaug et al. indicated an
amplified threat of injury to be associated with previous ACL damage and medial knee
dislocation.
In contrast, no association was found between medial knee injury and participants without
a history of a knee injury. An examination of the area under the curve for medial knee
dislocation using receiver operating characteristic curves found a value of 0.6 even when athletes
with prior injuries were included (Krosshaug et al., 2016). As a result, the test’s sensitivity and
specificity were rated as fair to low. Medial knee dislocation was connected to only one of the
five risk factors for ACL damage. For ACL injury screening, medial knee displacement has a
low sensitivity and specificity. No VDJ indicators were found to be related with an amplified
threat of athletes’ injury who had never been injured in the past (Krosshaug et al., 2016).
Brophy et al. conducted a research to see if a player’s dominant leg had an effect on their
risk of tearing their ACL. To find out whether soccer players more commonly rupture the ACL
of their preferred support leg than their preferred kicking leg, Brophy and colleagues set out to
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investigate, despite the fact that gender may play some influence in this disparity (Brophy et al.
2010). Over half of the injuries occurred in the player’s favorite kicking limb and the opposing
leg when there was no physical contact between the two parties. Non-contact occurrences
resulted in 74.1 percent of males and 32 percent of females suffering injuries to their dominant
kicking leg. Women are more likely to rupture the ACL in their leg sustaining the body when the
source of injury is non-contact, according to studies by Brophy et al. and Khayambashi et al
(Khayambashi et al. 2016). ACL injuries in soccer athletes have been linked to limb dominance,
according to research by Brophy et al. A combination of physical and neuromuscular differences
between men and women might be to blame for this.
Paterno et al. depicts that young, active persons with previous cases of ACL reconstruction
(ACLR) and return to sport (RTS) have an ACL re-injury rate that is 15 times higher than those
who have never suffered an ACL injury previously (Paterno et al. 2014). For the first year
following RTS and ACLR, there have been no studies or estimates concerning whether or not
this elevated relative rate of injury maintains beyond that year. An ACLR and RTS operation
resulted in a 1.39 per 1000 adverse occurrences in the first 24 months (Paterno et al., 2014). A
study by Paterno et al. found that after 24 months, female athletes in the ACLR group
experienced five times the injury risk of female controls than those in the control group.
A previously unexpected trend emerged in the ACLR group, where female patients had a
1.13% larger chance of being injured on the opposite side of the body than on the opposite side
(Paterno et al., 2014). RTS was performed on 29.5% of athletes during the first twenty-four
months following their first ACL injury, with 20.5% of those athletes experiencing a
contralateral injury and 9.0% of those athletes sustaining retear damage to the graft. Compared to
male participants, female participants were more likely to have a concussion (23.7 percent total)
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than male participants (10.5 percent). However, this was not statistically significant (P =.18).
Aside from ipsilateral injuries, both males and females had the same rate of ipsilateral injuries
(10.5 and 8.5 percent). Paterno et al. findings show that patients who have had ACLR and RTS
are extra probable to suffer an additional ACL injury in the next 24 months than young athletes
who have never had an ACL injury (Paterno et al., 2014). In addition, it appears that the
contralateral limb is the most vulnerable in female patients.
What kind of injury prevention programs are most used as primary prevention for athletes
who have torn their ACL?
Neuromuscular training (NMT), or injury prevention neuromuscular training, reduces the
likelihood of ACL damage. Petushek et al. states that since there are so many program elements,
it is hard to tell which strategies are most effective at reducing the risk of damage (Petushek et
al., 2019). A total of 27,231 people participated in Petushek’s meta-analyses, 347 of whom had
ACL injuries. Torn ACLs are now only as likely to occur in 1 in 111 people because of NMT.
Throughout the NMT, participants put in 18.17 hours of training every week. Younger athletes
(those in middle or high school) were less likely to suffer an injury than older ones (those in
college or the professional ranks). Every single one of them included training for intervention
implementers (Petushek et al., 2019). Exercises that target landing stability and lower body
strength can help prevent injury by increasing the amount of repetitions in each session. Thanks
to the development of a meta-regression model and a simple checklist based on the positive
components previously revealed, practitioners may now evaluate the potential efficacy of their
own ACL NMT and optimize injury prevention effects.
During their respective sports seasons, Petushek et al. report that ACL NMT programs
target younger athletes and emphasize lower body strength workouts with a particular focus on
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landing stability (jump/hop and hold). These projects should be implemented by people who
have the necessary expertise (Petushek et al., 2019).
Programs focused on reducing neuromuscular injuries, such as ACL tears caused by noncontact sports, have been developed. ACL injuries in women athletes were 67% less likely in
Mattu et al. study than in the utmost current meta-analysis of other meta-analyses (Mattu et al.
2022). Overall, ACL injuries rather than just non-contact ACL injuries showed that prevention
strategies for ACL tears were less successful than those for only those injuries. Therefore,
evaluations and primary research must distinguish concerning contact and non-contact injury
causes when investigative prevention programs’ true efficiency and regarding specific
populations. Compliance is a critical consideration when assessing the efficacy of programs to
prevent ACL injuries (Mattu et al., 2022). As there were not enough studies that retrieved and
reported compliance data from the source literature, Mattu et al. could not synthesize compliance
findings.
The different reviews utilized varied methodologies to compute compliance, so Mattu et al.
only had a limited number of reviews to pick from. According to many evaluations, one of the
most important obstacles to effectively evaluating agreement was a lack of data and a uniform
definition of acquiescence in the key studies. Mattu et al. and Petushek et al. found that greater
compliance was related with a lower risk of ACL damage (Petushek et al. 2019). Adolescent
female athletes were less probable to have non-contact ACL injuries due to ACL anticipation
agendas. Averting ACL injuries by engaging in a multifaceted training regimen that begins in the
offseason and continues throughout the season is a smart move (Mattu et al., 2022). Plyometric
and consolidation trainings, as well as feedback or an emphasis on correct technique, must be
included in any intervention program that is to be effective. The high-risk motions involved in a
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given activity must be linked to each training. A successful program to prevent ACL injuries
must also have high levels of compliance. Athletes should be encouraged to engage in every
training session to optimize neuromuscular and biomechanical adaptations (Mattu et al., 2022).
This should be a top priority for the coaching staff. It’s feasible that including a preventive
program in a warm-up might improve training devotion.
According to Dharamsi and LaBella, there is an amplified danger of an ACL injury in
female athletes contributing in competitive or recreational sports (Dharamsi & LaBella, 2013).
However, Dharamsi and LaBella state that this risk can be reduced by neuromuscular training
and intelligent coaching. Even if athletes take every precaution, sports-related injuries can
happen to unpredictably. The danger factors related to an athletes’ approach, training, and
lifestyle may be mitigated. Playing or practicing a sport comes with a certain amount of danger
of injury, but it may be greatly reduced by employing the proper technique. Dharamsi and
LaBella state that working with your coach or a sports physical therapist may discover what’s
wrong and how to repair it (Dharamsi & LaBella, 2013). When athletes are tired, it is much
easier to make mistakes or lose track of good technique. According to Dharamsi and LaBella,
preventing injury may be as simple as getting enough sleep and stopping a workout before is
completely exhausted. Core and extremity strength are key to success.
When one focuses on one item at the expense of another, they increase the risk of injury.
Injuries are more likely to occur if the muscles are overly tight or too lax. According to Dharamsi
and LaBella, strength training and flexibility exercises must be balanced to get the most out of an
athlete’s workout. Strength, endurance, and focus might be lost due to insufficient food
(Dharamsi & LaBella, 2013). Concentration and performance can both benefit from a healthy
diet. Female athletes amid the ages of 15 and 18 who have received NMT have shown the largest
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reduction in the danger of ACL injury (Petushek et al., 2019). As a result, NMT programs should
begin during the adolescent years. Dharamsi and LaBella findings are similar to Petushek et al.
since they prove that training for at least six to eight weeks is necessary before improvements in
neuromuscular function, as well as an increase in athletic performance. The most successful
NMT programs had athletes work out at least twice a week for six weeks (Petushek et al., 2019).
There is no doubt that training during and after the season is more effective than preseason
preparation. NMT programs may be most effectively implemented if an integrated program is
incorporated into everyday physical education lessons (Dharamsi & LaBella, 2013). Individuals
who participate in leisure physical activities and those who participate in competitive sports
might benefit from these programs.
Zebis et al. set out to examine the neuromuscular and biomechanical hazard features
related to non-contact ACL injuries and the effect of evidence-based training for injury
prevention in the lower extremities (Zebis et al., 2016). Zebis et al. findings state that after
completing a 12-week injury deterrence program in addition to their normal training and
competition, the agonist-antagonist muscle preactivity pattern throughout side cutting was
changed in teenage girls.
There is a reduction in knee abduction moments in both responder and non-responder
participants of an ACL injury deterrence program; however the demographic, anthropometric
and biomechanical variables that distinguish responders from non-responder participants were
the focus of Taylor et al’s research (ACL-IPP). Biomechanical testing (three-dimensional motion
analysis of a vertical drop jump) and performance evaluation were performed on 43 teenage
female athletes’ earlier and later randomization into a six-week ACL-IPP. Participants were
separated into responders and non-responders depending on how much their knee abduction
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moment dropped from the pre- to post-test. Taylor et al. found that those who responded to the
study had a larger amount of hip adduction than those who did not (p = 0.02), and they attended
more training sessions and played soccer rather than basketball (p = 0.07). There were major
upsurges in hip flexion angles, moments, and seizure angles, as well as knee abduction and
excursions (Taylor et al., 2020). Age and previous involvement in grievance deterrence programs
were not statistically significant in this study (n.s.). They also had the greatest rise in hip
adduction at baseline and the greatest decrease in knee abduction moments, and they show the
same gains in hip flexion, knee adduction, and hip motion (Taylor et al., 2020). ACL-IPPs can be
used to identify patients who may not respond to the procedure, and they can be used to
customize training for those who are at risk.
ACL injuries are rather rampant in sports. Michaelidis & Koumantakis met the criteria for
inclusion. A substantial drop in ACL injuries occurred due to four soccer and one handball
training programs. Basketball training interventions are not helpful. Preventing ACL injuries by
season-long exercise was more effective than preseason training. Sport-specific biomechanics
and the most efficient training strategy are the primary factors in these concerns. Similar to
Michaelidis and Koumantakis findings, Zebis et al. state that female athletes are more probable
to have ACL injuries than their male colleagues (Zebis et al., 2016). Physiology, anatomy,
biomechanics, and the hormones that regulate strength are to blame for this. Male and female
knees are physically distinct, and the ACL in female knees is more vulnerable to injury due to a
lack of space surrounding the bone. Biomechanical differences between men and women may
also be seen in how girls and boys fall after jumping. For women, the quadriceps muscles in the
front of the thighs are more pronounced than the hamstrings in the back of their legs, making the
knee joint more susceptible to injury.
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ACL strain might be exacerbated by this problem. Males and females may differ in their
ability to heal from ACL damage because of their differing hormone levels. Female ligaments
may become weaker at certain points in the menstrual cycle, increasing the risk of ACL
(Michaelidis & Koumantakis, 2014). Female collegiate football and basketball players are three
times as likely as their male counterparts to damage their ACL. According to Michaelidis and
Koumantakis, major knee injuries in high school girls are five times more common than
equivalent injuries in high school boys. Fifty percent of those who suffer an ACL injury require
surgery (Michaelidis & Koumantakis, 2014). Estimates indicate that the ACL procedures will
cost one billion dollars to implement. The ACL must be linked to a hamstring tendon below the
knee to be rebuilt. Due to the tissue’s lack of blood flow, repairing or sewing together the ACL
after it has been torn is impossible.
Liebert shows that female high school soccer players still have a significant chance of
damaging their ACL when participating in the sport. Liebert found that the most effective injury
prevention programs (IPPs) emphasized strengthening the core and improving proprioception in
this age range (Liebert, 2016). In the Midwest, a small girls’ high school soccer program
acquired an Individualized Player Plan (IPP). Liebert wanted to see whether the IPP helped with
core strength and proprioception. Both functional movement theory and exercises were
incorporated into the IPP. Analyzing the data was accomplished through t-tests on matched
samples. There were statistically substantial improvements in fundamental measures, as
evidenced by the statistics. Other teams can use IPP that incorporates functional movement and
training to improve core strength and proprioception and contribute to the growing literature on
functional movement training. Female athletes must be aware of the most common reasons to
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avoid suffering an ACL injury (Liebert, 2016). The ACL can be severely stretched, partially torn,
or completely ruptured due to several injuries.
Knee hurts are prevalent among female athletes who participate in sports like basketball,
volleyball, soccer, and other activities that require the knees to spin, twist and jerk. There is the
possibility of injury in contact and non-contact sports, such as ACL tears, strains or rips. A
contact tear develops when a knee is struck to the side, as is common in sports like soccer. In
sports such as basketball and skiing, the knee joint is subjected to an abnormally high degree of
stress due to the rapid pauses, directional changes, or landings from the required leaps (Liebert,
2016). Women are more probable than men to injure their ACL when participating in similar
physical activities (Elliot et al., 2010). Women are more probable than males to sustain injuries
following ACL repair, as seen by comparing male and female post-surgery sensitivity to injury.
Knee laxity following ACL reconstruction are less effective in women than in males having the
same form of ACL restoration.
During the first or second days of a woman’s menstrual cycle, the ACL is most frequently
injured. Consequently, McDaniel et al. reveals that ACL injuries are not the product of casual
chance but rather happen more frequently about the time of menstruation when circulating levels
of sex hormones are at their lowest and progesterone levels start to increase (McDaniel et al.
2010). There is some overlap between salivary and serum sex hormone profiles, and both can
reliably determine a woman’s menstrual cycle stage at injury. This is partly due to the method’s
prowess in handling enormous datasets. Females with generalized laxity, increased knee
hyperextension, and reduced iliotibial band flexibility were more susceptible to ACL injury
(McDaniel et al. 2010). In addition, a history of ankle sprains may be linked to an amplified
danger of ACL damage.
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Ankle rehabilitation plans may want to integrate components of ACL deterrence plans into
their routine procedures because of an association amid preceding ankle injuries and ACL
injuries. The quadriceps, ligaments, or complete leg dominance are all examples of
neuromuscular imbalances that female athletes may have. The assessment of active
neuromuscular training is a method for thoroughly dealing with and repairing these
neuromuscular defects (Myer et al., 2013). To ensure ideal biomechanics of sports actions and
decrease the amount of knee injuries incurred by female athletes, neuromuscular imbalance must
be repaired. Jump-landing risk evaluations for female athletes who may be at risk should be
undertaken as part of preseason screening. These tests may be administered to patients quickly
and simply by clinicians (Tanaka et al., 2020). Even though great progress has been made,
athletes’ risk of injury screening still needs to be improved. Evaluating a child’s maturity level
and incorporating possibly harmful high-risk sports movements must be comprised in screening
tests.
What portions of the injury prevention programs are successful?
ACL injuries in female athletes are more prevalent in adolescence, peaking in the middle to
late stages of the teenagers’ years. Regarding young female athletes, Myer et al. show that there
may be an ideal window to begin integrated neuromuscular training (NMT). The goal of Myer et
al. was to conduct a complete present a summary of the findings to answer the question, “How
does the age of NMT adoption impact the success of NMT in lowering the occurrence of ACL
damages?” It was predicted that NMT would have a greater impact on children and adolescents,
and this prediction was proven correct (Myer et al. 2013). Myer et al. found in this meta-analysis
that the use of NMT reduces the risk of ACL injuries as people’s ages rose in the study
population. Both biomechanical and epidemiological evidence point to a window of opportunity
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before the beginning of neuromuscular impairments and the peak frequency of knee injuries in
female athletes for maximizing the prevention of ACL damage. It appears that this is the case
based on the biomechanical evidence (Myer et al. 2013). NMT programs may be best started in
the early phases of adolescence when body mechanics are less likely to alter to avoid injury.
According to Willadsen et al., ACL injury deterrence agendas may benefit from stability or
neuromuscular training, which reduced knee valgus angles after landing in two studied trials
(Willadsen et al. 2019). The impacts of central stability training on landing knee valgus angles
were inconsistent. In contrast to Myer et al., Willadsen et al. observed that knee valgus angles
remained the same following core stability training. A difference in training methods might
explain some discrepancies in the outcomes observed by Willadsen et al. Core stability training
may not significantly impact landing knee valgus angulation (Willadsen et al 2019).. Studies
evaluating the impact of main stability exercise have conflicting findings on landing knee-flexion
angle.
Willadsen et al found that landing knee-flexion angles were unaffected by a combination of
core stability and balance training. Willadsen et al. states that study is required to evaluate if
essential steadiness exercise has more good impacts on knee valgus angle at landing than
negative effects on knee flexion angle (Willadsen et al, 2019). ACL injury prevention programs
should use core stability training with caution until further evidence is available. Balance or
neuromuscular training might be used in injury avoidance programs for the ACL to increase knee
flexion angles during landing (Willadsen et al, 2019). Willadsen et al. and Myer et al. found that
plyometric exercise helped improve knee flexion during landing.
Ninety-nine percent of female athletes polled by Tanaka et al. claimed they’d be open to
trying a PTP to avoid an ACL damage (Tanaka et al. 2020). PTP participation is more common
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among players who have had an ACL injury in the past or who are aware of the ailment of a
teammate. Women high school athletes were eager to take part in the PTP according to Tanaka et
al. provided statistics showed that they would be less at risk of suffering an ACL damage.
According to Tanaka et al., Myer et al. findings are also consistent. Tanaka et al’s study included
76 female high school athletes. Athletes’ refusal or reluctance to participate has made the use of
PTPs difficult (Tanaka et al. 2020). Distinguishing between “ready to perform,” sometimes
known as “wanting to perform,” and really doing so in line with regular PTP exercises is critical,
despite what many people believe.
PTP compliance was not influenced by individuals’ self-reported desire to participate
during the study, according Tanaka et al. ACL PTP knowledge was higher among players who
had either undergone an ACL damage themselves or known a teammate who had, according to
Tanaka et al findings Athletes who participated in high-risk sports, such as basketball, lacrosse,
and soccer, performed better than those who participated in low-risk sports (Tanaka et al. 2020).
More than that, these players were more likely than their counterparts in low-risk sports to be
aware of and experienced in PTP. Efforts to employ PTP in high-risk sports have mostly focused
on preventing injury. We don’t know why athletes who participate in high-risk sports are more
aware of potential risk factors (PTPs) than those who participate in low-risk sports.
As the number of children and teens engaging in competitive organized sports grows, so
does the occurrence of ACL injuries. ACL injuries in skeletally immature athletes present
orthopedic surgeons with a problem, according to Barber-Westin and Noyes. A reason for this is
that the proximal and distal bones of the leg need to be guarded while the damage heals (BarberWestin & Noyes, 2016). Barber-Westin and Noyes want to make sure that the pace of growth is
as natural as possible. Injuries to an athlete’s ACL) are often treated with a brace and a reduction
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in activity. ACL repair patients were labeled “non-copers” if they had suffered from instability
and needed to have it repaired. According to Barber-Westin and Noyes, postponing the repair of
articular cartilages and meniscuses may cause severe injury to the joint (Barber-Westin and
Noyes, 2016). If this is the case, the meniscus should be repaired immediately so that it may be
preserved and the person’s normal exercise can continue. For teenagers who have already
attained or are nearing bone maturity, standard repair methods may be effective.
It’s possible that these methods might have a negative impact on athletes who are still in
the process of developing. Both physeal-sparing and physical-respecting rebuilding procedures
have been explored as promising options to fulfill the increased demand for ACL repair surgeries
in skeletally immature people (Barber-Westin and Noyes, 2016). Physical-sparing reconstruction
strategies can preserve the physical growth plate, whereas physical-respecting reconstruction
methods cannot. There has been an increase in interest in ACL prevention in children and
adolescents due to a greater risk of re-tears of the ACL graft or the contralateral ACL. Preventing
ACL injuries has also been emphasized (Stojanovic et al., 2012). Barber-Westin and Noyes
(2016, p. 89). There is a potential of re-tearing the ACL in any direction, thus this should be
taken into account. Neuromuscular training, according to Myer et al., may reduce the chance of
tearing one’s ACL, either for the first time or in the future.
Neuromuscular training reduces the danger of ACL injury in female athletes by Sugimoto
and colleagues. A study by Sugimoto et al. found that neuromuscular training treatments may
reduce the probability of female athletes breaking their ACLs by using the absolute reduction in
risk (RRR) and number needed to treat metrics (Sugimoto et al. 2012). The RRR and NNT were
calculated for each study number of total non-contact and general ACL damages, the individual
patients, and the total amount of time spent investigating them. It was determined that 12 studies
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met the criteria for inclusion in the review. However, the relatively high NNT demonstrated that
there would need to be a significant number of athletes in order to avoid one injury, suggesting
that neuromuscular training may help prevent ACL injuries (Sugimoto et al. 2012). It is
recommended that a screening technique for identifying athletes at risk of ACL damage be
developed in order to reduce the NNT and improve ACL injury prevention measures’ efficiency.
In order to reduce NNT and improve the effectiveness of ACL injury prevention strategies, this
will be one of the next topics to be investigated.
Female athletes are three and a half times more likely to have a non-contact injury to the
ACL than males. Variations in landing tactics, neuromuscular adaptations, and biomechanical
processes, according to Voskanian, may be to blame for the gender differences in athletic
performance. Investigation of ACL injury prevention methods and whether or if they are already
in use and effective. Both biomechanical and neuromuscular dysfunctions are addressed in these
treatments (Voskanian, 2013). There has been much study on ACL deterrence in athletes, and
Voskanian reviews this data and sums up the most important components of ACL preventive
approaches that have been proven to minimize the danger of ACL damage in female athletes.
These techniques have been found to significantly decrease the danger of an ACL damage in
athletes. Many different theories and practical considerations should go into programs aimed at
preventing ACL injuries in various community contexts. ACL injuries in soccer players can be
decreased by modifying the risk variables linked with ACL injuries, according to Nessler and
colleagues’ research. Using neuromuscular training as well as core and trunk control exercises,
Nessler and colleagues concluded that it is possible to avoid ACL injuries (Nessler et al., 2017).
The results advocate that neuromuscular training is a crucial component of any program meant to
avoid ACL injury.
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As previously reported, female athletes were substantially less likely than male
counterparts to have an ACL injury to the contralateral side. A training routine that was easy to
implement was extremely beneficial to the athletes. When applied to male athletes, this training
reduced the risk of a second ACL injury by one risk per 40 athletes, but when applied to female
athletes, it was less effective. Female athletes, especially those under the age of 18, have distinct
needs when it comes to rehabilitation, but the programs now offered cannot meet those needs
(Johnson et al., 2020). Neuromuscular training has been linked to injury to the ACL in female
athletes. It’s an excellent long-term plan to increase the frequency, duration, and total volume of
your exercises. More than 10 training sessions spaced out over five weeks may be necessary for
women to reap the full benefits of their exercises, according to a research by Johnson and
colleagues. Research should be done on longer, more intensive and consistent tertiary preventive
interventions for female athletes (Johnson et al. 2020). In addition, study into the impacts of
various feedbacks and the mental preparation necessary for RTS is of crucial relevance.
In view of the recent explosion in the number of warm-up regimens aimed to avoid ACL
injuries, it is important to determine biomechanics and neuromuscular risk factors in female
athletes and develop programs to address specific weaknesses (Stojanovic et al., 2012). There is
currently a wide range of ACL injury prevention warm-up routines accessible as a result of the
recent boom in their creation. Programmers must always consider the vulnerability of the entire
kinetic chain, which includes their own bodies as well as those of their users (Bien, 2011). Video
study of the causes of ACL injuries as well as clinical studies has consistently shown the effect
of neuromuscular control and biomechanical abnormalities at the trunk and lower edges on ACL
injury risk. The distinctions between men and women may be clearly seen when they are
compared side by side. Women’s risk of tearing their ACL is significantly increased when they
19
do not participate in a multicomponent neuromuscular training program that includes training for
hips and hamstrings, plyometrics and nerve and muscle training, core normalization, stability and
proprioception training, swiftness training and stretching (Bien, 2011). Warm-up sessions, where
participants get verbal and visual feedback on their performance, may precede the start of this
training. Sportspeople are more likely to stick with training methods that have shown results in
the field. Bien suggests at least an eight-week plan to give for ample time for neuromuscular
changes (Bien, 2011). Let’s assume that efforts to prevent female athletes from sustaining ACL
injuries continue to be successful.” As a result, further research into the subject is needed in
order to improve upon and undertake an in-depth examination of the most significant features
and the ideal frequency and amount of training (Bien, 2011). In order to find these individuals, a
prescreening for noncontact ACL injuries in male athletes with the greatest amounts of
pathology may be useful.
What portions of female anatomy play a role in female ACL injuries compared to males?
Male and female anatomy, say Noyes and Barber-Westin, are distinct (Noyes and BarberWestin, 2018). When it comes to the femur, tibia, and thigh bones, women’s pelvis is wider than
the male pelvis, which causes the bones to move differently. That means that Westin is placing a
greater strain on the joints’ supporting soft tissues, according to Noyes and Barber’s
interpretation. As a result, a chronic injury (caused by overuse) or an acute injury might occur as
a result of this elevated stress (caused by a sudden traumatic event). An acute ACL rupture in a
woman is two to eight times more likely than an acute injury in a male athlete, say researchers
Noyes and Barber-Westin in the Journal of Orthopedic Research (Noyes and Barber-Westin,
2018). Despite its strength, the ACL in the knee, which joins the tibia and femur, has a very
restricted choice of motion. It breaks down when it can’t take any more strain. Contact sports like
20
football, basketball, and skiing are more likely to cause ligament and tendon tears as a result of
this. Males tend to have more muscle mass around their knees than females, whilst girls tend to
have less muscle mass in this area (Noyes and Barber-Westin, 2018). Overstretching a ligament
can put it at danger of ripping because of the instability it can generate. Stress, hormones, or a
combination of the two may be a factor in the current scenario. Males and females have different
amounts of testosterone, a hormone that is crucial to increasing muscle growth. The estrogen
levels in women are significantly greater than those seen in men, as is the case with other
hormones. During a woman’s menstrual cycle, this bone-building hormone undergoes several
changes (Noyes and Barber-Westin, 2018). Women’s tendons and ligaments may be more prone
to damage than men’s because hormone tends to make tissues slacker.
Retrospective studies of injury prevention devices have been conducted on athletes of both
sexes in order to gain a better understanding of the biomechanical pathokinematics involved in
the injury process (Silvers-Granelli, 2021). ACL injuries in male and female athletes have been
mapped out by means of video examination of these injuries. Hip adduction, side trunk
displacement, hip valgus rotation, and tibial torsion are common signs of injury in an athlete.
Defensive or unplanned action might lead to damage for athletes who adopt this high-risk stance.
An injured athlete is likely to display all of these signs. As indicated by Silvers-Granelli, females
were more likely to rip their non-dominant arms in a protective position than males. ACL
injuries in female athletes have long been a source of debate; however, in recent years, a new
narrative has emerged that takes a less either/or approach to the problem (Silvers-Granelli,
2021). There has been a lack of attention paid to socioeconomic and cultural aspects in the great
majority of ACL epidemiological and mechanistic studies.
21
Sporting opportunities for female athletes are far less than those for male counterparts. In
the realm of competitive sports, there is a notable disparity in the chances available to males and
females. All of this is due to a lack of high-quality training equipment, constant rehabilitation,
reduced coaching standards, and a reduction in childcare and maternity benefits. All of these
elements have played a role in creating the issue (Silvers-Granelli, 2021). Male and female ACL
injuries are treated surgically differently, depending on the gender of the patient. A study by
Silvers-Granelli found that after taking a break from playing, women were reluctant to get back
into it. Self-regulation in the form of a decrease in physical activity, such as the reduction in
triple hop distance, and a shift away from team sports, may be evidence of this in an effort to
limit the danger of further damage, following adjustments have been implemented. As a result,
for the great majority of women, the risk: reward ratio does not exist, it is probable that this
deliberate decision to reduce secondary risk overall by behavioral change has a large impact
(Silvers-Granelli, 2021). Despite the current emphasis on “biological component” affects in the
prevention of ACL injuries, this is not necessarily the most successful technique.
ACL injuries in female athletes are more common, according to a research conducted by
Mokhtarzadeh et al. One theory is that leg dominance, commonly referred to as “leg dominance,”
is caused by an imbalance in the muscles of the legs. The primary goal of Mokhtarzadeh et al.
was to examine how a single-leg drop-landing exercise affected lower limb movement patterns,
muscle forces, and ACL forces (Mokhtarzadeh et al., 2017). Mokhtarzadeh et al. expected that
the lower limb kinematics, muscle forces, and ACL stress would differ significantly between the
dominant and non-dominant limbs. As a result, Mokhtarzadeh et al. expected that the
participants’ limbs would change as they landed from a longer distance. Female leisure
participants performed 30- to 60-centimeter drop landings. There were eight of them. A method
22
developed by Mokhtarzadeh et al. was utilized to predict the loading on the ACL (Mokhtarzadeh
et al. 2017). At higher altitudes, the patient’s ACL forces and almost all of the kinetics and
kinematics variables changed significantly. Both dominant and non-dominant legs had identical
lower-limb muscle forces and ACL loads during single-leg landing. This demonstrates that there
is no alteration in the risk of harm between this group and any other (Mokhtarzadeh et al. 2017).
In order to evaluate whether or if female athletes are more likely to sustain ACL injuries as a
result of their limb dominance, further research including larger and more sport-specific cohorts
is required.
With the consideration and reference to ACL tear ad injury, young female athletes have a
far higher risk than male peers of the same age. Elliot et al. discovered that females were more
likely to suffer a sports-related injury than boys when both total activity level and the amount of
time spent playing a sport were taken into consideration. There are many reasons to fear ACL
injuries because of their potential for immediate morbidity, significant financial ramifications, as
well as long-term adverse effects (Elliot et al., 2010). ACL injuries can be avoided in some
cases, however these efforts have not been widely recognized or have not been able to provide
total protection. Additionally, there have been some successful MCL injury prevention strategies
in place. Neuromuscular and anatomical considerations have fallen out of favor in recent years
while aiming to prevent ACL injuries. The risk of female athletes becoming injured while
engaging in sports is increased by a number of other factors. Besides early specialization in a
single activity, other concerns we address in this research include poor eating habits, recurrent
sleep insufficiency, advanced stages of fatigue, material addiction, and mental health problems
(Elliot et al., 2010). We can improve our models of ACL injury by including these newly
revealed features.
23
During the development of new programs to prevent injuries, the extended injury model
provided will have a significant influence. Because the same choices that lead to better athletes
also lead to healthier lifestyles, high school athletes are the greatest setting for young people and
noteworthy coaches to advocate healthy living. More successful athletes often have healthier
lives. As healthier options become more readily available, better athletes are more likely to lead
healthier lives. This program’s primary goal is to promote healthy living while decreasing the
amount of unexpected consequences. Practices that promote psychological well-being and a
healthy way of life can aid avert injuries to the ACL (Elliot et al., 2010). Young female athletes
might benefit from these programs both on and off the field if they are successful in establishing
and proving their efficacy. If tested and proven to be effective, these strategies have the potential
to minimize the number of injuries.
FMS and YBT can recognize and indicate athletes who are at risk of injury and then
provide programs to minimize that risk; nevertheless, injured and non-injured athletes move
differently and balance differs from females to males (Chimera et al., 2015). The researchers at
Chimera et al. wanted to see if the FMS and YBT, which were administered to a large number of
Division I athletes as part of the study, were affected by historical characteristics such as gender
and a history of injury or surgery. For male and female athletes, the findings of the FMS CS
show that there are no performance disparities. Chimera et al. found that male and female
athletes varied in the performance of all movement patterns examined by the FMS, except for the
low squats and the hurdle step. The deep squat, according to Chimera and colleagues, is an
essential exercise for a wide range of sports (Chimera et al., 2015). In this reasoning, male and
female Division I athletes appear to have nearly equal chances of success in this sport. Male and
female Division I athletes do equally well on the hurdle steps and the Yo-Yo Transfer (YBT).
24
For this to work, the hips and torso need to be well-coordinated and stable, as well as
dynamically balanced. When doing YBTs, the athlete must maintain their dynamic stability even
while attempting to reach for the limb on the other side of their body. Chimera and colleagues
found that men and female athletes had similar levels of dynamic balance. Gender disparity in
YBT performance was discovered despite the fact that only a small number of subjects were
tested (Chimera et al., 2015). Type II mistakes are less likely to occur as a result of these
characteristics, according to the research undertaken by Chimera et al., which is the largest and
most comprehensive study to date. If Chimera and colleagues are correct, there appears to be no
difference in the performance of people of various genders when it comes to testing their
cognitive skills (CS).
According to Cheung et al., who observed comparable results, women are more likely than
men to tear their ACL. Smaller femoral notches, smaller posterior tibial and meniscal slopes, and
smaller native ligaments are found in women compared to men. Additionally, the femoral
notches are smaller in women. This is despite the fact that the sizes of the femoral notches on
women are the same. Men are more likely than women to get an ACL injury, which might be
explained in part by differences in their anatomical structures (Cheung et al., 2015). More
research is needed to see if these anatomical differences can be used to predict which women are
more likely to get an ACL damage.
In an effort to reduce the number of female athletes who rupture their ACLs, many injury
prevention programs (IPPs) have been devised. It was revealed that the success percentage of
each program, the length of each training session and the cumulative number of training sessions
varies widely (Pappas et al., 2016). A major flaw in the present IPP is that it tries to cure a wide
range of biomechanical defects using the same program followed by all athletes. If you’re an
25
athlete with a unique biomechanical weakness, you won’t be able to customize your training
program to address it. Athletes of the masculine gender spend a lot of effort fixing faults that
aren’t immediately obvious to female counterparts in order to maximize their resources (Pappas
et al., 2016). For female athletes, yearly training in order to prevent the risk of ACL damage has
been determined by the results of a meta-analysis called “number required to treat”.
It is difficult to implement them since they are time-consuming, thorough, and have
varying levels of success. ACL tears in female athletes have not decreased with time, according
to epidemiological studies. Biomechanical limits and the linkages between them are a major
impediment to the creation of ACL IPP that are more targeted, simpler to administer, and more
effective. They are hindered by this lack of comprehension (Pappas et al., 2016). Using this IPP
instead of the ones now in use provides a number of advantages. Pappas et al. believe that around
60% of female athletes fall into one of the high-risk categories they discuss. Other than the
ligament dominance profile, risk profiles are based on many biomechanical considerations. It is
possible to design approaches for preventing injuries based on the findings of Pappas and
colleagues. The findings will be utilized to design tests that are quick and easy to administer,
reliably put athletes into one of the profiles, and then prescribe tailored injury prevention
routines based on the results (Pappas et al., 2016). In comparison to currently available, more
generic programs, these new ones will be both more effective and efficient.
Non-contact ACL injuries are associated with abnormal trunk, hip, and knee movement
patterns, according to Khayambashi et al investigation. Non-contact ACL injuries are more likely
for Khayambashi et al. if their unusual movement patterns are caused by a lack of hip strength.
There were six girls and nine males who had ACL injuries that were not induced by contact in a
3% yearly incidence rate. For both abduction and external rotation, athletes who had incurred
26
injuries had significantly lower baseline hip strength ratings (Khayambashi et al., 2016).
Dissimilarities like these were noticeable. It appears that having a weak hip increases one’s risk
of additional injury, at least in part because of the logistic regression model. Individuals were
classified as high-risk if their abduction strength was larger than 35.4% of their body weight or
their external rotation strength was less than 20.3% of their body weight, according to clinical
cutoffs. Summer hip seizure and external spin strength tests can assist detect whether or not an
elite athlete will have a future damage to their ACL that was not caused by collision. Isometric
hip abduction should be measured as part of screening methods for the danger of ACL damage,
according to the results of Khayambashi and colleagues.
How do hormones play a role in females and the injuries that they go through?
The inability to regulate GRF during landing might be by reason of absence of
neuromuscular regulator, however this is only one theory. Preventing ACL injuries has become a
focus of research in recent years. Jump landing exercises are incorporated in these programs to
help athletes improve their neuromuscular control, according to Webster and Gribble. Webster
and Gribble used a testing approach that focused on the acquisition and maintenance of stable
postures following physical activity in their research (Webster and Gribble, 2010). Gribble and
Webster found that neuromuscular therapy for female athletes has a higher success rate than a
control group. In addition to learning how to land a leap correctly, these treatments included
exercises to improve flexibility and strength. Women’s soccer, volleyball, basketball, and
European handball teams were studied by Webster and Gribble. As a group, these athletes were
judged to be typical of the population studied. There was a greater chance of knee injuries in
untrained female soccer athletes, according to Webster and Gribble, than in female soccer
athletes who had undergone training. Similarly, trained male soccer players have the same
27
problem. However, researchers observed no major variances amid trained female athletes and
untrained male athletes in the same exercise. Injury rates to the ACL in female athletes have
fallen considerably, and the rate of these injuries has been brought down to a level comparable
with injuries incurred by male competitors. (Webster and Gribble, 2010).
Neuromuscular training can help prevent significant knee injuries in athletes who often
land, cut, and turn. When tested for dynamic-stability, it was found that female participants had a
lower score than their male counterparts even though they had gotten medical authorization to
participate fully in the sports of their choice. Women may have a lesser level of dynamic stability
than males, according to past study. In order to determine the effectiveness of training as an end
variable and its link to the probability of ACL injury, additional study is needed. For athletes
looking to cut training time while also improving landing technique and neuromuscular control,
Webster and Gribble suggest neuromuscular exercise (Webster and Gribble, 2010). It could be
beneficial to obtain TTS info on individuals with ACLR knees before and after neuromuscular
exercise and training in order to determine whether the treatment affects dynamic stability in
light of Webster and Gribble’s discovery that women with ACLR knees showed disparities in
TTS following surgery and rehabilitation compared to healthy participants. In this way, the
knee’s dynamic stability may be tested.
As the number of females participating in high school and college sports continues to
climb, medical practitioners need to be aware of the unique injury patterns and health problems
that affect feminine athletes. The ACL, patellofemoral dysfunctions, and fractured due to stress
in the lower extremities are more likely in female athletes who have reached the point in their
development where their skeleton is fully matured, according to Hilibrand and colleagues. It has
been possible to throw light on these issues thanks to both clinical and observational data.
28
Additionally, younger female athletes are more susceptible to acquiring the so-called “Female
Athlete Triad” than older female athletes. Among them include anorexia, infertility, and
osteoporosis. These components are more likely to be developed in younger female athletes. To
decrease the danger of injury and improve long-term health, there are presently programs that
treat the causes of these disorders in female athletes (Hilibrand et al., 2011). These projects were
made feasible by the recognition of these illnesses’ pathophysiology. Aims to provide medical
specialists a chance to explore the sex-specific causes of injuries, as well as techniques for injury
prevention and treatment for injuries that are more frequent in female athletes.
In order to prevent ACL damage during cutting and landing, increased activation and
strength of hip abductor muscles are needed. The ACL is particularly vulnerable to damage in
female athletes, who, according to Hewett and Myer, can benefit from “core-based” treatments
that reduce the danger of ACL damage. Anticipatory muscle activation and movement patterns
can be used by athletes to lessen the risk of injury due to unforeseen interruptions in
performance. Reflexive muscle movement lasting more than 100 milliseconds is unlikely to be
achievable if the ACL is damaged quickly. To put it another way, Hewett and Myer’s outcomes
propose that a diminished capacity to modulate the trunk’s muscles may increase joint stress,
which in chance increases the likelihood of ACL injury in female athletes (the lateral motion of
the GRF and the reactive hip adduction torque). Stress on the knee may be measured, and this
increases the risk of ACL rupture. Neuromuscular exercise that enhances stability in the coronal
plane of the trunk may help alleviate knee pain (Hewett & Myer, 2011). Increasing hip adductor
strength and activation through neuromuscular training reduces the negative consequences of an
increased load by lowering GRFv. Many advantages come from neuromuscular training.
Depending on how well female athletes comprehend these systems, it’s possible to divide them
29
into distinct risk categories (Hewett & Myer, 2011). Efforts to decrease the danger of injury in
female athletes may be more effective if neuromuscular training regimens emphasize the
mechanics of the load more.
Female soccer players are three times likely than males to tear their ACL while not being
struck by an opponent. It is possible to decrease the risk of ACL damage by implementing a
variety of techniques. Analyzing the variance (ANOVA) of the mixed model factorial with
repeated measurements allowed us to see what influence the treatments had on the dependent
variables. In the first six weeks of PEP, sprint timings for 27.3 and 36.6 meters increased greatly;
however, these speeds returned to their baseline levels at the end of the 12-week trial. Neither the
9.1 meter sprint nor the 18.2 meter sprint times changed for any group in the competition. CMJ
height remained the same in PEP for six and twelve weeks, whereas CON decreased
significantly. Performance on the Illinois exam and the pro-agility test declined for both groups,
showing an overall deterioration. There was no effect on players’ ability to countermove jump
(CMJ) or agility, according to Vescovi and VanHeest’s studies, only slight gains in linear sprint
performance were seen. A lack of stimulation in systematic warm-up routines for knee ligament
injury prevention might be a problem (Vescovi and VanHeest, 2010).
More and more young athletes, particularly those between the ages of 13 and 15, are
suffering ACL injuries. Participation in injury deterrence agendas is linked to a reduced
occurrence of ACL tears in older athletes. Thompson-Kolesar and colleagues sought to find out
if the 11+ program, which was financed by the F-MARC and aimed to minimize the likelihood
of accidents and other issues, would be less beneficial if participants were older or younger than
the program’s intended target audience. For this study, they were interested in the biomechanical
risk factors for ACL damage in pre-adolescent and teenage female soccer players (Thompson-
30
Kolesar et al., 2018). To begin with, it was expected that young adolescent athletes would have
bigger knee valgus angles and moments, however these parameters would improve more for the
young adolescent participants following training. An increase in muscular co-contraction
following training was expected to occur in pre- and teenage athletes. Pre- and post-adolescent
sportsmen showed no change in initial contact angle or peak knee valgus angle during any of the
experiments. The pre-adolescent athletes’ initial contact knee valgus angle and peak knee valgus
moment were drastically reduced as a result of the intervention training they received during the
double-legged jump task (Thompson-Kolesar et al., 2018). At the beginning of every session,
preteen athletes showed a considerably greater baseline weight-accepting flexion/extension cocontraction than teenage athletes, according to Thompson-Kolesar et al. More pre-contact flexor
and flexor-extensor muscle co-contraction during planned cutting was observed in preadolescent
athletes who contributed in the intrusion.
Conclusion
In conclusion, ACL injuries are less common in those who exercise with higher levels of
compliance. In addition, it was shown that the total of sessions per week and the amount of time
spent getting NMT had close relation and linkage to the occurrence of ACL injuries. NMT is
strongly linked to the risk of an athlete tearing and damaging their ACL based on how much time
they spend performing it and how well they execute it. Doing exercises just twice a week for
twenty minutes each time is enough to lessen injury risk (Noyes & Barber-Westin, 2018). Likely,
providing athletes with the necessary feedback while undergoing neuromuscular training, such as
verbal feedback and video instruction, can enhance the benefits of training. Because
neuromuscular training is not a one-size-fits-all approach, training must be adapted to each
athlete’s individual needs. Unfortunately, ACL injuries are rising, especially among children and
31
teenagers who participate in contact sports. More research is being conducted to ensure that
young athletes may continue to participate in the sports and activities they love, and ACL injury
prevention is being expanded.
1
Introduction
The material should be analyzed to determine the efficiency of ACL injury prevention
plans to reduce the ACL injuries amid young female athletes. Many studies have been done on
the topic; however, none met the criterion for inclusion in contemporary studies. Meta-analysis
and synthesis are updated, and systematic review analyses are also included in this information,
making it more up-to-date.
Does the field of play or equipment affect the possibility of injury in athletes?
According to the analysis of the available literature, play and exercise have been linked to
a danger of ACL injuries in young female athletes. Mostly, plyometrics and strengthening
exercises were commended as part of an ACL injury preventive procedure (Beynnon et al.,
2014). Training throughout the off-season and during the current season yielded higher benefits
than each season’s training alone. For at least ten minutes, preventative programs should include
exercise three times a week. A meta-regression shows that full exercise time and session duration
do not affect the efficiency of decreasing probability of injury threat. An exercise program
including three various workout kinds and either practice responsiveness or response effectively
decreased the risk of ACL injury, even though there was insufficient evidence to support any
specific type of exercise component on its own.
What kind of injury prevention programs are most used as primary prevention for athletes
who have torn their ACL?
It is possible to enhance a female athlete’s aptitude to establish ideal muscle firing designs,
develop active joint steadiness, and do movements that are critical in everyday life and sports
activities. Most researchers and injury prevention programs refer to “neuromuscular training” as
2
a key component of their work. Plyometrics, agility training, and sport-specific workouts are all
examples of activities that can be included in this type of training. Balance and proprioceptive
actions on stability and tremble boards, as well as dynamic joint stability exercises, are other
possible components (Petushek et al., 2019). These various categories of proprioceptive and
balance training can recover postural regulator and lower extremity imbalances. Athletes should
engage in multi-component training regimens twice weekly throughout the preseason and during
the regular season. In addition to at least one other type of physical exercise, the intervention
program should incorporate plyometrics and strength training.
What portions of the injury prevention programs are successful?
Injury to the ACL, most commonly caused by incorrect plyometric movements, can be
reduced with proper form and procedures. The application of strength training may be adequate
to avoid ACL problems. To reduce ACL injuries, regimens that included strength training were
among the most beneficial in the literature review (Myer et al., 2013). The programs discovered
to decrease the number of ACL injuries need strength training. When joint with different training
techniques, strength training might lessen the threat of ACL harms amid female athletes.
What portions of female anatomy play a role in female ACL injuries compared to males?
The ACL rupture rate in females is thought to be three times greater than in male athletes.
Because of basic aspects such as higher quadriceps angle and enlarged posterior tibial slope,
females may be more likely than males to rupture their ACL. The ACL cross-sectional area is
lower and the notch widths are narrower in females (Noyes & Barber-Westin, 2018). These
measures will show the difference in this measurement. Neuromuscular intervention approaches
reduce the number of injuries incurred by females and girls. A tiny intercondylar notch shaped
3
like an A is more prevalent in females than males, necessitating special surgical precautions. The
contralateral ACL is more likely to rupture in female athletes following ACL reconstruction than
in male athletes; nonetheless, both male and female athletes had an equivalent chance of
rupturing the healed knee.
How do hormones play a role in females and the injuries that they go through?
Throughout the period of the menstrual cycle, there might be an increase in laxity of the
knee ligaments and an amplified danger of ACL injury, according to the literature review. The
use of hormonal contraceptives that inhibit ovulation and follicular development may reduce this
risk. The hormones estrogen, progesterone, testosterone, and relaxin all have receptors on the
ACL; therefore, these hormones may alter ligament laxity or stiffness directly or affect knee
alignment through changes in neuromuscular function. Lower fibroblast proliferation and
anomalies in collagen production have been seen in ACLs exposed to high amounts of estrogen
in cell culture. Regarding fibroblast proliferation and collagen production, progesterone has the
opposite effect. Menstrual cycle hormonal changes may have a role in joint laxity and the risk of
ligament rupture resulting from this instability (Webster & Gribble, 2010). Ligamentous laxity
has received more attention as a potential cause of ACL ruptures in female athletes due to the
higher prevalence of these injuries in female athletes. Several non-contact mechanisms can cause
the ACL to rupture, such as a change in direction and an internal rotation. The ACL is put under
severe pressure when the tibia undergoes internal spin and anterior transformation, resulting in a
“pivot shift.” This means that greater tibiofemoral motion due to ligament laxity increases the
risk of injury.
4
Conclusion
The frequency of ACL injuries experienced by young female athletes decreased due to
ACL injury deterrence plans. Taking part in a comprehensive preseason and season-long training
program lessens the danger of ACL injury. Plyometric and strengthening workouts, as well as
response or a stress on good system, must be included in any intervention program that is to be
effective. The high-risk motions involved in a given activity must be linked to each training. For
an ACL injury prevention program to succeed, there must be a high level of participation.
Athletes’ neuromuscular and biomechanical adaptations can be boosted if they attend every
training session. This should be highly encouraged. Incorporating a preventive program into the
warm-up can likely help increase adherence to the workout.
5
References
Beynnon, B. D., Vacek, P. M., Newell, M. K., Tourville, T. W., Smith, H. C., Shultz, S. J.,
American Journal of Sports Medicine, 42(8), 1806–1812.
https://doi.org/10.1177/0363546514540862
Myer, G. D., Sugimoto, D., Thomas, S., & Hewett, T. E. (2013). The influence of age on the
effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in
female athletes: a meta-analysis. The American Journal of Sports Medicine, 41(1), 203215.
Noyes, F. R., & Barber-Westin, S. (Eds.). (2018). ACL injuries in the female athlete: causes,
impacts, and conditioning programs. Springer.
Petushek, E. J., Sugimoto, D., Stoolmiller, M., Smith, G., & Myer, G. D. (2019). Evidence-based
best-practice guidelines for preventing anterior cruciate ligament injuries in young female
athletes: a systematic review and meta-analysis. The American Journal of Sports
Medicine, 47(7), 1744-1753.
Slauterbeck, J. R., & Johnson, R. J. (2014). The effects of level of competition, sport, and
sex on the incidence of first-time noncontact anterior cruciate ligament injury. The
Webster, K. A., & Gribble, P. A. (2010). Time to stabilization of anterior cruciate ligament–
reconstructed versus healthy knees in National Collegiate Athletic Association Division I
female athletes. Journal of Athletic Training, 45(6), 580-585.
1
Research Summary and Discussion
In the contemporary world, the prevalence of Anterior cruciate ligament (ACL) injuries
among female athletes are one of the significant issues that have been in consideration by the
sports fraternity. The focus ensures that these accounts of ACL have been dealt with effectively
to assist in managing both the financial and emotional consequences (Beynnon et al., 2014). The
leading cause of the ACL is mainly a result of possible direct physical impacts that, in some
cases, can be avoided in case necessary measures are taken in the long run. Similarly, some other
causes consist of dietary habits, types of strength training regimens, specific equipment, the
difference in the environment for participation, and issues relating to anatomical variances.
Therefore, the need to plan some preventive measures can be significant and done in various
ways depending on the most effective programs selected (Beynnon et al., 2014). This research
aims to examine different ways that female athletes can prevent ACL injury in the long run.
Developing various proactive measures is essential in preventing future ACL injuries among
female athletes.
Notably, understanding this research on ACL injuries among females provides a critical
overview of various aspects in the context of measures and actions most athletes undertake to
prevent them. A review of the research questions established from the literature review will be
critical in providing a significant understanding of the existing literature. The concern on
whether the field of play or even the equipment can affect injuries within the athletes provides
different perspectives relating to ACL injuries (Petushek et al., 2019). Further, the conclusion on
this fact is that there is a possibility that the field of play and equipment can affect the injuries.
Substantially female athletes tend to have a greater danger of fulfilling since most are
noncontract activities. The play of the field is also seen to pose a threat since fewer factors are
2
considered. The other essential research question on the types of injury prevention programs
considered adequate by athletes to manage ACL was also necessary for discussion. One of the
noted prevention programs is neuromuscular training, which significantly minimizes the
likelihood of ACL damage. Studies indicate that it improves landing stability and lowers body
strength to prevent possible injuries in the long run (Petushek et al., 2019). The other general
outcome of a research question reviewed in the study was to determine the portions of female
anatomy that play significant roles in ACL injuries compared to the males. The major issue is a
clear distinction between the male and female anatomy. These differences come from the tibia,
femur, thigh bones, and the pelvis of women, which seems to be more comprehensive than the
male, and tends to cause bones to be more different. The possibility of acute ACL injury among
women is more likely than in men due to the difference in body anatomy (Webster and Gribble,
2010). Besides, men have more muscle mass on their knees than females, making it possible for
cases of overstretching to generate rapture. Another major issue that causes women to be more
prone to an ACL injury than men are that they have smaller femoral notches, meniscal slopes,
and posterior tibial. Lastly, the hormone issue discussed in the literature review is also critical in
providing the necessary explanation in the long run (Webster and Gribble, 2010). The results
from the review indicate that the potential inability to regulate the GRF is one of the major
concerns. Besides, no specific study has justified the necessary exercises to incorporate these
programs to prevent the injuries relating to ACL.
Recommendations
Nonetheless, various recommendations need to be considered as established for this
study. Qualitative social studies in sports have been considerable strides over recent years.
Qualitative research is critical in building and making necessary summaries that produce the
3
need to balance different approaches and cases presented (Beynnon et al., 2014). However, one
of the noticed elements is that the study has moved out of established procedures that require
more in-depth studies from the experimental field. The theoretical cluster or framework for the
study was not included. It would be significant in the future to provide guidelines to build on
different arguments in epistemology and methodological rigor in the research. Adding these
elements will substantially influence various theoretical parameters that can permeate nearly
every aspect of the study in the future. Addressing the limitation on the issue of
interdisciplinarity and uniform standards that can overlook the nuance and possible difference
within research should be considered. These are vital in establishing the theoretical
underpinnings within and between various academic disciplines. Another significant
recommendation that would be essential for such studies in the future is to establish and develop
approaches to capture qualitative experiences. The main aim is to evaluate the different
perspectives of the research studies that have mixed outcomes to give different contexts on the
need to explore the effectiveness of the expected results expected to be achieved in the long
term.
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References
Beynnon, B. D., Vacek, P. M., Newell, M. K., Tourville, T. W., Smith, H. C., Shultz, S. J., … &
Johnson, R. J. (2014). The effects of level of competition, sport, and sex on the incidence
of first-time noncontact anterior cruciate ligament injury. The American journal of sports
medicine, 42(8), 1806-1812.
Petushek, E. J., Sugimoto, D., Stoolmiller, M., Smith, G., & Myer, G. D. (2019). Evidence-based
best-practice guidelines for preventing anterior cruciate ligament injuries in young female
athletes: a systematic review and meta-analysis. The American journal of sports
medicine, 47(7), 1744-1753.
Webster, K. A., & Gribble, P. A. (2010). Time to stabilization of anterior cruciate ligament–
reconstructed versus healthy knees in National Collegiate Athletic Association Division I
female athletes. Journal of athletic training, 45(6), 580-585.
Introduction
Injuries in athletes occur randomly throughout any athletes’ career. From a simple strain
or pulled muscle that can last a few days of recovery to career ending dislocations or ruptures in
tendon or ligaments. Injuries are not something an athlete can predict are coming. Injuries can
occur due to many different things. An inefficiency in the anatomy, external factors such as
weather or equipment, and intrinsic factors such as hormone levels can all cause injuries and are
not the only risk factors for injuries. The purpose of this literature review is to illustrate
correlation of non-contact and contact, female ACL injuries in athletes due to different extrinsic
and intrinsic factors. To explain further, this project will discuss the effects of equipment and
field of play, the anatomical differences of females compared to males, poor nutrition habits,
lack of strength training programs, and hormone changes in females that can all lead to risk
factors of ACL injuries.
Within this project articles and studies have shown many discrepancies for females and
their reasons for injury. Previous investigators have divided risk factors into hormonal,
neuromuscular response, and anatomic subgroups (Cheung et al., 2015). In this project we will
divide up even further into hormonal, anatomic subgroups, nutrition, and extrinsic factors
including equipment and field of play as well. Not only is this review illustrating the necessary
risk factors associated with ACL injuries in female athletes but, it is also analyzing injury
prevention programs that have shown to reduce risk factors associated with a primary and
secondary ACL injury. An understanding of the pathophysiology of the risk factors of female
athletes has led to the development of programs that can treat their underlying causes, decrease
susceptibility to injury, and improve the long-term health of the female athlete (Hilibrand et al.,
2015). The importance of creating a program that elicits a strong prevention of injury in athletes
is necessary to ensure the overall health of the females in their sports. Convincing athletes,
parents, coaches, and others of the necessity for injury prevention training may be less
challenging if evidence exists that athletic performance indices will also benefit (Noyes &
Barber Westin, 2012). As we progress through this review, analysis of studies involving risk
factors and preventative care for female ACL injuries will play a large role in preventing
secondary and possibly primary injuries.
Purpose of the Project
The purpose of the project is to bring to light the numerous risk factors associated with
ACL injuries in female athletes. The project will provide evidence of extrinsic and intrinsic
factors that can be associated with causes of ACL injuries and preventative measures that allow
the possibility of negating further ACL injuries in female athletes. This literature topic will
diagnose topics involving equipment, hormone levels, field of play, nutrition, strength straining
programs, and anatomical differences of females and how each can have risk factors for ACL
injuries in female athletes.
Research Questions
Does field of play or equipment affect the possibility of injury in athletes?
What kind of injury prevention programs are most used as a primary prevention for athletes who
have torn their ACL?
What portions of the injury prevention programs are successful?
What portions of female anatomy play a role in ACL injuries in females compared to males?
How do hormones play a role in females and the injuries that they go through?
Does nutrition play a role in prevention of ACL injuries in female athletes?
Definition of Terms
Atheltic performance tests: such as isokinetic strength, vertical jump height, speed, agility, and
dynamic balance (Noyes & Barber Westin, 2012).
Methodology
The database in which I used for this project was primarily the Volpe Library for
Tennessee Tech University. Within the library I was able to find relevant and key sources for my
project by searching for keywords involving my project. These keywords included “ACL
injuries in female athletes”, “hormones involved in ACL injuries”, “treatment plans for ACL
injuries, and “nutrition involvement in ACL rehabilitation”. The database allowed me to find the
most recent and information filled articles that I needed in order to fill my project with complete
resources. The articles included in this project were primarily involved with the topic of this
project involving ACL injuries in female athletes.
The headings and subheadings of this literature review were created in respect to the research
topics involved in the project. The basic understanding of this project was to talk about the risk
factors involved in ACL injuries in female athlete. With that in mind the headings and
subheadings were correlated to the topic and were able to fulfil the research question headings
with substantial data from resources to fulfil the projects needs. This project is capable of
showing the necessary steps to preventing ACL injuries in female athletes through sports
medicine, strength training, hormone control, and nutrition to all who might need the
information.

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