Rupturing an anterior cruciate ligament in the knee is a nightmare. As the parent of a teenage son who is seven months out from ACL reconstruction surgery, I can attest to the physical and psychological toll it can take, not to mention the medical bills. But a practical new study suggests that changing how sports teams warm up before practices and games could substantially lower the risk that athletes will hurt a knee, at a cost of barely a dollar per player.
Injuries to the ACL, which connects the tibia and femur and stabilizes the knee joint, are soaring, with an estimated 150,000 cases a year. The ligament is prone to tearing if the knee shears sideways during hard, awkward landings or abrupt shifts in direction — the kind of movements that are especially common in sports like basketball, football, soccer, volleyball and skiing.
Motivated by the growing occurrence of these knee injuries, many researchers have been working in recent years to develop training programs to reduce their number. These programs, formally known as neuromuscular training, use a series of exercises to teach athletes how to land, cut, shift directions, plant their legs, and otherwise move during play so that they are less likely to injure themselves. Studies have found that the programs can reduce the number of ACL tears per season by 50 per cent or more, particularly among girls, who tear their ACLs at a higher rate than boys do (although, numerically, far more boys are affected).
But to date, few leagues, high schools or teams across the country have instituted neuromuscular training. That puzzled Dr Eric Swart, a resident in orthopaedic surgery at Presbyterian/Columbia University Medical Center.
Wondering what might motivate coaches and other interested parties to take up ACL injury-prevention programs, Dr Swart and his colleagues settled on naked self-interest. They set out to see what the financial savings involved in undertaking — or resisting — an ACL-injury prevention programme might be.
So, for a study presented last Friday at the American Academy of Orthopedic Surgeons annual meeting in New Orleans, he and his colleagues gathered recent clinical trials related to neuromuscular training and used them to create a model of what would happen in a hypothetical sports league composed of male and female athletes, ages 14 to 22, if they did or did not practice neuromuscular training. The researchers then began running the monetary numbers.
They first determined that, not surprisingly, the medical costs associated with a single ACL tear are staggering, with the estimated price for reconstructive surgery and rehabilitation averaging $15,000.
The cost of the training was negligible, since several of the programs included in the analysis are available free on the Internet and require almost no equipment.
According to the researchers’ calculations, the cost of starting a neuromuscular training programme averaged $1.25 per player per year, “which is so much cheaper than visiting an orthopaedic surgeon,” said Dr Swart, an orthopaedic surgeon.