Differential neuromuscular training effects onACL injury risk factors in "high-risk" versus "low-risk" athletes

Background: Neuromuscular training may reduce risk factors that contribute to ACL injury incidence in female athletes. Multi-component, ACL injury prevention training programs can be time and labor intensive, which may ultimately limit training program utilization or compliance. The purpose of this study was to determine the effect of neuromuscular training on those classified as "high-risk" compared to those classified as "low-risk." The hypothesis was that high-risk athletes would decrease knee abduction moments while low-risk and control athletes would not show measurable changes. Methods: Eighteen high school female athletes participated in neuromuscular training 3 x/ week over a 7-week period. Knee kinematics and kinetics were measured during a drop vertical jump (DVJ) test at pre/post training. External knee abduction moments were calculated using inverse dynamics. Logistic regression indicated maximal sensitivity and specificity for prediction of ACL injury risk using external knee abduction (25.25 Nm cutoff) during a DVJ. Based on these data, 12 study subjects ( and 4 controls) were grouped into the high-risk ( knee abduction moment > 25.25 Nm) and 6 subjects ( and 7 controls) were grouped into the low-risk ( knee abduction < 25.25 Nm) categories using mean right and left leg knee abduction moments. A mixed design repeated measures ANOVA was used to determine differences between athletes categorized as high or low-risk. Results: Athletes classified as high-risk decreased their knee abduction moments by 13% following training ( Dominant pre: 39.9 +/- 15.8 Nm to 34.6 +/- 9.6 Nm; Non-dominant pre: 37.1 +/- 9.2 to 32.4 +/- 10.7 Nm; p = 0.033 training X risk factor interaction). Athletes grouped into the low-risk category did not change their abduction moments following training ( p > 0.05). Control subjects classified as either high or low-risk also did not significantly change from pre to post-testing. Conclusion: These results indicate that "high-risk" female athletes decreased the magnitude of the previously identified risk factor to ACL injury following neuromuscular training. However, the mean values for the high-risk subjects were not reduced to levels similar to low-risk group following training. Targeting female athletes who demonstrate high-risk knee abduction loads during dynamic tasks may improve efficacy of neuromuscular training. Yet, increased training volume or more specific techniques may be necessary for high-risk athletes to substantially decrease ACL injury risk.