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Review articles  SPORT INJURIES AND REHABILITATION


The Journal of Sports Medicine and Physical Fitness 2003 June;43(2):165-79

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Prevention of knee injuries in sports. A systematic review of the literature

Thacker S. B. 1, 2, Stroup D. F. 1, Branche C. M. 2, Gilchrist J. 2, Goodman R. A. 3, Porter Kelling E. 1

1 Epidemiology Program Office Centers for Disease Control and Prevention Atlanta, GA, USA 2 National Center for Injury Prevention and Control Centers for Disease Control and Prevention Atlanta, GA, USA 3 Financial Management Office Centers for Disease Control and Prevention Atlanta, GA, USA


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Aim. We ­reviewed evi­dence regard­ing ­risk fac­tors asso­ciat­ed ­with inci­dence of ­knee inju­ries ­both to ­assess the effec­tive­ness of pre­ven­tion strat­e­gies, and to ­offer evi­dence-­based rec­om­men­da­tions to phy­si­cians, coach­es, train­ers, ath­letes, and research­ers.
Meth­ods. We ­searched elec­tron­ic ­data bas­es with­out lan­guage restric­tion for the ­years 1966 - Sep­tem­ber 1, 2001, iden­ti­fied cita­tions ­from ref­er­ence sec­tions of ­research ­papers ­retrieved, con­tact­ed ­experts in the ­field, and ­searched the ­Cochrane Col­lab­o­ra­tion. Of the 328 cita­tions iden­ti­fied, we empha­sized the ­results ­from the 13 ­reports ­that com­pared alter­na­tive meth­ods to pre­vent ­knee inju­ry and ­assessed the method­o­log­ic qual­ity of ­these ­reports ­using a stan­dard­ized instru­ment.
­Results. ­Five stud­ies ­addressed the effec­tive­ness of brac­ing in foot­ball ­players; ­these stud­ies ­showed no con­sis­tent evi­dence of ben­e­fit. Two stud­ies com­par­ing alter­na­tive ­cleat ­designs and a con­trolled ­study test­ing the ­effects of adjust­ments in the ski ­boot/bind­ing ­system ­were dif­fi­cult to inter­pret ­because of inad­e­quate report­ing of meth­o­dol­o­gy. Six pros­pec­tive stud­ies ­that ­addressed the ­impact of con­di­tion­ing and train­ing ­showed prom­ise of pro­pri­o­cep­tion and neu­ro­mus­cu­lar train­ing for pro­tec­tion ­against ­knee inju­ry. We iden­ti­fied seri­ous ­flaws in ­study ­design, con­trol of ­bias, and sta­tis­ti­cal meth­ods; the ­median qual­ity ­scores ­ranged ­from 11 to 56 (out of 100).
Con­clu­sion. Struc­tured train­ing pro­grams ­that empha­size neu­ro­mus­cu­lar and pro­pri­o­cep­tive train­ing ­offer encour­ag­ing evi­dence for the pre­ven­tion of ­knee inju­ries. How­ev­er, ­flaws in ­study ­design and imple­men­ta­tion ­have lim­it­ed the effec­tive­ness of ­work in ­this ­field. A rig­or­ous­ly imple­ment­ed ­research pro­gram is need­ed to ­address ­this crit­i­cal­ly impor­tant ­sports med­i­cine prob­lem.

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