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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-02-2020 | KNEE

Prevention of severe knee injuries in men’s elite football by implementing specific training modules

Authors: Werner Krutsch, Jennifer Lehmann, Petra Jansen, Peter Angele, Birgit Fellner, Leonard Achenbach, Volker Krutsch, Michael Nerlich, Volker Alt, Oliver Loose

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2020

Abstract

Purpose

Injury prevention of knee injuries by means of training and warm-up exercises has been investigated in several studies in amateur football. However, the number of investigations in elite football is limited despite the currently higher injury incidence of severe knee injuries. Therefore, the purpose of this study was to investigate whether specifically adapted preventive training modules may reduce severe knee injuries in elite football.

Methods

In a prospective controlled cohort study of elite football players in Germany, an injury prevention programme with 5 modules was implemented in the season of 2015–2016. The training modules were specifically adapted to this skill level and based on scientific evidence, team coach preferences, and the specific environment of this playing level. Of the 62 teams taking part in this study, 26 used the new trainings modules and 36 continued their standard programme as a control group. Success of the programme was documented by means of an injury report over one season. The primary outcome was reduction in severe knee injuries.

Results

A pre-seasonal investigation had identified five modules to be implemented in the training routine. Postural stability, mobilisation of lower extremity joints, leg and trunk stabilisation, jumping, and landing exercises as well as agility movements were incorporated into the programme to prevent severe knee injuries in elite football. Over the season, the study group (529 players) with the adapted training modules had sustained 52 severe knee injuries (incidence: 0.38 per 1000 h football exposure; prevalence: 9.8%) compared to 108 severe knee injuries in the control group (601 players) using the standard programme (incidence: 0.68 per 1000 h football exposure; prevalence: 18.0%; p < 0.05). The overall injury incidence for any other type of injury was comparable between the two groups (3.3 vs. 3.4 in h 1000 football, n.s.).

Conclusion

Appropriate preventive training modules reduce severe knee injuries in elite football significantly. The key for the sustainability of preventive training measures are programmes specifically adapted to the demands of the playing level and to the preferences of the coaches

Level of evidence

II.

Achenbach L, Krutsch V, Weber J, Nerlich M, Luig P, Loose O, Angele P, Krutsch W (2018) Neuromuscular exercises prevent severe knee injury in adolescent team handball players. Knee Surg Sports Traumatol Arthrosc 26(7):1901–1908CrossRef

Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro- Haro C, Cugat R (2009) Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanism of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 17:705–729CrossRef

Andrews K, Lu A, Mckean L, Ebraheim N (2017) Review: medial collateral ligament injuries. J Orthop 14(4):550–554CrossRef

Barengo NC, Meneses-Echávez JF, Ramírez-Vélez R, Cohen DD, Tovar G, Bautista JE (2014) The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review. Int J Environ Res Public Health 11(11):11986–12000CrossRef

Beaudouin F, Rössler R, Aus der Fünten K, Bizzini M, Chomiak J, Verhagen E, Junge A, Dvorak J, Lichtenstein E, Meyer T, Faude O (2018) Effects of the '11+ Kids' injury prevention programme on severe injuries in children's football: a secondary analysis of data from a multicentre cluster-randomised controlled trial. Br J Sports Med. https://doi.org/10.1136/bjsports-2018-099062 CrossRefPubMed

Bizzini M, Dvorak J (2015) FIFA 11+: an effective programme to prevent football injuries in various player groups worldwide-a narrative review. Br J Sports Med. https://doi.org/10.1136/bjsports-2015-094765 CrossRefPubMedPubMedCentral

Bizzini M, Junge A, Dvorak J (2013) Implementation of the FIFA 11+ football warm up program: How to approach and convince the football associations to invest in prevention. Br J Sports Med 47:803–806CrossRef

Boden BP, Sheehan FT, Torg JS, Hewett TE (2010) Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J Am Acad Orthop Surg 18(9):277–520CrossRef

Donaldson A, Callaghan A, Bizzini M, Jowett A, Keyzer P, Nicholson M (2019) A concept mapping approach to identifying the barriers to implementing an evidence-based sports injury prevention programme. Inj Prev. 25:244-251CrossRef

10.

Ekstrand J, Hägglund M, Walden M (2011) Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 45:553–558CrossRef

11.

Ekstrand J, Lundqvist D, Davison M, D'Hooghe M, Pensgaard AM (2018) Communication quality between the medical team and the head coach/manager is associated with injury burden and player availability in elite football clubs. Br J Sports Med 53:304–308CrossRef

12.

Emery CA, Meeuwisse WH (2010) The effectiveness of a neuromuscular prevention strategy to reduce injuries in youth soccer: a cluster-randomised controlled trial. Br J Sports Med 44:555–562CrossRef

13.

Engebretsen AH, Myklebust G, Holme I et al (2008) Prevention of injuries among male soccer players. A prospective randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med 36:1052–1060CrossRef

14.

Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Haegglund M, McCrory P, Meeuwisse WH (2006) Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Clin J Sport Med 16(2):97–106CrossRef

15.

Gilchrist J, Mandelbaum BR, Melancon H, Ryan GW, Silvers HJ, Griffin LY et al (2008) A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med 36:1476–1483CrossRef

16.

Gomes Neto M, Conceição CS, de Lima Brasileiro AJA, de Sousa CS, Carvalho VO, de Jesus FLA (2017) Effects of the FIFA 11 training program on injury prevention and performance in football players: a systematic review and meta-analysis. Clin Rehabil 31(5):651–659CrossRef

17.

Hägglund M, Waldén M, Bahr R, Ekstrand J (2005) Methods for epidemiological study of injuries to professional football players: developing the UEFA model. Br J Sports Med 39(6):340–346CrossRef

18.

Hägglund M, Walden M, Ekstrand J (2003) Exposure and injury risk in Swedish elite football: a comparison between seasons 1982 and 2001. Scand J Med Sci Sports 13:364–370CrossRef

19.

Hägglund M, Walden M, Ekstrand J (2005) Injury incidence and distribution in elite football—a prospective study of the Danish and the Swedish top divisions. Scand J Med Sci Sports 15:21–28CrossRef

20.

Hägglund M, Walden M, Ekstrand J (2006) Previous injury as a risk factor for injury in elite football: a prospective study over two consecutive seasons. Br J Sports Med 40:767–772CrossRef

21.

Hägglund M, Waldén M, Ekstrand J (2013) Risk factors for lower extremity muscle injury in professional soccer: the UEFA Injury Study. Am J Sports Med 41:327–335CrossRef

22.

Hägglund M, Waldén M, Magnusson H, Kristenson K, Bengtsson H, Ekstrand J (2013) Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med 47:738–742CrossRef

23.

Harøy J, Clarsen B, Wiger EG, Øyen MG, Serner A, Thorborg K, Hölmich P, Andersen TE, Bahr R (2019) The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med 53:150–157CrossRef

24.

Heidt RS Jr, Sweeterman LM, Carlonas RL, Traub JA, Tekulve FX (2000) Avoidance of soccer injuries with preseason conditioning. Am J Sports Med 28:659–662CrossRef

25.

Hewett TE, Ford KR, Hoogenboom BJ, Myer GD (2010) Understanding and preventing ACL injuries: Current biomechanical and epidemiologic considerations—update 2010. N Am J Sports Phys Ther 5:234–251PubMedPubMedCentral

26.

Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR (1999) The effect of neuromuscular training on the incidence of knee injury in female athletes. Am J Sports Med 27:699–706CrossRef

27.

Hewett TE, Myer GD, Ford KR et al (2005) Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 33:492–501CrossRef

28.

Hewett TE, Ford KR, Myer GD (2006) Anterior cruciate ligament injuries in female athletes: part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med 34(3):490–498CrossRef

29.

Klügl M, Shrier I, Shultz R et al (2010) The prevention of sport injury: an analysis of 12,000 published manuscripts. Clin J Sport Med 20:407–412CrossRef

30.

Krutsch W, Zeman F, Zellner J, Pfeifer C, Nerlich M, Angele P (2016) Increase in ACL and PCL injuries after implementation of a new professional football league. Knee Surg Sports Traumatol Arthrosc 24(7):2271–2279CrossRef

31.

Loose O, Fellner B, lehmann J, Achenbach L, Krutsch V, Gerling S, Jansen P, Angele P, Nerlich M, Krutsch W (2019) Injury incidence in semi-professional football claims for increased need of injury prevention in elite junior football. Knee Surg Sports Traumatol Arthrosc 27:978–984CrossRef

32.

Loose O, Achenbach L, Fellner B, Lehmann J, Jansen P, Nerlich M, Angele P, Krutsch W (2018) Return to play decision after injuries in elite football—no consent between players and team coaches. Arch Orthop Trauma Surg 138(7):985–992CrossRef

33.

Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garrett W Jr (2005) Evectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med 33(7):1003–1010CrossRef

34.

Salzmann GM, Preiss S, Zenobi-Wong M, Harder LP, Maier D, Dvorák J (2017) Osteoarthritis in Football. Cartilage 8(2):162–172CrossRef

35.

Silvers-Granelli HJ, Bizzini M, Arundale A, Mandelbaum BR, Snyder-Mackler L (2018) Higher compliance to a neuromuscular injury prevention program improves overall injury rate in male football players. Knee Surg Sports Traumatol Arthrosc 7:1975–1983CrossRef

36.

Soligard T, Myklebust G, Steffen K, Holme I, Silvers H, Bizzini M, Junge A, Dvorak J, Bahr R, Andersen TE (2008) Comprehensive warm-up programme to prevent injuries in young female footballers: cluster randomised controlled trial. BMJ 337:a2469CrossRef

37.

Soligard T, Nilstad A, Steffen K, Myklebust G, Holme I, Dvorak J, Bahr R, Andersen TE (2010) Compliance with a comprehensive warm-up programme to prevent injuries in youth football. Br J Sports Med 44(11):787–793CrossRef

38.

Thorborg K, Krommes KK, Esteve E et al (2017) Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. Br J Sports Med 51:562–571CrossRef

39.

Von Porat A, Roos EM, Roos H (2004) High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 63:269–273CrossRef

40.

Walden M, Atroshi I, Magnusson H, Wagner P, Hagglund M (2012) Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial. BMJ 2012(344):e3042CrossRef

41.

Watt FE, Corp N, Kingsbury SR et al (2019) Towards prevention of post-traumatic osteoarthritis: report from an international expert working group on considerations for the design and conduct of interventional studies following acute knee injury. Osteoarthr Cartil 27:23–33CrossRef

42.

Werner J, Hägglund M, Ekstrand J, Waldén M (2019) Hip and groin time-loss injuries decreased slightly but injury burden remained constant in men's professional football: the 15-year prospective UEFA Elite Club Injury Study. Br J Sports Med 53:539–546CrossRef

Title: Prevention of severe knee injuries in men’s elite football by implementing specific training modules
Authors: Werner Krutsch
Jennifer Lehmann
Petra Jansen
Peter Angele
Birgit Fellner
Leonard Achenbach
Volker Krutsch
Michael Nerlich
Volker Alt
Oliver Loose
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-019-05706-w

At a glance: The STEP trials

Springer Medicine

Prevention of severe knee injuries in men’s elite football by implementing specific training modules

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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