“What we can do against kruisbandletsels’

Why tear there ‘suddenly’ a cruciate ligament in professional footballers in the richness of their lives, often even without an opponent in the vicinity ? And what can be prevention is more to be done than the classic ‘kniestabiliserende exercises’? The answer of Bart Dingenen, that scientific research is performing a phd on the subject of front kruisbandletsels.

The legs of Owned by © Belga Image

In a recent study were all male players of 78 European professional football clubs from 16 different countries followed between January 2001 and may 2015. The results showed that:

– about this period, an average increase of front kruisbandletsels (VKB-injury) was 6 percent per year;

– you, on average, can expect 1 VKB-injury will be within a male professional football team 2 years;

– the risk of a VKB-injury to get during a game 20 times higher than during training and relatively higher in women than in men.

Data from the United States show that the number of VKB-reconstructions (surgical recovery), a strong increase was noted between 2002 and 2014. The strongest increase is noticeable in both the male and female adolescents (13-17 years).


What we can do against kruisbandletsels

The high risk of recurrence in a new VKB-injury after return to sport is still a bigger problem. In the general population (not elite) is the risk to re-VKB-injury to get, on average, 15 percent. For persons under the age of 25 who are returning to sport this amounts to a whopping 23 percent. Both the operated leg and the non-operated leg has an increased risk.

Within the male professional football times more players back to the same competitive sportniveau, but only 65 percent acted three years later, still at the same level. Four percent of the population will get again a VKB-injury, and three percent have re-surgery for another problem to the same knee.

These new injuries get them usually within a very short period of time after the sporthervatting (within two years). Overall, you can say that there is scientific research that confirms that there is a trend to increase in the number of VKB-injury, and that the recurrence in a new injury at this moment was unacceptable.


There exists a trend to an increase in the number of front kruisbandletsels, and the recrudescence, in a new injury is at the moment unacceptable

How does this happen?

Approximately 85 percent of the VKB-injuries within the male professional football happens without a direct contact with an opponent. A typical blessuremechanisme is a wrong landing or a change of direction. During these non-contact mechanisms, it is often the case that a planned action of a player not consistent with the final action that must be executed.

Despite the fact that there’s no physical contact with an opponent, there is on a cognitive level, however, an interaction with the changing environment in which the movement will need to be carried out. In normal circumstances, our brain creates the ability to the attention to the environment and the main aspects from this environment to observe, analyze and interpret. So there may be an appropriate motor program to be activated in a coordinated movement, even when the environmental factors are less predictable and/or changing.

When our brain is, however, a less than optimal assessment of these unexpected and changing environmental conditions or too long for the situation to be able to correctly assess, this can be for a sudden disorientation in time and space.

That will then lead to a moment of diminished muscle control and co-ordination of the relevant joints. The load at the height of the knee, this can increase. When this load becomes larger than the tensile strength of the joints, these movements also would have to absorb, this may eventually lead to an acute knee injury, such as a VKB-injury.


Approximately 85 percent of the VKB-injuries within the male professional football happens without a direct contact with an opponent

What are the risk factors?

The risk factors are multifactorial. Therefore, it is ascribing (an increase of) VKB-injury to only 1 factor, by definition, is too simplistic. As there may be intrinsic risk factors are described (a combination of blessurevoorgeschiedenis, anatomical, neuromuscular, biomechanical, genetic, hormonal and other risk factors) and extrinsic factors (such as, for example, the substrate).

But also the design of the course, is a risk factor (not enough recovery between matches or a sudden increase in load). All of these factors can interact with each other, and work together to ensure that the risk at a given time may be greater.

The most important risk factor is a previous VKB-injury. This increases the risk to re-VKB-injury to get even 30 to 40 times, especially with the younger players who return to sports. Reasons for this may be that many players to quickly return to sport, incomplete recovery and back on the field when there are still important deficieten that the risk of recurrence increase.

An example of a to early sporthervatting was Arkadiusz Owned of Napoli: four months after his VKB-reconstruction, he turned back to matches, but recently he rent so the anterior cruciate ligament on his other knee.

However, it gives the science clearly states that after the operation it is best to use a combination of strict criteria and time (> 9 months) return to sport safely as possible. There are no shortcuts in such rehabilitation. Players that certain criteria are not achieving and earlier than 9 months after the operation, the sports resume, have a higher risk of a new injury.


The physical and tactical demands of modern football are no more to compare with 10 years ago

Other factors which, in function of the increased trend to VKB-injuries along can look, the very busy wedstrijdkalenders and the short recovery between races. In addition, the physical and tactical demands of modern football can’t be compared with those of, for example, 10 years ago. In comparison with the season of 2006-2007 was in the 2012-2013 season in the English Premier League, for example, 30 per cent more distance at high intensity is discarded.

A reason why VKB-injuries increasingly occur among young people, is a very early form of sportspecialisatie that we increasingly see in voetbalopleidingen. An early sportspecialisatie with very one-sided forms of training can provide a one-sided motor development, impaired development of the essential general motor skills and an increased blessurerisico. A wide and varied training of children is essential to the enormous potential of our whole motor system, including our brain, to make optimum use of. The younger you start with blessurepreventieve measures, the better the effect. The key to success later in life often lies in the development of our youth players.


A reason why kruisbandletsels also increasingly occur among young people, is a very early form of sportspecialisatie that we increasingly see in voetbalopleidingen

Preventive measures?

The blessurepreventieve measures are usually not in proportion with the increased physical demands of football players. Only a minority of professional football teams fits sufficiently effective preventive measures.

Blessurepreventieprogramma pages consist of multi-modal interventions, involving different influenceable risk factors be trained (such as balance, jumps, changes of direction, strength, anticipation and reaction time), and where the tax which a player is given and the way in which a player with a load interacts closely followed.


The blessurepreventieve measures are usually not in proportion with the increased physical demands of football players

These programs are especially studied in female athletes, and show a reduction from an average of 50 percent in the number of VKB-injury. The better these programs are followed, the better the effect.

It is also important that the exercises progressively more difficult, so it’s challenging and fun for the athlete. The modern and scientific principles of prevention and rehabilitation, however, there is still little applied in practice. That is a big problem.”

Of course there is from research to optimization of these interventions sought and we realize all too well that everything can be better. So, we now know that the brain play an important role during the very rapid decision-making process and, there are interventions developed to better integrate in the training.

For further information about VKB-prevention, I refer you to some texts that I for the Flemish Trainersschool made. They summarize in a simple way how a blessurepreventieprogramma can be built.

From revalidatiestandpunt I did recently have a ‘Facebook Live’ for a facebook group of more than 250,000 members. Also in this video is on the basis of the current scientific research made a translation to practice.

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