Åman Malin, Larsén Karin, Forssblad Magnus, Näsmark Annica, Waldén Markus, Hägglund Martin
Swedish School of Sport and Health Sciences, Stockholm, Sweden.
Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
Orthop J Sports Med. 2018 Dec 21;6(12):2325967118813841. doi: 10.1177/2325967118813841. eCollection 2018 Dec.
A cruciate ligament (CL) injury is a severe injury in soccer. Neuromuscular training programs have a well-documented preventive effect, but there are few studies on the effectiveness of such a program at a national level. The Swedish Knee Control Program (KCP) was found to be effective in preventing CL injuries in youth female soccer players. The KCP was implemented nationwide in Sweden in 2010.
To evaluate the effectiveness of the Swedish KCP in reducing acute knee injuries in soccer players at a nationwide level.
Descriptive epidemiology study.
All licensed soccer players in Sweden are covered by the same insurance company. Using this insurance database, around 17,500 acute knee injuries that were reported to the insurance company between 2006 and 2015 were included in the study. By matching the number of licensed soccer players with the number of reported injuries each year, the annual incidence of knee and CL injuries was able to be calculated. To evaluate the spread of the KCP nationally, a questionnaire was sent to all 24 Swedish district football associations (FAs) with questions regarding KCP education. The number of downloads of the KCP mobile application (app) was obtained.
The incidence of CL injuries decreased during the study period for both male (from 2.9 to 2.4 per 1000 player-years) and female players (from 4.9 to 3.9 per 1000 player-years). The overall incidence of knee injuries decreased in both male (from 5.6 to 4.6 per 1000 player-years) and female players (from 8.7 to 6.4 per 1000 player-years). Comparing before and after the nationwide implementation of the KCP, there was a decrease in the incidence of CL injuries by 6% (rate ratio [RR], 0.94 [95% CI, 0.89-0.98]) in male players and 13% (RR, 0.87 [95% CI, 0.81-0.92]) in female players and a decrease in the incidence of knee injuries by 8% (RR, 0.92 [95% CI, 0.89-0.96]) and 21% (RR, 0.79 [95% CI, 0.75-0.83]), respectively ( < .01 for all). This trend corresponded to a reduction of approximately 100 CL injuries each year in Sweden. A total of 21 of 24 district FAs held organized KCP educational courses during the study period. The percentage of district FAs holding KCP courses was between 46% and 79% each year. There were 101,236 downloads of the KCP app.
The KCP can be considered partially implemented nationwide, and the incidence of knee and CL injuries has decreased in both sexes at a nationwide level.
十字韧带（CL）损伤是足球运动中的一种严重损伤。神经肌肉训练计划具有充分记录的预防效果，但在国家层面上关于此类计划有效性的研究较少。瑞典膝关节控制计划（KCP）被发现对预防青年女子足球运动员的CL损伤有效。KCP于2010年在瑞典全国范围内实施。
在全国范围内评估瑞典KCP在减少足球运动员急性膝关节损伤方面的有效性。
描述性流行病学研究。
瑞典所有获得许可的足球运动员都由同一家保险公司承保。利用该保险数据库，2006年至2015年期间向保险公司报告的约17500例急性膝关节损伤被纳入研究。通过将获得许可的足球运动员数量与每年报告的损伤数量相匹配，能够计算出膝关节和CL损伤的年发病率。为了评估KCP在全国的推广情况，向瑞典所有24个地区足球协会（FA）发送了一份问卷，询问有关KCP教育的问题。获取了KCP移动应用程序（应用）的下载量。
在研究期间，男性（从每1000运动员年2.9例降至2.4例）和女性运动员（从每1000运动员年4.9例降至3.9例）的CL损伤发病率均有所下降。男性（从每1000运动员年5.6例降至4.6例）和女性运动员（从每1000运动员年8.7例降至6.4例）的膝关节损伤总体发病率均有所下降。比较KCP在全国实施前后，男性运动员的CL损伤发病率下降了6%（率比[RR]，0.94[95%CI，0.89 - 0.98]），女性运动员下降了13%（RR，0.87[95%CI，0.81 - 0.92]），膝关节损伤发病率分别下降了8%（RR，0.92[95%CI，0.89 - 0.96]）和21%（RR，0.79[95%CI，0.75 - 0.83]）（所有P<0.01）。这一趋势相当于瑞典每年减少约100例CL损伤。在研究期间，24个地区FA中有21个举办了KCP组织教育课程。每年举办KCP课程的地区FA百分比在46%至79%之间。KCP应用程序有101236次下载。
可以认为KCP在全国部分地区得到了实施，并且在全国范围内，男女的膝关节和CL损伤发病率均有所下降。
