In the United States, youth participation in organized sports continues to rise annually. More than 7.6 million students played sports during the 2010 to 2011 school year. The National Federation of State High School Associations estimates that 55.5% of all high-school students play a sport. The increase in sports participation among the nation’s youth has not occurred without consequences. School systems have added more sports to accommodate the desires of the students and their families. These new programs carry new costs to the school systems and the parents to cover coaching, equipment, field space, and other associated costs. Participation has also grown outside the school systems. Many of the high-school athletes are also participating on costly “elite” or club teams and are specializing in a single sport at a much younger age. Unfortunately, this fervor for sports participation comes with the cost of increased injury rates—both overuse and traumatic. Undoubtedly, the injury that receives the most attention is rupture of the anterior cruciate ligament (ACL). The injury is often devastating to the athlete and his or her family. In most cases, it is considered a season-ending injury, and there are always concerns it is a career-ending injury. Since the injury is almost always treated surgically, another element of emotional distress is added to the situation. For these and other reasons, there is a large body of research aimed at preventing injuries to the ACL and identifying those at risk for ACL injury.

This study uses a decision analytic model and review of a large body of high-quality published literature to compare the cost-effectiveness of two strategies for decreasing the incidence of ACL injuries in a hypothetical cohort of young athletes. The first strategy enrolled all athletes in neuromuscular training programs. The second strategy screened all athletes for risk of ACL injury, on the basis of anthropomorphic and kinematic data, and enrolled only high-risk athletes in neuromuscular training programs. The control was no training or screening. Inputs into the model, such as injury rates, costs of ACL reconstruction, and costs of neuromuscular training programs and screening programs, were varied to allow for sensitivity analysis. The authors concluded that universal neuromuscular training was the most cost-effective strategy to reduce the cost associated with ACL injuries.

There are substantial strengths to the design of this study. The authors selected high-quality studies for this analysis. Additionally, they selected a neuromuscular training protocol that is practical in terms of implementation at many levels. A protocol that was too time-consuming, required substantial training by coaches and/or trainers, or necessitated the hiring of new, specialized trainers to implement the program would have very little chance for universal acceptance. The screening program was also selected in a manner that made it practical for universal implementation without unreasonable costs or specialized staff.