Dr. Bert Mandelbaum discusses his involvement with building and growing a strong ACL injury prevention program.
Bert Mandelbaum, MD, is an orthopedic surgeon with Santa Monica Orthopaedics and Sports Medicine Group and Saint John's Health Center in Santa Monica, Calif. Here he discusses the small beginnings of an ACL injury prevention program that has grown to a national and international scale and aspires to support ACL injury prevention across the globe.
Question: How did the idea of building an ACL injury prevention program first arise?
Dr. Bert Mandelbaum: The idea first began in the 1990s. I was living and practicing as an orthopedic surgeon in southern California. There were a number of young women, from ages 14 to 18, playing sports and frequently incurring ACL injuries. As an orthopedic sports medicine physician, I was mostly seeing male patients at the time, but as the 1990s evolved I began seeing young women tearing their ACLs at an alarming rate. Orthopedic surgeons were seeing the same thing happen in many different places.
In 1999, a multidisciplinary group in Hunt Valley, Maryland gathered to study film of women playing sports. Most of the ACL tears occurring were non-contact injuries. We had to ask what was happening. This multidisciplinary group analyzed factors such as anatomy, hormones and environment, but eventually found that neuromuscular control and biomechanics was the main culprit behind noncontact ACL injuries. In response, the Santa Monica Sports Medicine Foundation began the Prevent Injury Enhance Performance Program.
Q: What was the program's initial area of focus?
BM: The program was designed to train young female athletes to be more biomechanically sound. The program trained these athletes and minimized the risk of ACL injury through better neuromuscular control. We collaborated with Dr. Chris Powers and the University of Southern California to validate the program. In is first year, the program was shown to be 88 percent effective in preventing ACL injury. The program was further evaluated in the National Collegiate Athletic Association. The program was found to be statistically effective at Preventing ACL injuries.
Q: How has the PEP Program evolved since its inception?
BM: At the Santa Monica Sports Medicine Foundation, the major objective has grown to be worldwide participation. Last year, we evaluated the PEP Program on male athletes in Fédération Internationale de Football Association and created the FIFA 11+ program. The program has significantly decreased not only ACL injuries, but ankle and hamstring injuries as well. We are hoping to involve coaches, parents, physical therapists, sports medicine physicians and orthopedic surgeons: a truly multidisciplinary approach.
Q: What impact have you seen the program have as it continues to grow?
BM: The program really morphed when we were approached by FIFA. FIFA is in 207 countries across the world. Prevention can be especially important in underdeveloped countries, where people don't always have access to care after the injury occurs.
We have been working with this program for 14 years. We have implemented the program in schools and parks across the country. Johnson & Johnson is now a sponsor. We implement the program wherever we can. Prevention is key.
Q: Why should orthopedic surgeons focus on preventative care?
BM: Orthopedic surgeons have seen what causes injuries. We know the mechanisms: strength, balance, control. But, we as surgeons don't just have to fix the injury. It is bigger than that. We need to work with people to minimize the incidence of injury, as well as help athletes optimize their performance. This is not natural for orthopedic surgeons. We want to operate, but the sheer number of ACL injuries and the consequences are significant.
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