Home > Injury Prevention, Knee Injury > ACL Injury Rates Reduced by 50-85% Following Implementation of a Preventive Training Program

ACL Injury Rates Reduced by 50-85% Following Implementation of a Preventive Training Program

Sadoghi P, Keudell von A, Vavken P.  Effect of Anterior Cruciate Ligament Injury Prevention Training Programs. The Journal of Bone and Joint Surgery 94: 1-8, 2012.

PMID: 22456856

RATIONALE & PURPOSE: Anterior cruciate ligament (ACL) rupture has been identified to be a significant encumbrance on today’s healthcare system, and represents a significant financial, emotional, and physical burden for the individual suffering the injury. The most common treatment for the injury is surgical repair, using a tissue graft to replace the damaged structure. Current literature suggests that even with surgical repair there are enduring consequences of injury, with a predisposition for osteoarthritis most commonly being identified as a long-term repercussion. Perhaps the most glaring aftereffect of ACL rupture is that of increased risk of ACL injury compared to those who have never sustained an ACL injury. Recent publications suggest that an individual who has previously sustained an ACL injury is up to 6 times at risk for suffering an ACL injury compared to an individual with no history of ACL rupture. It is thus prudent that effective injury prevention strategies be implemented to help reduce one’s risk of primary injury as well as re-injury.

Up to 80% of ACL injuries have been identified to be a result of a noncontact mechanism, indicating the injury was a result of an individual’s self-imposed motion. Understanding that human movement is modifiable, a substantial volume of research efforts have been aimed at identifying methods to promote safe and efficient movement strategies in individuals who may be exposed to events in which ACL rupture have been known to occur. High-risk circumstances have been identified as athletic activities demanding high-magnitude accelerations/decelerations and changes in direction. As a result, various ACL injury prevention programs have been deployed in the athletic population, and after scientific study have been determined to be individually effective in reducing ACL injury incidence. As such, studies investigating the effects of ACL injury prevention programs on ACL injury incidence are growing numerous. However, different studies present a broad range of prevention programming, thus making it difficult to determine the specific elements of programming that are most efficacious in reducing ACL injury rates. Furthermore, due to deployment of prevention efforts in different populations the general effect of programming has not been described. Thus the purpose of this systematic review study was to evaluate and describe the general effect of ACL injury prevention programming on decreasing injury incidence, and to identify if there is a programming protocol that is “best” in terms of reducing ACL injury incidence.

OVERVIEW OF RESEARCH METHODS: An initial search of online databases of peer-reviewed journals with the search terms “anterior cruciate ligament, knee, injury, prevention, and control” returned 909 results. The authors report including only studies that were described to be “prospective, controlled studies that directly compared ACL injury prevention programs to no treatment in human subjects,” resulting in a final evaluation of 8 studies. Data from the 8 studies was pooled to compare the risk of experiencing an ACL injury between those completing a prevention program and those not executing a prevention program. In addition to evaluating the overall effect of prevention programming on reducing ACL injury risk across the populations of the studies, the effect of programming for males and females was differentiated. An attempt to compare the effectiveness of different programs was unsuccessful due to the differing populations each study represented. However a qualitative analysis of elements common to programs proving to be effective in reducing injury rates was carried out.


  • ACL injury prevention programs effectively decrease ACL injury risk by 62% in male and female soccer, basketball, volleyball, and team handball athletes.
  • ACL injury prevention programs decrease ACL injury risk by 85% in male athletes.
  • ACL injury prevention programs decrease ACL injury risk by 52% in female athletes.
  • There was no specific program that was identified to be the “best” program in reducing ACL injury risk.
  • EffectiveACL injury prevention programs:
    • Include at least 10 minutes of exercises
    • Are executed at least 3 times per week
    • Focus on neuromuscular training

CLINICAL IMPLICATIONS: The results of this systematic literature review provides cogent evidence supporting the implementation of ACL injury prevention programming into clinical practice by sports medicine professionals. ACL injury prevention programming efforts that at a minimum include at least 10 minutes of exercises, conducted at least 3 times per week, focusing on neuromuscular decrease an individual’s risk of ACL injury. Individuals who are exposed to athletic activities representing high-risk exposures such as soccer, basketball, team handball, and volleyball, or any physical activity that incorporates high-magnitude accelerations/decelerations and changes in direction should execute ACL injury prevention programming.

Furthermore, it is understood that the sports medicine professional may not have the ability to individually reach each athlete who may experience exposure to high-risk events, thus it is imperative physicians, athletic trainers, and physical therapists be capable of educating athletes, coaches, parents, and administrators regarding the benefits and of ACL injury prevention programming. Additionally it is imperative sports medicine professionals be able to direct the above individuals to efficacious programming efforts. Currently many effective programming resources are available and are listed below.

Written by Barnett Frank, MA, ATC
Approved by Darin Padua, PhD, ATC

  1. April 7, 2013 at 5:14 pm

    Hey, your site is fantastic. We do appreciate you great posts.

  2. April 15, 2013 at 6:45 pm

    Thanks in favor of sharing such a good thinking, article is fastidious, thats why i have read it fully

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