Primary prevention

Prevention of anterior cruciate ligament (ACL) injuries has generally focused on high-risk athletes. Efforts have focused on training programmes targeting proprioception, neuromuscular control, and proper sport-specific technique.[40][41][42][43][44]​​​​ Training programmes that develop proper footwork, landing technique, correct body alignment, improved strength, fitness, and neuromuscular recruitment patterns can decrease the risk of significant knee injury.[45][46][47]​​ One systematic review concluded that there is strong evidence in support of a significant effect of ACL injury prevention programs.[48]

There is limited evidence for the use of a knee brace to prevent ACL injury and it is not a preferred option for primary prevention.[44]

Multicomponent injury-prevention programs, comprising feedback on movement technique, are recommended for reducing indirect-contact and non-contact ACL injuries. These may focus on improving balance, biomechanics, muscle activation, functional performance, strength and power.[49] The American Academy of Orthopaedic Surgeons has determined the appropriateness of supervised ACL injury prevention programmes for 48 different individual scenarios, ranging from competitive athletes involved in high-risk sports, to recreational athletes involved in low-risk sports.[50]

Secondary prevention

ACL injury prevention training programmes have a substantial beneficial effect in reducing risk of ACL injury in athletes.[48] These measures can be instituted as secondary prevention to minimise the risk of ipsilateral recurrence or contralateral injury.[116] A brace is usually worn initially when an athlete is returning to play after ACL reconstruction, but there is no definitive proof that any brace actually decreases the risk of an ACL injury.[117][118]​ 

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