Anterior cruciate ligament injury

Efforts have focused on training programs targeting proprioception, neuromuscular control, and proper sport-specific technique.[38]Koyanagi M, Shino K, Yoshimoto Y, et al. Effects of changes in skiing posture on the kinetics of the knee joint. Knee Surg Sports Traumatol Arthrosc. 2006;14:88-93. http://www.ncbi.nlm.nih.gov/pubmed/15909205?tool=bestpractice.com [39]Giza E, Micheli LJ. Soccer injuries. Med Sport Sci. 2005;49:140-69. http://www.ncbi.nlm.nih.gov/pubmed/16247265?tool=bestpractice.com [40]Yoo JH, Lim BO, Ha M, et al. A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 2010;18:824-30. http://www.ncbi.nlm.nih.gov/pubmed/19760399?tool=bestpractice.com [41]Arundale AJH, Bizzini M, Giordano A, et al. Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention. J Orthop Sports Phys Ther. 2018 Sep;48(9):A1-A42. https://www.orthopt.org/uploads/content_files/files/jospt.2023.0301.pdf http://www.ncbi.nlm.nih.gov/pubmed/30170521?tool=bestpractice.com ​​​[42]American Academy of Orthopaedic Surgeons. Management of anterior cruciate ligament injuries​: evidence-based clinical practice guideline. Aug 2022 [internet publication]. https://www.aaos.org/globalassets/quality-and-practice-resources/anterior-cruciate-ligament-injuries/aclcpg.pdf ​ One systematic review concluded that there is strong evidence in support of a significant effect of ACL injury prevention programs.[43]Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94:769-76. http://www.ncbi.nlm.nih.gov/pubmed/22456856?tool=bestpractice.com

Multicomponent injury-prevention programs, comprising feedback on movement technique, are recommended for reducing indirect-contact and noncontact ACL injuries. These may focus on improving balance, biomechanics, muscle activation, functional performance, strength and power.[44]Padua DA, DiStefano LJ, Hewett TE, et al. National Athletic Trainers' Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. J Athl Train. 2018 Jan;53(1):5-19. https://www.doi.org/10.4085/1062-6050-99-16 http://www.ncbi.nlm.nih.gov/pubmed/29314903?tool=bestpractice.com

Further work is required to determine the ideal regimen for specific sports.

Prevention of ACL injuries has generally focused on high-risk athletes, such as females involved in soccer, skiing, and basketball. Multiple small studies have shown that training programs that develop proper footwork, landing technique, correct body alignment, improved proprioception, strength, fitness, and neuromuscular recruitment patterns can decrease the risk of significant knee injury.[116]Silvers HJ, Mandelbaum BR. Prevention of anterior cruciate ligament injury in the female athlete. Br J Sports Med. 2007;41(suppl 1):i52-9. http://www.ncbi.nlm.nih.gov/pubmed/17609222?tool=bestpractice.com [117]Hewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med. 2006;34:490-8. http://www.ncbi.nlm.nih.gov/pubmed/16382007?tool=bestpractice.com [118]Stevenson JH, Beattie CS, Schwartz JB, et al. Assessing the effectiveness of neuromuscular training programs in reducing the incidence of anterior cruciate ligament injuries in female athletes: a systematic review. Am J Sports Med. 2015;43:482-90. http://www.ncbi.nlm.nih.gov/pubmed/24569703?tool=bestpractice.com Furthermore, results of a systematic review suggest that ACL injury prevention training programs have a substantial beneficial effect in reducing risk of ACL injury in athletes - particularly male athletes.[43]Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94:769-76. http://www.ncbi.nlm.nih.gov/pubmed/22456856?tool=bestpractice.com These measures can be instituted as secondary prevention to minimize the risk of ipsilateral recurrence or contralateral injury, but may also be effective as primary prevention.[119]Grindstaff TL, Hammill RR, Tuzson AE, et al. Neuromuscular control training programs and noncontact anterior cruciate ligament injury rates in female athletes: a numbers-needed-to-treat analysis. J Athl Train. 2006;41:450-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1748422 http://www.ncbi.nlm.nih.gov/pubmed/17273472?tool=bestpractice.com 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.[120]Wright RW, Fetzer GB. Bracing after ACL reconstruction: a systematic review. Clin Orthop Rel Res. 2007;455:162-8. http://www.ncbi.nlm.nih.gov/pubmed/17279043?tool=bestpractice.com [121]Najibi S, Albright JP. The use of knee braces, part 1: prophylactic knee braces in contact sports. Am J Sports Med. 2005;33:602-11. http://www.ncbi.nlm.nih.gov/pubmed/15788733?tool=bestpractice.com Other approaches include rule changes (e.g., eliminating certain blocks and tackles in football); further study of the risks and benefits of various footwear types; tailoring ski boots and bindings; assessing playing surfaces; and investigation of biochemical, biomechanical, and genetic factors that may increase risk of ACL injury.