#015-Anterior Cruciate Ligament (ACL) Prevention Programs

Estimated reading time: 1 minute, 57 seconds.

ACL Injury Prevention Programs Can Reduce ACL Injury Rates by 53%

Since 2006 there has been 11 systematic reviews and meta-analyses on ACL injury prevention programs, most of these studies supported the use of the prevention programs, however, the size of the effect varied from not significant to 60% reduction in injury rate, this was due to at least 1 methodological limitation of the following:

  1. Not excluding non–randomized controlled designs.
  2. Not accounting for participant time at risk.
  3. Not adjusting for potential clustering effects.

This systematic review and meta-analysis aimed to adjust for these limitations and investigate the effectiveness of ACL injury prevention programs.

8 Studies including 13,562 participants.


  • 53% reduction in ACL injury rate in athletes that received injury prevention program compared to athletes that did not.
  • For a prevention program to meet the minimum recommendation, it should include at least 3 of the following exercise types:
    • Strength, plyometrics, agility, balance, and flexibility.
  • However, with novel evidence, this study stated that it is necessary for a prevention program to include:
    • Strengthening, plyometrics and agility exercises.
    • Also, given that therapists/coaches include the above mentioned exercises, they have flexibility selecting specific exercises.
    • Feedback on proper movement techniques has shown to be important.

Prevention programs used by the included studies:

  • Strengthening: (7/8 studies)
    • Examples: Single/double squat, prone/side plank, lunge, Nordic hamstring, heel rises, prone lift and Romanian dead lift.
  • Plyometrics: (7/8 studies)
    • Examples: Single-leg hop, lunge jumps, hop to stabilization and reach, broad jumps, scissor jumps, ankle bounces, tuck jumps, 180 jumps.
  • Agility: (7/8 studies)
    • Examples: Double Legged jump with ball header, zigzag shuffle, Single Leg hop to side hop, carioca, parade, forward running with intermittent stops, speed runs, planting and cutting, shuttle run, diagonal run, lateral shuffle and unanticipated hop to stabilization.
  • Balance: (8/8 studies)
    • Examples: Cross-country skiing, single leg stance chest pass, single leg stance forward bend, single leg stance figure-of-8, lateral jump and hold, Bosu double-knee hold, unanticipated hop to stabilization and Airex hop-hold.
  • Flexibility: (4/8 studies)
    • Examples: Forward running with heel kicks, forward running with knee lifts, forward running with trunk rotation, calf stretch, quad stretch, figure-of-4 hamstring stretch, groin/adductor stretch, hip flexor stretch, high knee skipping, high knee carioca, arm swings, leg swings, side shuffles with arm swings and hip in/hip out.
  • Feedback: (6/8 studies)
    • Feedback on proper movement by coaches, medicine staff and/or teammates.


  • Sports: Football (Soccer) (7 studies), Handball, volleyball and Basket ball (1 study each).

This is the strongest evidence to date to support the ACL injury prevention programs.

Recommended reads:


  1. A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by Injury Prevention Programs: A Systematic Review of Randomized Controlled Trials and Cluster–Randomized Controlled Trials With Meta-analysis. (Restricted Access)

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