Injury to the anterior cruciate ligament (ACL) is one of the most common knee injuries sustained in sports. The anterior cruciate ligament attaches from the femur to the tibia and is one of the four primary ligaments that stabilizes the knee joint. The ACL prevents the tibia from translating forward excessively on the femur and gives rotational stability to the knee joint.
An increase in participation of youth in sports has led to a rise in ACL injuries in young athletes. Female athletes have a significantly greater risk of ACL injury than their male counterparts due to multiple anatomical and neuromuscular factors. Most ACL injuries occur during non-contact situations such as during landing and decelerating, cutting, or pivoting. Specifically, these injuries are most likely to occur when the knee is in a valgus position (inwards) or when the knee is straight or hyperextended upon landing. Recent evidence shows that targeted preventative programs can be effective in reducing risk of non-contact anterior cruciate ligament injury in young athletes.
There are multiple factors that contribute to an increased risk of ACL injury. Poor movement patterns during landing, cutting, and pivoting can cause excess stress to the knee. Other factors that may predispose an athlete to injury include muscle weakness or poor muscle balance, decreased joint range of motion, as well as decreased flexibility. ACL injury prevention programs should be unique to each athlete; however, they will generally focus on strengthening the core, gluteal, and hamstring muscles as well as optimizing muscle flexibility for that individual. Training athletes how to move effectively and safely through agility and plyometric training can decrease their risk of injury when placed in a competitive, dynamic situation.
An effective ACL prevention program typically consists of training a minimum of 2 times per week for 6-8 weeks prior to the competitive season. Ideally, exercises can be integrated into warmup and cool down by coaches during the sports season. Proper performance of exercises should continually be monitored.
All athletes, young and old, can benefit from targeted neuromuscular and strength training to reduce their risk of knee, and specifically, ACL injury in the future. By teaching movement strategies and proper biomechanics as well as targeted muscle strengthening, prevention programs can contribute to decreased risk of ACL injury.