Prevention training halves ACL rupture risk
Structured training programs reduce anterior cruciate ligament (ACL) ruptures in athletes.
*Systematic review and meta-analysis of trials; Level 2a (OCEBM).

Citation

Watson SL, Gohal C, Owen MM, Bajaj PM, Plantz MA, Tjong VK. Team Physician’s Corner: A Systematic Review and Meta-analysis of Anterior Cruciate Ligament Injury Prevention Programs. The American Journal of Sports Medicine. 2026;54(3):733–740. doi:10.1177/03635465251376670

Background

ACL ruptures are common, costly, and can cause long-term knee problems. Many teams use structured warm-up and movement-training programs, but effectiveness varies across studies.

Patients

25,166 athletes (mean age 19.3 years; mostly female) in handball, soccer, basketball, or volleyball. Excluded: treatment/rehabilitation studies, reinjury after reconstruction, and studies reporting only movement risk factors (not injury rates).

Intervention

ACL injury prevention programs emphasizing strength, landing/cutting technique, agility, and balance; some used balance boards.

Control

Usual training without the prevention program.

Outcome

ACL rupture incidence (primary).

Follow-up Period

At least 1 season (average 1.3 seasons).

Results

Analysis Risk ratio (95% confidence interval)
All athletes (primary) 0.46 (0.36 to 0.57)
Female athletes 0.57 (0.43 to 0.74)
Age under 18 years 0.35 (0.22 to 0.55)
Age 18 years and older 0.50 (0.38 to 0.64)
Soccer 0.30 (0.19 to 0.46)
Handball 0.66 (0.46 to 0.96)
Programs including balance boards 0.49 (0.35 to 0.67)
Overall absolute ACL rupture rates were 1.0% with programs vs 2.3% with usual training (absolute reduction 1.3%); number needed to train ≈ 77 athletes for one season to prevent 1 ACL rupture.

Limitations

Studies mixed randomized and non-randomized designs, with varying programs and adherence. Most participants were female team-sport athletes, limiting generalizability to other sports or individual training. Event rates were low, and the review was not registered in advance.

Funding

No external funding reported; one author consulted for Smith & Nephew.

Clinical Application

Use a brief, repeatable neuromuscular warm-up program in team practices; expect meaningful ACL rupture reduction, especially in soccer and youth athletes.