Introduction
Anterior cruciate ligament (ACL) injuries are among the most common and severe in sports, significantly impacting athletes’ quality of life, with changes ranging from physical to psychological aspects. An ACL tear or reconstruction not only requires a long recovery period (on average 9-12 months) but may also lead to reduced future athletic performance, an increased risk of osteoarthritis, and potential psychological repercussions (Frobell et al., 2013; Lohmander et al., 2007). Although guidelines recommend adopting prevention programs, these measures are often underutilized due to barriers related to a lack of knowledge and the limited time available during training sessions. This literature review aims to analyze current prevention practices, identify barriers to implementation, and provide practical recommendations for ACL injury prevention.
Guidelines for ACL Injury Prevention
International guidelines recommend implementing prevention programs to reduce the risk of ACL injuries. These programs include strength, agility, and neuromuscular training exercises, which have been proven effective in lowering the incidence of these injuries (Arundale et al., 2023). However, the implementation of such programs is often lacking, primarily due to limited specific knowledge and the time required to correctly execute these exercises on the field (Owoeye et al., 2020).
Barriers to Prevention Implementation
The literature identifies several barriers to the effective implementation of ACL injury prevention programs. The most significant include:
- Lack of Knowledge: Many coaches and athletic trainers are not sufficiently informed about the effectiveness and importance of ACL injury prevention programs (Donaldson et al., 2017).
- Limited Time: The available training time is often insufficient to integrate prevention programs effectively, as they require regular and dedicated sessions (Whalan et al., 2019).
- Resistance to Change: Some coaches and athletes may be reluctant to adopt new programs or modify established training routines (Steffen et al., 2008).
Practical Recommendations for On-Field Prevention
To overcome these barriers and improve the implementation of ACL injury prevention programs, a practical and integrated approach is essential. Below are some useful recommendations for coaches and athletic trainers:
1. Education and Training
Investing in the continuous education of coaches and athletic trainers is crucial to improving awareness of prevention programs and their effective implementation (Mandelbaum et al., 2005). Continuing education courses and workshops can be valuable tools to enhance knowledge and awareness.
2. Gradual Integration
Introducing prevention exercises into existing training routines can help overcome resistance to change. For example, including balance and strength exercises during warm-up sessions can be an effective first step (Silvers-Granelli et al., 2017).
3. Specific and Adapted Programs
Using specific prevention programs, such as FIFA 11+ or Knäkontroll, which have been shown to be effective in different contexts, provides a structured approach that can be easily adapted to athletes’ specific needs (Grooms et al., 2013).
4. Monitoring and Feedback
Implementing a monitoring system to assess the effectiveness of prevention programs and provide feedback to athletes is essential. This can include periodic physical performance tests and athlete well-being questionnaires (Waldén et al., 2012).
5. Interdisciplinary Collaboration
Working closely with physiotherapists, sports doctors, and other healthcare professionals can enhance the effectiveness of prevention programs. An interdisciplinary approach ensures that all aspects of injury prevention are considered (Heidt et al., 2000).
A systematic review with meta-analysis (Petushek et al., 2019) confirmed the effectiveness of prevention programs, particularly in young female athletes, the group at highest risk. The most effective exercises include:
- Landing stabilization drills
- Lower limb strength exercises (such as Nordic Hamstring curls and forward lunges)
The study found better outcomes in adolescent athletes compared to university-level athletes.
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Conclusion
ACL injury prevention is essential for enhancing long-term athlete safety and performance. Despite the well-documented barriers to implementation, adopting a practical and integrated approach can help overcome them and promote the effective use of prevention programs.
It is crucial to continue educating and training coaches and athletic trainers, gradually integrating prevention exercises into training routines, using specific programs, and regularly monitoring progress.
Only through a coordinated effort can the incidence of ACL injuries be significantly reduced, ultimately improving athletes’ quality of life.
Table 1 (below) compares different prevention programs to provide insights into their potential implementation in practice.
| Program | Main Components | Session Duration | Frequency | Effectiveness (Risk Reduction) |
|---|---|---|---|---|
| FIFA 11+ | Warm-up, strength, balance, agility, plyometric exercises | 20 min | 2-3 times/week | High (Log HR = -1.23) |
| Knäkontroll | Strength, balance, neuromuscular control | 15 min | 2 times/week | High (Log HR = -0.76) |
| CORE | Trunk and lower limb exercises | 20 min | 3 times/week | Moderate (Log HR = -0.48) |
| PEP | Warm-up, strength, plyometrics, agility, stretching | <30 min | 3 times/week | Moderate (Log HR = -0.42) |
| Balance | Balance exercises | 10-15 min | 2-3 times/week | Low (Log HR = -0.23) |
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