Anterior cruciate ligament (ACL) is the most commonly injured knee ligament in sports-related activities, especially in pivoting sports. In general, knee joint movements about the off-axes are much more limited and musculoskeletal injuries are usually associated with excessive loading/movement about the off-axes. The purposes of this project were to develop an injury prevention program including a pivoting elliptical exercise machine to address the specific ACL injury mechanisms, especially in women. ACL injury prevention training was carried out to target the specific injury mechanisms associated with tibial rotation. The pivoting elliptical training improved the off-axis neuromuscular control considerably. Training-induced neuromuscular changes in tibial rotation were assessed with multiple outcome measures.