Effects of knee injury primary prevention programs on anterior cruciate ligament injury rates in female athletes in different sports: a systematic review

Phys Ther Sport. 2014 Aug;15(3):200-10. doi: 10.1016/j.ptsp.2013.12.002. Epub 2013 Dec 19.


Background: Anterior Cruciate Ligament (ACL) injury is frequently encountered in sports.

Purpose: To analyze the effects of ACL injury prevention programs on injury rates in female athletes between different sports.

Methods: A comprehensive literature search was performed in September 2012 using Pubmed Central, Science Direct, CINAHL, PEDro, Cochrane Library, SCOPUS, SPORTDiscus. The key words used were: 'anterior cruciate ligament', 'ACL', 'knee joint', 'knee injuries', 'female', 'athletes', 'neuromuscular', 'training', 'prevention'. The inclusion criteria applied were: (1) ACL injury prevention training programs for female athletes; (2) Athlete-exposure data reporting; (3) Effect of training on ACL incidence rates for female athletes.

Results: 13 studies met the inclusion criteria. Three training programs in soccer and one in handball led to reduced ACL injury incidence. In basketball no effective training intervention was found. In season training was more effective than preseason in ACL injury prevention. A combination of strength training, plyometrics, balance training, technique monitoring with feedback, produced the most favorable results.

Conclusion: Comparing the main components of ACL injury prevention programs for female athletes, some sports-dependent training specificity issues may need addressing in future studies, related primarily to the individual biomechanics of each sport but also their most effective method of delivery.

Keywords: Basketball; Handball; Knee injury prevention; Neuromuscular training; Plyometrics; Soccer.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anterior Cruciate Ligament Injuries*
  • Athletes*
  • Athletic Injuries / epidemiology*
  • Athletic Injuries / prevention & control*
  • Female
  • Global Health
  • Humans
  • Incidence
  • Knee Injuries / epidemiology*
  • Knee Injuries / prevention & control*
  • Program Evaluation*