A Secondary Injury Prevention Program May Decrease Contralateral Anterior Cruciate Ligament Injuries in Female Athletes: 2-Year Injury Rates in the ACL-SPORTS Randomized Controlled Trial

J Orthop Sports Phys Ther. 2020 Sep;50(9):523-530. doi: 10.2519/jospt.2020.9407. Epub 2020 Aug 1.


Objective: To determine whether the addition of perturbation training to a secondary injury prevention program reduces the rate of second anterior cruciate ligament (ACL) injury compared to the prevention program alone.

Design: Single-blinded randomized controlled trial.

Methods: Thirty-nine female athletes who intended to return to cutting/pivoting sports were enrolled 3 to 9 months after primary anterior cruciate ligament reconstruction (ACLR). Athletes were randomized to receive a training program of either progressive strengthening, agility, plyometrics, and prevention (SAPP) (n = 20) or SAPP plus perturbation training (n = 19); each had 10 sessions over 5 weeks. Occurrence and side of second ACL injury were recorded for 2 years after primary ACLR.

Results: There were 9 second ACL injuries in the 2 years after ACLR. There was no statistically significant difference in rate or side of second ACL injury between the SAPP-plus-perturbation training and SAPP groups.

Conclusion: Adding perturbation training to a secondary ACL injury prevention program did not affect the rate of second ACL injury in female athletes. J Orthop Sports Phys Ther 2020;50(9):523-530. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9407.

Keywords: ACL; female athletes; perturbation; return to sport; secondary injury prevention; young athletes.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament Injuries / prevention & control*
  • Anterior Cruciate Ligament Injuries / surgery
  • Anterior Cruciate Ligament Reconstruction
  • Athletic Injuries / prevention & control*
  • Athletic Injuries / surgery
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Middle Aged
  • Resistance Training / methods*
  • Return to Sport
  • Secondary Prevention*
  • Single-Blind Method
  • Young Adult