In a recent motion-analysis lab study testing the FIFA 11+ , preadolescent athletes demonstrated some (but not complete) improvement in peak valgus moments and other biomechanical factors associated with the risk of ACL injury after implementation of the program—suggesting that there is room to improve and still much to learn about how these prevention programs exert their protective effects.
Strategies for implementing prevention programs need to be planned or augmented at all levels and ages, and identifying the best implementation personnel will be important. Coaches may be the best instigators of implementation . In fact, Switzerland successfully implemented a country-wide FIFA 11+ program for their amateur soccer leagues through a large-scale coaching education campaign . Additionally, a randomized control study of FIFA 11+ implementation strategies identified preseason coaching workshops to be an effective method for implementation and adherence to the program [1, 5].
A better understanding of the gaps in knowledge regarding prevention programs is needed. For example, the role of the sports medicine surgeon and nonoperative sports providers in increasing participation in these types of programs is not well-defined. Often, surgeons are not on the front lines of prevention strategies, as their first encounter with the athlete is after an ACL injury. Yet, these specialists are relied upon by patients, parents, coaches, and athletic trainers for valuable input at all points in the process.
The facilitators and barriers to greater implementation of ACL injury prevention programs need to be further studied. Increased marketing to athletes and parents, as well as further education across the board for physicians, therapists, and trainers could potentially increase athlete participation and adherence to ACL injury prevention programs.
As broader implementation and acceptance is sought, we, as a sports medicine community (physicians, therapists, trainers), must decide which program to use and whether a consensus can be forged around a single prevention program. The existence of numerous programs may be a barrier to implementation, while a single program would help streamline its delivery to players and coaches while facilitating consistency of future research.