Skip to main content

ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program

Current Reviews in Musculoskeletal Medicine volume 6, pages 158–163 (2013)Cite this article

Abstract

Female athletes are at 3.5 times risk of sustaining a non-contact ACL injury compared with males. Research has shown that this gender discrepancy results from differences in neuromuscular adaptations and biomechanics related to landing techniques. Studies have examined the preventative effect of ACL prevention programs, which have been designed to address these risky neuromuscular and biomechanical patterns. We review the key studies on ACL prevention in female athletes and summarize the critical components of ACL prevention strategies that have been shown to successfully decrease ACL injury risk. We also discuss recommendations and practical considerations in the implementation of ACL prevention programs in various community settings.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance∙

  1. Ireland ML. The female ACL: why is it more prone to injury? Orthoped Clin N Am. 2002;33:637–51.

    Article  Google Scholar 

  2. Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. J Athletic Training. 1999;34:86–92.

    CAS  Google Scholar 

  3. Lohmander LS, Ostenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. 2004;50:3145–52.

    PubMed  CAS  Article  Google Scholar 

  4. Boden BP, Griffin LY, Garrett Jr WE. Etiology and prevention of noncontact ACL injury. Phys Sportsmed. 2000;8:53–60.

    Google Scholar 

  5. Agel J, Olson DE, Dick R, et al. Descriptive epidemiology of collegiate women's basketball injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004. J Athletic Training. 2007;42:202–10.

    Google Scholar 

  6. Shimokochi Y, Shultz SJ. Mechanisms of noncontact anterior cruciate ligament injury. J Athletic Training. 2008;43:396–408.

    Article  Google Scholar 

  7. Huston LJ, Wojtys EM. Neuromuscular performance characteristics in elite female athletes. Am J Sports Med. 1996;24:427–36.

    PubMed  CAS  Article  Google Scholar 

  8. Chappell JD, Yu B, Kirkendall DT, Garrett WE. A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. Am J Sports Med. 2002;30:261–7.

    PubMed  Google Scholar 

  9. Hewett TE, Myer GD, Ford KR, et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33:492–501.

    PubMed  Article  Google Scholar 

  10. Barber-Westin SD, Noyes FR, Smith ST, Campbell TM. Reducing the risk of noncontact anterior cruciate ligament injuries in the female athlete. Phys Sportsmed. 2009;37:49–61.

    PubMed  Article  Google Scholar 

  11. • Renstrom P, Ljungqvist A, Arendt E, et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. 2008;42:394–412. Summary of research and recommended guidelines regarding ACL prevention by the International Olympic Committee.

    PubMed  CAS  Article  Google Scholar 

  12. Malinzak RA, Colby SM, Kirkendall DT, et al. A comparison of knee joint motion patterns between men and women in selected athletic tasks. Clin Biomech. 2001;16:438–45.

    CAS  Article  Google Scholar 

  13. Caraffa A, Cerulli G, Projetti M, et al. Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthroscopy. 1996;4:19–21.

    CAS  Article  Google Scholar 

  14. Soderman K, Werner S, Pietilla T, et al. Balance board training: prevention of traumatic injuries of the lower extremities in female soccer players? A prospective randomized intervention study. Knee Surg Sports Traumatol Arthroscopy. 2000;8:356–63.

    CAS  Article  Google Scholar 

  15. Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med. 1999;27:699–706.

    PubMed  CAS  Google Scholar 

  16. Myklebust G, Engebretsen L, Braekken IH, et al. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over 3 seasons. Clin J Sport Med. 2003;13:71–8.

    PubMed  Article  Google Scholar 

  17. Mandelbaum BR, Silvers HJ, Watanabe DS, et al. Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2-year follow-up. Am J Sports Med. 2005;33:1003–10.

    PubMed  Article  Google Scholar 

  18. Gilchrist J, Mandelbaum BR, Melancon H, et al. A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. Am J Sports Med. 2008;36:1476–83.

    PubMed  Article  Google Scholar 

  19. LaBella CR, Huxford MR, Grissom J, et al. Effect of neuromuscular warm-up on injuries in female soccer and basketball athletes in urban public high schools: cluster randomized controlled trial. Arch Pediatr Adolesc Med. 2011;165:1033–40.

    PubMed  Article  Google Scholar 

  20. Myer GD, Chu DA, Brent JL, Hewett TE. Trunk and hip control neuromuscular training for the prevention of knee joint injury. Clin Sports Med. 2008;27:425–48. ix.

    PubMed  Article  Google Scholar 

  21. Noyes FR, Barber-Westin SD. Anterior cruciate ligament injury prevention training in female athletes: a systematic review of injury reduction and results of athletic performance tests. Sports Health. 2012;4:36–46.

    PubMed  Article  Google Scholar 

  22. Noyes FR, Barber-Westin SD, Smith ST, et al. A training program to improve neuromuscular and performance indices in female high school basketball players. J Strength Conditioning Res. 2012;26:709–19.

    Google Scholar 

  23. Myer GD, Ford KR, Palumbo JP, Hewett TE. Neuromuscular training improves performance and lower-extremity biomechanics in female athletes. J Strength Conditioning Res. 2005;19:51–60.

    Google Scholar 

  24. Barber-Westin SD, Smith ST, Campbell T, Noyes FR. The drop-jump video screening test: retention of improvement in neuromuscular control in female volleyball players. J Strength Conditioning Res. 2010;24:3055–62.

    Article  Google Scholar 

  25. • Sugimoto D, Myer GD, McKeon JM, Hewett TE. Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses. Br J Sports Med. 2012;46:979–88. An analysis of ACL prevention programs with calculations for number needed to treat and relative risk reduction for each program as well as pooled data.

    PubMed  Article  Google Scholar 

Download references

Disclosure

No potential conflict of interest relevant to this article was reported.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California San Diego, 350 Dickinson St., #121, San Diego, CA, 92103-8894, USA

    Natalie Voskanian

Authors
  1. Natalie Voskanian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Natalie Voskanian.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Voskanian, N. ACL Injury prevention in female athletes: review of the literature and practical considerations in implementing an ACL prevention program. Curr Rev Musculoskelet Med 6, 158–163 (2013). https://doi.org/10.1007/s12178-013-9158-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-013-9158-y

Keywords

  • ACL
  • ACL prevention
  • ACL injury
  • Injury
  • Knee Injury
  • Injury prevention
  • Non-contact
  • Anterior cruciate ligament
  • Prevention program
  • Female athletes
  • Females
  • Neuromuscular
  • Landing
  • Plyometrics
  • Injury risk
  • Athletes
  • Sports
  • Soccer
  • Basketball
  • Volleyball
  • Knee valgus
  • Hamstring recruitment
  • Prevention training
  • Biomechanics
  • Practical