Approximately 100,000 ACL reconstructions are performed annually in the United States. Fortunately, many of these injuries can be prevented with a relatively simple exercise program. There have been many studies on this topic and the current literature has been summarized in Dr. Marx’s recent book, The ACL Solution: Prevention and Recovery for Sports’ Most Devastating Knee Injury. The key principles to ACL prevention exercises include strength and balance training as well as body position training. Strength includes lower extremity strength and also core strength through exercises such as bridges and planks. Balance training can be accomplished by standing on one leg and made more interesting by throwing a ball or using a racquet depending on one’s sport. Balance boards can also be used to train and other games can be created, such as trying to push a teammate off their balance board while standing on one. Position training involves learning safe body positions including knee-over-toe to avoid the valgus or “knock knee” position. Many studies over the last decade have shown that these exercises clearly reduce the risk of ACL injury. The better news is that they also reduce the risk of other injuries such as shin splints and ankle sprains.
One may ask why these programs to prevent ACL injuries aren’t being done by all athletes everywhere. The answer is that it takes time for knowledge to disseminate and that the programs are gradually being incorporated more and more. ACL prevention was recently featured on CNN. Many Division I female basketball and soccer teams have implemented these programs for their athletes because of the high risk nature of these sports. Some high schools are also implementing the programs and interest is gradually increasing as the knowledge spreads.
Unfortunately, participating in an ACL prevention program is not a guarantee that one will not get injured. Although the risk is reduced by approximately 50% (depending on which study you read), ACL injuries still occur. In those cases, we advocate for prompt medical care with early diagnosis and expert surgery and rehabilitation as appropriate. Hopefully, we will be seeing less ACL tears in our athletes in the future as prevention becomes more widespread.