A Systematic Review and Meta-analysis of Anterior Cruciate Ligament Injury Prevention Programs: Training to Stay in the Game

BACKGROUND: Approximately 400,000 anterior cruciate ligament (ACL) reconstructions are performed each year in the United States. Effective ACL injury prevention programs may be paramount in reducing this significant injury burden. PURPOSE: To determine the effectiveness of ACL injury prevention programs and generate updated guidelines to protect athletes from these injuries. STUDY DESIGN: Meta-analysis, Level of evidence, 2. METHODS: The Embase, PubMed, and Ovid (MEDLINE) databases were searched in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies focused on ACL injury prevention as opposed to treatment and provided data on ACL injury rates after intervention implementation. Using random-effects models, the authors generated the pooled risk ratio (RR) for all data and female-only data, 85% female) played handball, soccer, basketball, or volleyball. All interventions were studied for a minimum of 1 season (mean, 1.3 ± 0.59). Athletes who participated in an ACL injury prevention program were significantly less likely to sustain an ACL rupture with a pooled RR of 0.46 (95% CI, 0.36-0.57). When analyzed by age, there was a significant risk reduction in ACL rupture for both athletes