Exercise-based knee and anterior cruciate ligament injury prevention

This guideline from the Academy of Orthopaedic Physical Therapy and the American Academy of Sports Physical Therapy, published in JOSPT in January 2023, updates the 2018 original with evidence published since then. It is written for physical therapists, athletic trainers, strength and conditioning professionals, coaches, athletes and parents.

It strongly recommends exercise-based knee injury prevention programs for athletes, especially young female athletes and soccer players, and names specific programs with supporting evidence. Programs should combine several components, such as strength, plyometrics and proximal control. They should run several times a week from preseason through the season, and balance training should not be the only component.

It recommends offering programs to all young athletes rather than only those screened as high risk, stresses high compliance, and supports delivery by coaches alone or together with medical staff. Neuromuscular training late in ACL reconstruction rehabilitation is listed as an option to help prevent a second injury.