Anterior cruciate ligament injury prevention training in athletes

Introduction: After reconstruction, the return to full competition rate of athletes was low, while the re-injury rate remains high despite the completion of a rehabilitation programme. Primary anterior cruciate ligament (ACL) injury prevention programmes are well developed, yet few research papers focus on secondary ACL injury prevention. This study is to determine if current secondary ACL injury prevention training has a positive influence on the re-injury rate, the clinical or functional outcomes, or the risk of re-injury in athletes.

Methods: Studies investigating secondary prevention of ACL injury were searched in PubMed and EBSCOhost, followed by a review of the references in the identified articles. Inclusion criteria included randomised trials, English-language studies, contain secondary prevention training for athletes who had undergone a unilateral ACL reconstruction (ACLR) and have completed rehabilitation, and the effects of training reported.

Results: All studies investigated the effectiveness of secondary prevention in modifying the risk factors of re-injury rather than the re-injury rates. The effectiveness of secondary prevention in modifying the risk factors of ACL re-injury in athletes is controversial (4 in favour, 5 against). The existing evidence is prone to suggest neuromuscular training, eccentric strengthening, and plyometric exercises may have a positive impact on the biomechanical, functional, and psychological outcomes in athletes, while secondary prevention programmes may be ineffective in influencing gait asymmetries.

Discussion and Conclusion: Literature available regarding secondary prevention of ACL injury in athletes is scarce and not conclusive. Future research is needed to investigate the effectiveness of secondary ACL injury prevention in reducing the re-injury rates.