ACL injury prevention programs due to intrinsic and modifiable risk factors in female Athletes

Epidemiological studies have shown that female athletes are vulnerable to ACL injuries 2 to 10 times more than male athletes. Neuromuscular and biomechanical factors in anterior cruciate ligament injuries are among modifiable risk factors. The high cost of treatment, increasing the potential loss of the competitive season and long-term disability and secondary damage have made the application of injury prevention programs more prominent. In this literature review, related research regarding modifiable risk factors and ACL injury prevention training was studied. To identify the research, databases such as Medline Pubmed, Science Direct, SPORTDiscuss and SCOPUS using the keywords "ACL", "Knee injuries", "modifiable risk factors", "neuromuscular risk factor", "biomechanical risk factor", "training prevention program " were used. Finally, 8500 studies were identified. After exclusion of non-English, duplicated, similar indexed studies, animal studies, studies with injured subjects, studies focused on clinical treatment, and studies without any intervention, 60 articles remained eligible for studying. Weakness and imbalance of the trunk and lower limb neuromuscular control increase prevalence of ACL injuries in female. Prevention training was categorized in two levels with the aim to modify the risk factors and reduce the rate of ACL injury. Majority of the effective intervention training exercises are multilateral program for at least 6 weeks in advance of the season and continued throughout the season with a repetition of at least once or twice a week with a trainer in the practice. Identifying neuromuscular imbalance can be used for screening the athletes at risk and designing the intervention training. However, a standard program aimed at preventing for a specific sport has not been introduced, yet.