Do ACL injury prevention programs work?
ACL injury prevention programs were linked to about half the ACL rupture risk (pooled RR 0.46) in a 2026 meta-analysis of 25,166 athletes. What it shows.
In a 2026 meta-analysis of 25,166 athletes, taking part in an ACL injury prevention program was associated with roughly half the risk of ACL rupture (pooled risk ratio 0.46, 95% CI 0.36 to 0.57). Nine of the 18 pooled studies were randomised trials and nine were prospective cohort studies, so the estimate mixes study designs.
What did the meta-analysis of ACL prevention programs find?
Watson et al., American Journal of Sports Medicine 2026 pooled 18 studies of athletes in handball, soccer, basketball and volleyball. The mean age was 19.3 years, and more than 85% of participants were female.
The risk ratio was 0.35 (95% CI 0.22 to 0.55) under age 18 and 0.50 (0.38 to 0.64) at 18 and over. By sport it was 0.30 (0.19 to 0.46) in soccer and 0.66 (0.46 to 0.96) in handball.
These are relative figures. How many ruptures a program avoids depends on how common ACL injury is in a given group, and cohort studies cannot rule out that teams adopting a program differ in other ways. Strength work aimed at running economy is covered in our post on how to improve your running.
Does the training dose or adherence matter?
Gu et al., Frontiers in Public Health 2026 restricted the question to randomised trials in female team-sport athletes: 13 trials and 13,675 players. Six trials contributed to the ACL analysis, which gave a risk ratio of 0.62 (95% CI 0.43 to 0.89), a smaller effect than the pooled 0.46 above.
The same review looked at dose for overall injury, not ACL injury alone. Programs delivering 51 to 120 minutes a week had a risk ratio of 0.48 versus 0.80 for 1 to 50 minutes. Trials with adherence of 75% or more had a ratio of 0.55, versus 0.93 for lower adherence.
The authors describe these as exploratory signals rather than definitive thresholds, and rated the certainty of evidence for overall injury as low. The dose and adherence figures come from comparing trials that differed in dose and adherence, so they are not a controlled test of either.
The bottom line
- Across 18 studies and 25,166 athletes, ACL injury prevention programs were associated with a pooled ACL rupture risk ratio of 0.46 (95% CI 0.36 to 0.57).
- In six randomised trials of female team-sport athletes the ACL risk ratio was 0.62 (95% CI 0.43 to 0.89).
- Signals on weekly minutes and adherence of 75% or more are exploratory and rest on low-certainty evidence for overall injury.
Frequently asked questions
- Do injury prevention programs reduce ACL tears?
- In pooled data they were associated with fewer ACL ruptures: a risk ratio of 0.46 across 18 studies and 0.62 across six randomised trials in female team-sport athletes. Both figures are relative, so the number of ruptures avoided depends on how common ACL injury is in the group studied.
- Do ACL prevention programs work the same in every sport?
- Not necessarily. In Watson et al. the risk ratio was 0.30 in soccer and 0.66 in handball, and most participants were female. The review covered four team sports, so it says little about other sports or about mostly male groups.
Sources
- Watson SL, Gohal C, Owen MM, Bajaj PM, Plantz MA, Tjong VK, 2026. A Systematic Review and Meta-analysis of Anterior Cruciate Ligament Injury Prevention Programs: Training to Stay in the Game. American Journal of Sports Medicine 54(3):733-740.
- Gu J, Li Y, Deng H, Qi Y, Xiao L, Zhang R, 2026. Effectiveness of injury prevention programmes in female team sports: a systematic review and meta-analysis of hierarchical injury outcomes, training dose-response relationships, and adherence. Frontiers in Public Health 14, article 1950998.