Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention

Publication Date: August 31, 2018
Last Updated: March 14, 2022

Summary of Recommendations

REVIEW THE EVIDENCE IN THE SCIENTIFIC LITERATURE FOR EXERCISE-BASED KNEE INJURY PREVENTION PROGRAMS

Clinicians should recommend use of exercise-based knee injury prevention programs in athletes for the prevention of knee and anterior cruciate ligament (ACL) injuries.* (A)
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IDENTIFY EXERCISE-BASED KNEE INJURY PREVENTION PROGRAMS THAT ARE EFFECTIVE FOR SPECIFIC SUBGROUPS OF ATHLETES

Clinicians, coaches, parents, and athletes should implement exercise-based knee injury prevention programs prior to athletic training sessions/practices or games in female athletes to reduce the risk of ACL injuries, especially in female athletes younger than 18 years of age.* (A)
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Soccer players, especially women, should use exercise-based knee injury prevention programs to reduce the risk of severe knee and ACL injuries.* (A)
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Male and female team handball players, particularly those 15 to 17 years of age, should implement exercise-based knee injury prevention programs.* (B)
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* See full text Guideline for references.

DESCRIBE THE EVIDENCE FOR COMPONENTS, DOSAGE, AND DELIVERY OF EXERCISE-BASED KNEE INJURY PREVENTION PROGRAMS

Exercise-based knee injury prevention programs used for women should incorporate multiple components, proximal control exercises, and a combination of strength and plyometric exercises. (A)
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Exercise-based knee injury prevention programs should involve training multiple times per week, training sessions that last longer than 20 minutes, and training volumes that are longer than 30 minutes per week. (A)
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Clinicians, coaches, parents, and athletes should start exercise-based knee injury prevention programs in the preseason and continue performing the program through the regular season. (A)
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Clinicians, coaches, parents, and athletes must ensure high compliance with exercise-based knee injury prevention programs, particularly in female athletes. (A)
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Exercise-based knee injury prevention programs may not need to incorporate balance exercises, and balance should not be the sole component of a program. (B)
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PROVIDE SUGGESTIONS FOR IMPLEMENTATION OF EXERCISE-BASED KNEE INJURY PREVENTION PROGRAMS

Clinicians, coaches, parents, and athletes should implement exercise-based knee injury prevention programs in all young athletes, not just those athletes identified through screening as being at high risk for ACL injury, to optimize the numbers needed to treat while reducing cost. (A)
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For the greatest reduction in future medical costs and prevention of ACL injuries, osteoarthritis, and total knee replacements, clinicians, coaches, parents, and athletes should encourage implementation of exercise-based ACL injury prevention programs in athletes 12 to 25 years of age and involved in sports with a high risk of ACL injury. (A)
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Clinicians, coaches, parents, and athletes should support implementation of exercise-based knee injury prevention programs led by either coaches or a group of coaches and medical professionals. (B)
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Recommendation Grading

Overview

Title

Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention

Authoring Organization

Publication Month/Year

August 31, 2018

Last Updated Month/Year

January 23, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Describe evidence-based practice, including diagnosis, prognosis, intervention, and assessments of outcomes for musculoskeletal disorders. Classify and define common musculoskeletal conditions using the World Health Organization's terminology related to impairments of body function and body structure, activity limitations, and participation restrictions. Identify interventions supported by current best evidence to address impairments of body function and structure, activity limitations, and participation restrictions associated with common musculoskeletal conditions. Identify appropriate outcome measures to assess changes resulting from physical therapy interventions in body function and structure as well as in activity and participation of the individual. Provide a description to policy makers, using internationally accepted terminology, of the practice of orthopaedic physical therapists and hand rehabilitation. Provide information for payers and claims reviewers regarding the practice of orthopaedic and hand therapy for common musculoskeletal conditions. Create a reference publication for clinicians, academic instructors, clinical instructors, students, interns, residents, and fellows regarding the best current practice of orthopaedic physical therapy and hand rehabilitation

Inclusion Criteria

Male, Female, Adolescent, Adult

Health Care Settings

Ambulatory, Emergency care, Home health, Hospital, Long term care, Outpatient, School, Operating and recovery room

Intended Users

Athletics coaching, occupational therapist, physical therapist, nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Treatment, Management, Prevention, Rehabilitation

Diseases/Conditions (MeSH)

D007718 - Knee Injuries, D000070598 - Anterior Cruciate Ligament Injuries, D020497 - Problems and Exercises

Keywords

Exercise-Based Prevention, knee injury, exercise pain, ACL injury

Methodology

Number of Source Documents
149
Literature Search Start Date
March 1, 2015
Literature Search End Date
October 1, 2017