Neuromuscular and proprioceptive training programs can decrease noncontact anterior cruciate ligament injuries; however, they may be difficult to implement within an entire team or the community at large. Hypothesis: A simple on-field alternative warm-up program can reduce noncontact ACL injuries. Study Design: Randomized controlled trial (clustered); Level of evidence, 1. Methods: Participating National Collegiate Athletic Association Division I women`s soccer teams were assigned randomly to intervention or control groups. Intervention teams were asked to perform the program 3 times per week during the fall 2002 season. All teams reported athletes` participation in games and practices and any knee injuries. Injury rates were calculated based on athlete exposures, expressed as rate per 1000 athlete exposures. A z statistic was used for rate ratio comparisons. Results: Sixty-one teams with 1435 athletes completed the study (852 control athletes; 583 intervention). The overall anterior cruciate ligament injury rate among intervention athletes was 1.7 times less than in control athletes (0.199 vs 0.340; P = .198; 41% decrease). Noncontact anterior cruciate ligament injury rate among intervention athletes was 3.3 times less than in control athletes (0.057 vs 0.189; P = .066; 70% decrease). No anterior cruciate ligament injuries occurred among intervention athletes during practice versus 6 among control athletes (P = .014). Game-related noncontact anterior cruciate ligament injury rates in intervention athletes were reduced by more than half (0.233 vs 0.564; P = .218). Intervention athletes with a history of anterior cruciate ligament injury were significantly less likely to suffer another anterior cruciate ligament injury compared with control athletes with a similar history (P = .046 for noncontact injuries). Conclusion: This program, which focuses on neuromuscular control, appears to reduce the risk of anterior cruciate ligament injuries in collegiate female soccer players, especially those with a history of anterior cruciate ligament injury.
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