Anterior cruciate ligament (ACL) injuries are prevalent in sports with a high chance of re-injury. ACL prevention programs have demonstrated inconsistent results, which may be attributed to different training methodologies. The purpose of this review was to examine the efficacy of ACL prevention programs based on the employed training methodologies and to present an evidence-based approach to reduce the likelihood of such injuries. The methodology included searches for specific information relating to ACL injuries and ACL prevention, utilising peer-reviewed articles relating to ACL injury etiology and ACL prevention. The main findings were that a systematic and progressive strength training regime for the lower extremities and proximal control exercises demonstrated the most effective approach to reduce the likelihood of ACL injury. Incorporating plyometric exercises into the prevention program had little additional benefit. However, the underlying adaptations associated with a progressive plyometric training may still be of value with regards to ACL injury reduction. The use of balance exercises on unstable surfaces had little to no positive effects. Dynamic balance exercises on stable surfaces are more specific to on-field demands and offer a higher degree of transfer towards time constrained joint stabilising actions. Based on the current evidence, the practitioner is recommended to implement an appropriately progressed ACL injury reduction program with methods to increase lower body strength qualities, proximal control/trunk stability and dynamic stability in high velocity movements.
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