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Preventing an Anterior Cruciate Ligament Injury

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The anterior cruciate ligament (ACL) plays a pivotal role in preventing your shin bone (tibia) from moving forwards with respect to your thigh bone (femur). Tears of the ACL are commonly seen in pivoting sports such as football, and can take as long as 6-12 months for a complete return to competitive sport. More significantly, a third of players are unable to return to pre-injury levels of competition two years after ACL reconstruction surgery. It is for this reason that it's worthwhile taking measures to prevent an ACL injury.


Most (60-80%) of ACL injuries occur in non-contact situations, namely during a cutting manoeuvre and during one leg landing. Therefore it's sensible to be aware of unfavourable lower leg positions where the knee collapses inward with respect to the hip and foot. This position is commonly referred to by researchers as the 'point of no return' or the 'injury prone position'. Players should instead adopt the 'position of safety' where the knee is flexed but is kept straight with respect to the hip and foot. Both of these positions are outlined in figures 2 and 3 below.

point-of-no-return diag

ACL injuries can also be prevented by implementing an effective warm up program prior to training and games. Julie Gilchrist and a group of researchers in the United States investigated the effect of implementing a program consisting of warming up, stretching, strengthening, plyometric and sports specific agility training on 1435 female college soccer players on preventing ACL injuries. They found there to be a 70% decrease in non-contact ACL injuries and a 41% decrease in ACL injuries overall during the winter season. Their program titled 'Prevent Injury and Enhance Performance Program' or 'PEP' for short is outlined below in Figure 3. It should be ideally employed 2-3 times per week during your footy season. It is similarly utilised following ACL repairs and reconstructions by Dr Leo Pinczewski and Dr Justin Roe, two leading Orthopaedic Surgeons who consult out of Hills Street Sports Medicine and Rehabilitation Centre.

By Don Denagamage - Physiotherapist



Brukner, P & Khan,K. (2009). Clinical Sports Medicine North Ryde, NSW: McGraw Hill
Gilchrist, J et al. (2008). A randomized controlled trial to prevent noncontact anterior cruciate ligament injury in female collegiate soccer players. American Journal of Sports Medicine, 36(8), 1476 - 83


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