How to Prevent ACL Tears in Student Athletes
How to Prevent ACL Tears in Student Athletes
By Eric Leach
An ACL tear, short for anterior cruciate ligament tear, is a common yet serious injury among student athletes in all sports. Typically requiring surgical reconstruction followed by a 9-12 month rehabilitation phase, ACL tears underscore the importance of injury prevention in athletic training.
The good news is that many ACL tears are preventable. Studies indicate that between 60-85% of ACL tears are non-contact injuries, occurring due to the athlete’s movement on the field rather than through direct contact with another player.
Understanding ACL Tears
Most non-contact ACL tears happen when an athlete plants their leg to change direction with their knee in a position called knee valgus, where the knee collapses inward towards the other knee. By training athletes to avoid this position, coaches can significantly reduce the incidence of ACL injuries.
Below: the position most athletes are injured
2. Evaluating Landing Technique
It is important to evaluate and teachlanding technique since most ACL injuries occur while the athlete is landing or decelerating. When teaching athletes to land from jumps, use cues such as “land softly,” “keep your knees over your toes,” and “bend your knees and hips.” Proper technique, as shown in the figure below, minimizes the risk of knee valgus during landing. You can use and review the “landing error score system” to learn about more advanced landing mechanics evaluations to spot poor movement patterns early.
The landing error score system: Padua DA, DiStefano LJ, Beutler AI, de la Motte SJ, DiStefano MJ, Marshall SW. The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury-Prevention Program in Elite-Youth Soccer Athletes. J Athl Train. 2015 Jun;50(6):589-95. doi: 10.4085/1062-6050-50.1.10. Epub 2015 Mar 26. PMID: 25811846; PMCID: PMC4527442.
Below, we can see an athlete demonstrating knee valgus when landing during this test, a warning sign that they are at an increased risk of injury.
The figure below shows what the feet and knees should look like when squatting and landing from a jump to prevent ACL injuries.
- Specific Exercises
Now that we have discussed the mechanics we want our athletes to train with, we can discuss specific exercises to help prevent ACL tears. Improving our athlete’s ability to decelerate and turn on a dime.
The sprinter step up has the athlete place one foot on a step. The athlete pushes upward, jumping off the step, and then lands back down with the working side before the contralateral leg touches down. This exercise focuses on the athlete’s landing mechanics, and attention should be focused on preventing knee valgus during the take off and landing phase. Perform for 3×6-10 reps
This drill has the athlete run forward 5 meters before their coach calls off a direction or color. This can also be made specific to a sport by having the athlete respond to an external cue like a soccer ball kick. The athlete should react to which side the stimulus is applied to an run another 5M through the gate. The coach should pay attention to how the athlete’s knee moves when changing direction. In the below image, A shows poor cutting technique, and B shows adequate cutting technique.
- T test
The T test involves the athlete running in a T while facing one direction, touching a cone at each turning point. This is an excellent example of a drill that both informs you of an athlete’s athletic performance and will demonstrate red flags if an athlete is moving poorly. During the first cone touch, a coach should be on the lookout for poor mechanics. In the image below, you can compare effective breaking mechanics and foot placement, and poor deceleration mechanics/ foot placement.
Proper deceleration mechanics (green) and improper (red).
- Monitoring and Progression
After identifying athletes at risk, focus on refining movement mechanics throughout the season. Progression should emphasize correct form during drills to improve on-field movement and reduce injury risk.
Conclusion
By implementing targeted interventions and emphasizing proper technique, coaches can significantly reduce ACL tears in athletes. This approach not only enhances performance but also keeps athletes safer and more effective on the field.
References
- Di Paolo, Stefano & Zaffagnini, Stefano & Tosarelli, Filippo & Aggio, Fabrizio & Bragonzoni, Laura & Grassi, Alberto & Della Villa, Francesco. (2021). A 2D qualitative movement assessment of a deceleration task detects football players with high knee joint loading. Knee Surgery, Sports Traumatology, Arthroscopy. 29. 10.1007/s00167-021-06709-2.
- Hanzlíková I, Hébert-Losier K. Is the Landing Error Scoring System Reliable and Valid? A Systematic Review. Sports Health. 2020 2020 Mar/Apr;12(2):181-8. PubMed PMID: 31961778. Epub 2020/01/21. eng.
- Kaeding CC, Léger-St-Jean B, Magnussen RA. Epidemiology and Diagnosis of Anterior Cruciate Ligament Injuries. Clin Sports Med. 2017 Jan;36(1):1-8. doi: 10.1016/j.csm.2016.08.001. Epub 2016 Oct 4. PMID: 27871652.
- Padua DA, DiStefano LJ, Hewett TE, Garrett WE, Marshall SW, Golden GM, Shultz SJ, Sigward SM. National Athletic Trainers’ Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. J Athl Train. 2018 Jan;53(1):5-19. doi: 10.4085/1062-6050-99-16. Epub 2018 Jan 9. PMID: 29314903; PMCID: PMC5800728.
- Padua DA, DiStefano LJ, Beutler AI, de la Motte SJ, DiStefano MJ, Marshall SW. The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury-Prevention Program in Elite-Youth Soccer Athletes. J Athl Train. 2015 Jun;50(6):589-95. doi: 10.4085/1062-6050-50.1.10. Epub 2015 Mar 26. PMID: 25811846; PMCID: PMC4527442.
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