Current Concepts in Hip and Core Assessment to Reduce the Risk of ACL Injury

Area of Science:

• Sports Medicine
• Biomechanics
• Rehabilitation Science

Background:

• Hip and trunk (core) muscle dysfunction is a key factor in lower-limb biomechanics related to non-contact anterior cruciate ligament (ACL) injuries.
• Current clinical practices increasingly focus on core stability and control for injury prevention and post-operative rehabilitation.
• A comprehensive synthesis of core-directed strategies for ACL injury mitigation is lacking in the scientific literature.

Purpose of the Study:

• To synthesize current evidence on hip- and core-focused assessment strategies for mitigating ACL injury risk.
• To review rehabilitation strategies targeting hip and core muscles for ACL injury prevention.

Main Methods:

• A narrative literature search was conducted on PubMed and Google Scholar (January 2000 - April 2025).
• Studies included biomechanical, prospective, interventional, and return-to-sport research examining hip/trunk function and ACL injury risk or recovery.
• Findings were categorized into injury mechanisms, screening/return-to-play tests, and interventions, with attention to sex-specific data.

Main Results:

• Reduced hip abduction/extension strength and trunk neuromuscular control predict dynamic knee valgus and increased ACL strain.
• Functional and muscular assessments reliably identify high-risk athletes and post-ACL reconstruction (ACLR) patients.
• Neuromuscular programs focusing on hip and core strengthening reduce knee-ligament injury rates by 20-60% in youth, with greater effects in females. Early rehab incorporation improves outcomes.

Conclusions:

• Routine integration of hip and trunk assessment and strengthening is supported for ACL injury mitigation, rehabilitation, and return-to-play protocols.
• Future research should refine trunk-specific evaluation tools and establish optimal exercise parameters for different sexes and competition levels.