Anterior cruciate ligament injury prevention: who is responsible for implementation and what are the challenges?

The incidence of anterior cruciate ligament (ACL) injuries is increasing in the UK, with a particularly sharp increase among young female athletes participating in sport. ACL injuries result in significant morbidity, with a profound impact on the physical, mental and social health of individuals, alongside lengthy rehabilitation. Therefore, primary prevention of ACL injuries is desirable. The intrinsic and extrinsic risk factors associated with ACL injury, such as deficits in neuromuscular control, impaired movement quality, fatigue, strength imbalances, and suboptimal load management, are shared with a spectrum of other lower-limb musculoskeletal injuries. This overlap supports the concept that ACL injury prevention may not be best considered a condition-specific endeavour, but rather as a component of a comprehensive lower-limb injury prevention strategy. ACL prevention interventions typically include multi-component training methods designed to improve neuromuscular control, functional performance, balance, strength and power. while often framed around ACL injury reduction, their effects extend beyond the knee, conveying protection against other lower-limb injuries and improving overall performance. Despite a growing body of evidence demonstrating the efficacy of neuromuscular injury prevention programmes, their translation into routine practice has been inconsistent. This annotation outlines the current best evidence relating to ACL injury epidemiology and the effectiveness of injury prevention strategies, supporting a transition to integrate ACL injury prevention into wider, sport-specific lower-limb injury prevention programmes. In doing so, it highlights key stakeholders and barriers relevant to large-scale implementation of injury prevention programmes.