Neuromuscular training has a significant effect on reducing relative ACL injury risk in female athletes in high-risk landing and cutting sports like soccer, basketball, volleyball, and team handball. As many as 1 in 20 collegiate-level and 1 in 50 to 100 high school-level female athletes sustain an anterior cruciate ligament (ACL) injury during any given year of varsity sports.1,2 The answer to the posed rhetorical question "do ACL prevention programs actually reduce risk?" is neuromuscular training has a significant effect, from 24% to 82% reduction of relative ACL injury risk in female athletes in high-risk landing and cutting sports like soccer, basketball, volleyball, and team handball. Growth in female sports participation at a two- to ten-fold higher rate has led to a great gender inequity in ACL injury. The National Collegiate Athletic Association (NCAA) reported >150,000 female participants in varsity sports each year.3 The National Federation of State High School Associations (NFSHSA) reported >3.2 million female participants annually in high school sports programs.4 Based on these figures, >50,000 debilitating ACL injuries likely occur in female athletes at the high school and intercollegiate varsity levels during an average year. Most ACL injuries occur by noncontact mechanisms, during deceleration from a landing or making a lateral pivot.5 Neuromuscular training is effective in the reduction of ACL injury risk in females because females demonstrate 4 neuromuscular imbalances that may put them at greater risk of ACL injury than males and that may be ameliorated with neuromuscular training. These potentially correctable neuromuscular imbalances—ligament dominance (increased load on the knee joint), quadriceps dominance (decreased knee flexor recruitment and strength), leg dominance (increased leg-to-leg differences in muscle coordination and strength), and trunk dominance (increased motion of the body`s center of mass)—may decrease dynamic knee stability in females and lead to the gender bias in ACL injury risk.
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