Purpose: Anterior cruciate ligament (ACL) injury prevention programs have been shown to have mixed success in reducing injury rates, raising the question whether these programs are effectively targeting biomechanical mechanisms of injury. The current study examined the efficacy of a biomechanically informed ACL injury prevention training program in reducing injury risk and injury incidence and investigated its effect on athletic performance. Participants: Twenty-six elite female field hockey players participated in this study. Methods: Athletes participated in a 2-yr injury prevention training program. Injury incidence (i.e., lower limb and ACL) and athletic performance (i.e., strength, speed, and aerobic power) were measured during a control season and after two intervention seasons. Biomechanical ACL injury risk factors were recorded during unplanned sidestepping at baseline and after intensive (9 wk: 4 × 20 min·wk-1) and maintenance (16 wk: 3 × 10 min·wk-1) training phases for a subset of athletes (n = 17). Results: Training was effective in reducing ACL and lower limb injury incidence after the 2-yr program, where zero ACL injuries occurred after implementation (vs 0.4 per 1000 player hours in the control year). High-risk athletes reduced their peak knee valgus moments by 30% (P = 0.045) and demonstrated improvements in desirable muscle activation strategies after intensive training. The majority of benefits elicited in intensive training were retained during the maintenance phase. One-repetition max strength, beep test scores, and sprint times improved or were maintained over the 2-yr intervention period. Conclusions: Biomechanically informed injury prevention training was successful in reducing both biomechanical ACL injury risk factors and ACL injury incidence while maintaining and/or improving athletic performance. It is important to consider the biomechanical mechanisms of injury when designing injury prevention programs.
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