THE FUTURE IS HYBRID: COMBINED APPROACHES YIELD BEST RESULTS IN ANTERIOR CRUCIATE LIGAMENT INJURY PREVENTION

N.G. Biavardi¹ , G. Placella¹ , F. Pezone² , M. Alessio-Mazzola² , G. Cerulli³ , V. Salini¹

¹ Vita-Salute University, IRCCS San Raffaele Hospital, Milan, Italy
² IRCCS San Raffaele Hospital, Milan, Italy
³ Catholic University of the Sacred Heart, Rome, Italy

Correspondence to:

Journal of Orthopedics 2025 September-December; 17(3): 133-145
https://doi.org/10.69149/orthopedics/2025v17iss3_9

Received: 3 October 2025 Accepted: 3 November 2025

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Abstract

Anterior cruciate ligament (ACL) injuries represent a significant challenge in sports medicine, with an estimated incidence of 0.07 per 1000 player-hours and an annual economic burden exceeding S2 billion in the United States alone. This narrative review examines current prevention mechanisms and emerging technologies in ACL injury prevention. We analyzed traditional prevention approaches, including strength training and proprioceptive exercises, which have demonstrated significant efficacy, resulting in a reduction of up to 72% in injury rates among female athletes. The review also explores the integration of artificial intelligence and wearable technology in injury prevention, including inertial measurement units (IMUs) and motion capture systems for real-time biomechanical analysis. Economic analysis reveals compelling cost-effectiveness, with prevention programs averaging $166 per injury prevented compared to $11,768 per surgical reconstruction. Risk factors were categorized as intrinsic (HR: 1.2-2.6), extrinsic (HR: 1.3-2.0), and sport-specific (HR: 2.0-6.8), highlighting the multifactorial nature of ACL injuries. While technological advances offer promising solutions for personalized risk assessment and prevention, implementation challenges include cost barriers and integration complexities. Future directions should focus on developing accessible technological solutions, conducting longitudinal studies on combined prevention approaches, and creating population-specific interventions. This review suggests that optimal ACL injury prevention requires the successful integration of traditional mechanisms with emerging technologies while ensuring accessibility across all levels of sport.

Keywords: ACL, AI, cruciate, disabilities, ligament injuries, sports medicine