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J Bone Joint Surg Am. 2014 May 7;96(9):705-11. doi: 10.2106/JBJS.M.00560.

Prevention and screening programs for anterior cruciate ligament injuries in young athletes: a cost-effectiveness analysis.

Author information

  • 1Columbia University Medical Center, 622 West 168th Street, PH-1130, New York, NY 10032. E-mail address for E. Swart:
  • 2Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.
  • 3Santa Monica Orthopaedic Sports Medicine and Research Foundation, 1301 Twentieth Street, Suite 150, Santa Monica, CA 90404.
  • 4Department of Health Policy and Management, Columbia Mailman School of Public Health, 600 West 168th Street, 6th Floor, New York, NY 10032.



Anterior cruciate ligament (ACL) injuries are common among young athletes. Biomechanical studies have led to the development of training programs to improve neuromuscular control and reduce ACL injury rates as well as screening tools to identify athletes at higher risk for ACL injury. The purpose of this study was to evaluate the cost-effectiveness of these training methods and screening strategies for preventing ACL injuries.


A decision-analysis model was created to evaluate three strategies for a population of young athletes participating in organized sports: (1) no training or screening, (2) universal neuromuscular training, and (3) universal screening, with neuromuscular training for identified high-risk athletes only. Risk of injury, risk reduction from training, and sensitivity and specificity of screening were based on published data from clinical trials. Costs of training and screening programs were estimated on the basis of the literature. Sensitivity analyses were performed on key model parameters to evaluate their effect on base case conclusions.


Universal neuromuscular training of all athletes was the dominant strategy, with better outcomes and lower costs compared with screening. On average, the implementation of a universal training program would save $100 per player per season, and would reduce the incidence of ACL injury from 3% to 1.1% per season. Screening was not cost-effective within the range of reported sensitivity and specificity values.


Given its low cost and ease of implementation, neuromuscular training of all young athletes represents a cost-effective strategy for reducing costs and morbidity from ACL injuries. While continued innovations on inexpensive and accurate screening methods to identify high-risk athletes remain of interest, improving existing training protocols and implementing neuromuscular training into routine training for all young athletes is warranted.

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