Biomechanics of ACL Injuries: Why Prevention Programs Fail and How to Fix Them—A Systematic Review

Anterior cruciate ligament (ACL) injuries are considered to be one of the most disabling and expensive musculoskeletal injuries, especially among athletic groups. After decades of study and the proliferation of prevention programs, injury rates have not dropped to an acceptable level. This systematic review critically examines the biomechanical basis of ACL injury and raises questions about the limitations of current prevention measures. It states that most programs implement a one-size-fits-all model, which does not consider the biomechanical uniqueness of individuals, the needs of the sports, and the differences between the sexes in terms of neuromuscular control. Moreover, protocols cannot accurately identify high-risk movement patterns or strengthen long-term neuromotor adaptations. The systematic review synthesizes the most relevant evidence from biomechanical analyses, motion capture research, and randomized interventions to highlight the physiological aspects of injury and the systemic shortcomings of modern preventive work. Lastly, it provides evidence-based suggestions to maximize program effectiveness, including personalized risk profiling, real-time biofeedback, the incorporation of wearable devices, and AI-powered movement detection. It is essential to reduce the gap between laboratory evidence and on-field implementation. Injury rates are unlikely to drop if prevention activities remain at the level of generic protocols and do not acquire biomechanical sophistication. This article provides an outline and guidelines for reengineering ACL prevention strategies based on dynamic and athlete-centered biomechanical science.