Prevalence of ACL Injury Prevention Protocols in Girls' High School Athletics: A Metro Detroit Survey Study With Socioeconomic Analysis.

BACKGROUND: Female athletes sustain anterior cruciate ligament (ACL) injuries at higher rates than male athletes, particularly in pivoting sports. Although neuromuscular prevention programs reduce ACL injury risk, implementation of these programs in high school athletics remains inconsistent. PURPOSE: To determine the prevalence of ACL injury prevention protocols (IPPs) in girls' high school athletics in Metro Detroit and evaluate whether socioeconomic status (SES), school type, and access to athletic trainers (ATs) are associated with implementation. STUDY DESIGN: Cross-sectional study. METHODS: A cross-sectional survey was conducted from August 2022 to July 2023 among girls' basketball, soccer, and volleyball coaches at 131 Metro Detroit high schools. Surveys were distributed through athletic directors at all eligible schools. Survey items assessed coaching characteristics, AT access, awareness of ACL injury risk and prevention programs, and use of general and ACL-specific IPPs. School-level SES and school type were obtained from public education reports. Descriptive statistics summarized responses, and Spearman correlations evaluated associations between SES and prevention-related outcomes. RESULTS: A total of 28 of 131 schools (21%) responded, yielding 57 coach responses. Among the 57 responding coaches, 68.4% reported AT access, 77.2% recognized increased ACL injury risk in female athletes, and 73.7% were aware of ACL prevention programs. General injury prevention programs were used by 70.2% of coaches, whereas 47.4% reported an ACL-specific IPP. Lower SES was significantly associated with reduced awareness of ACL prevention programs (ρ = -0.26; P = .0036). CONCLUSION: Our study showed that, despite widespread awareness of the increased risk of ACL injury in female athletes, fewer than half of responding coaches reported implementing ACL-specific prevention programs. Lower-SES schools demonstrated reduced awareness of prevention strategies, highlighting opportunities for targeted educational outreach and resource support.