Effects of an 8-Week PEP Training Program on Lower-Extremity Kinematics and Injury Incidence During a 90° Cutting Maneuver in Soccer Players With and Without ACL Reconstruction
Ghorbani M, Daneshmandi H, Majelan AS, Majlesi M. · Research Square · 2026
Abstract
Background: Anterior cruciate ligament reconstruction (ACLR) restores knee stability, but biomechanical deficits during cutting often persist after return to sport, potentially increasing the risk of subsequent injury. This study investigated the effects of an 8-week Prevent Injury and Enhance Performance (PEP) training program on three-dimensional lower-extremity kinematics during a 90° cutting maneuver and subsequent 6-month injury incidence in soccer players with ACLR and healthy controls.
Methods: Forty-two male competitive soccer players (ACLR, n = 21; control, n = 21) participated in this quasi-experimental pre-test/post-test study. Participants completed three-dimensional biomechanical assessments before and after an 8-week PEP training program (three sessions/week, 15–20 min/session). Lower-extremity kinematics during a 90° cutting maneuver were recorded using a Vicon motion analysis system. Injury surveillance was conducted prospectively for six months after the intervention, and injury incidence rates were calculated based on soccer training and match exposure. Changes in kinematic variables were analyzed using two-way mixed-
Design: ANOVA.
Results: Significant improvements over time were observed in several ankle, knee, and hip kinematic variables, with the largest effects found for knee flexion (ηp² = 0.589), hip flexion (ηp² = 0.463), and ankle abduction (ηp² = 0.401). Significant Group × Time interactions were identified for ankle eversion (p = 0.009), knee flexion (p = 0.031), and hip flexion (p = 0.007), indicating greater improvements in the ACLR group. During the 6-month follow-up, injury incidence rates were comparable between groups (11.43 vs. 13.03 injuries per 1000 exposure hours), and no ACL graft ruptures or contralateral ACL injuries were recorded.
Conclusion: The 8-week PEP training program improved lower-extremity movement patterns during a sport-specific cutting task in both groups, with greater biomechanical adaptations observed in athletes following ACL reconstruction. Although injury incidence was similar between groups during follow-up, the study was not powered to evaluate injury prevention outcomes. These
Findings: support incorporating structured neuromuscular training into late-stage rehabilitation to address persistent movement deficits after ACL reconstruction.