Joint Undertaking to Monitor and Prevent ACL Injury


Prevention of ACL and Other Lower Extremity Injury:

Principal Investigator:
Stephen W. Marshall, Ph.D.

Dr. Marshall is closely involved in an ongoing program of research on the prevention of Anterior Cruciate Ligament (ACL) injury and other lower extremity injuries.


One of his studies is JUMP-ACL (Joint Undertaking to Monitor and Prevent ACL Injury), a collaborative multi-site prospective cohort study of neuromuscular risk factors for Anterior Cruciate Ligament (ACL) injury. The focus of this prospective cohort study is to study risks for ACL injury, with an emphasis on factors that are related to human movement and therefore are preventable. This cohort study has enrolled over 5,500 subjects. The cohort is 38% female.


Subjects were followed prospectively for 4 years for incident ACL injury and other musculoskeletal injuries. The baseline assessment protocol included motion analysis of human movement patterns when landing from jump, strength assessment, postural alignment assessment, and a questionnaire on injury history and sports participation.

Another closely-related project (currently in progress) involves a cluster-randomized controlled trial of an intervention training program is in progress at one of the sites. The endpoint of interest is stress fractures.

The team, which includes Associate Professor Darin Padua, Ph. D., A.T.C., from UNC’s Department of Exercise & Sport Science, has also conducted research in local youth soccer leagues in the area.


Relevant papers in this area:

  1. Padua DA, Boling MC, Distefano LJ, Onate JA, Beutler AI, Marshall SW. Reliability of the landing error scoring system-real time, a clinical assessment tool of jump-landing biomechanics. Journal of Sport Rehabilitation 2011;20(2):145-56
  2. Marshall SW. Recommendations for defining and classifying ACL injuries in epidemiologic studies. Journal of Athletic Training 2010; 45(5):516-8
  3. Boling MC, Padua DA, Marshall SW, Pyne SW, Beutler AI. Gender differences in the incidence and prevalence of anterior knee pain: the JUMP-ACL study. Scandinavian Journal of Medicine and Science in Sports 2010; 25(5): 725-730.
  4. DiStefano LJ, Padua DA, Blackburn JT, Garrett WE, Guskiewicz KM, Marshall SW. Integrated injury prevention program improves balance and vertical jump height in children. J Strength Cond Res. 2010 Feb;24(2):332-42.
  5. Beutler AI, de la Motte SJ, Marshall SW, Padua DA, Boden BP. Muscle strength and qualitative jump-landing differences in male and female military cadets: The JUMP-ACL study. Journal of Sports Science and Medicine 2009; 8: 663-671.
  6. Boling MC, Padua DA, Marshall SW, Pyne SW, Beutler AI. A prospective investigation of biomechanical risk factors for patellofemoral pain syndrome: the Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) cohort. American Journal of Sports Medicine 2009;37(11):2108-16
  7. Padua DA, Marshall SW, Boling MC, Thigpen CA, Garrett WE, Beutler AI. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics: the JUMP-ACL study. American Journal of Sports Medicine 2009;37(10):1996-2002
  8. Distefano LJ, Blackburn JT, Marshall SW, Padua DA. Gluteal muscle activation during common therapeutic exercises. Journal of Orthopedics & Sports Physical Therapy. 2009;39(7):532-40.
  9. DiStefano LS, Padua DA, DiStefano M, Marshall SW. Influence of Age, Sex, Technique, and Exercise Program on Movement Patterns Following an ACL Injury Prevention Program in Youth Soccer. American Journal of Sports Medicine. 2009:37(3):495-505

Funding for this project:

National Institute of Arthritis, Musculoskeletal, and Skin Disorders at the National Institutes of Health (NIAMS R01-AR050461001)