Sustainable performance plan development to prevent non-contact ACL injuries in youth and adolescent athletes: a clinical practice review.

Growing evidence suggests that many non-contact mechanical fatigue-related anterior cruciate ligament (ACL) injuries are related to the accumulated microtrauma that leads to sudden failure. These factors may play a critical role in enhancing both sports performance and adherence to ACL injury prevention programs among youth and adolescent athletes. This clinical practice review synthesizes existing literature on sustainable performance plan principles that integrate active rest and recovery, with an emphasis on boredom mitigation and self-control development. A comprehensive literature search was conducted using PubMed, Web of Science, and OVID MEDLINE databases to identify key themes presented in the following sub-sections: The elite training industry and rise of specialization; Lessons from sports diversity and delayed specialization; Developing more than muscles; Mitigating boredom, developing self-control; Active rest and recovery; Culture, context, and compliance; and Blending performance training and injury prevention. By fostering engagement and adherence among all stakeholders, sustainable performance plans that incorporate boredom mitigation, self-control development, and structured active rest and recovery may enhance compliance with neuromuscular training programs aimed at reducing non-contact ACL injury risk in youth and adolescent athletes. Further research is needed to assess the most effective strategies for integrating these principles into existing training models.