Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis
Open accessAbstract
Context: Clinical trials have demonstrated that preventive neuromuscular training (PNMT) can be effective to reduce ACL injuries in young females. However, the magnitude of the overall effect of PNMT for ACL injury reduction has not reached consensus. In addition, the effects of individual exercises in PNMT that optimise ACL injury reduction are unknown. Objective: The purpose of this project was to systematically review previously published clinical trials and evaluate types of exercises that best support ACL injury reduction in young females. Data sources: The key words ‘knee’, ‘anterior cruciate ligament’, ‘ACL’, ‘prospective’, ‘neuromuscular’, ‘training’, ‘female’, and ‘prevention’ were used for studies published from 1995 to May 2012 in PubMed and EBSCO host. Study selection: Inclusion criteria for the current analysis were: (1) documented number of ACL injuries, (2) employed a PNMT intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective controlled study design, (5) recruited female athletes and (6) recorded exercises implemented in the PNMT. Data extraction: The number of ACL injuries and female athletes in each group (control and intervention) were extracted. In addition, exercises were categorised into four types and analysed for each investigation. Data synthesis: A total of 14 clinical trials met the inclusion criteria. The subgroup analyses identified fewer ACL injuries in PNMT that focused on strengthening (OR 0.32, 95% CI 0.23 to 0.46, p=0.001), proximal control exercises (OR 0.33, 95% CI 0.23 to 0.47, p=0.001) and multiple exercise interventions (OR 0.32, CI 0.22 to 0.46, p=0.001). Conclusions: The current subgroup analyses indicate strengthening, proximal control exercises and multi exercise genres increased efficacy in PNMT intervention designed to reduce ACL injury in young female athletes.
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These gendered training dynamics may be a significant contributor to the ACL injury rate disparity between women and men, given lower resistance training participation among girls/women and the importance of that activity for effective ACL injury prevention.
“These gendered training dynamics may be a significant contributor to the ACL injury rate disparity between women and men, given the well-documented lower resistance training participation rates among girls and women compared with boys and men, 40 41 and the importance of that activity for effective ACL injury prevention programmes.38”
From Anterior cruciate ligament injury: towards a gendered environmental approach (2021) · cites this paper as [38]
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Self-citation
- Authors
- Sugimoto, D., Myer, G. D., Barber Foss, K. D., & Hewett, T. E.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Sugimoto, Dai
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2014-12-01
- Volume
- 49
- Issue
- 5
- Pages
- 282-289
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W2170629034
- Semantic Scholar
- f98876542ae701520c4c643d918c07ea2e8c4a30
- Cited by
- 212
- References
- 68
- Citations by year
- 2026: 19 · 2025: 12 · 2024: 7 · 2023: 20 · 2022: 14 · 2021: 22 · 2020: 27 · 2019: 22 · 2018: 24 · 2017: 28 · 2016: 12 · 2015: 4 · 2014: 1
- FWCI
- 2.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR049735, R01AR055563, R01AR056259)
- Topics
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Keywords
- anterior cruciate ligament injury, ACL injury prevention, female athletes, knee injury, resistance training, exercise type, injury risk reduction
- MeSH terms
- Anterior Cruciate Ligament Injuries, Adolescent, Athletic Injuries, Clinical Trials as Topic, Postural Balance, Exercise Therapy, Female, Humans, Knee Injuries, Prospective Studies, Risk Reduction Behavior, Resistance Training, Young Adult, Plyometric Exercise
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