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Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis
  1. Dai Sugimoto1,2,3,
  2. Gregory D Myer1,4,5,6,7,
  3. Kim D Barber Foss4,5,
  4. Michael J Pepin2,
  5. Lyle J Micheli1,2,3,
  6. Timothy E Hewett8
  1. 1The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
  2. 2Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
  3. 3Harvard Medical School, Boston, Massachusetts, USA
  4. 4Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  5. 5Human Performance Laboratory, Sports Medicine Biodynamics Center, Cincinnati, Ohio, USA
  6. 6Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
  7. 7Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  8. 8Biomechanics Laboratories and Sports Medicine Center, Orthopedic Surgery, Physical Medicine & Rehabilitation Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Dai Sugimoto, The Micheli Center for Sports Injury Prevention, 9 Hope Ave, Suite 100, Waltham, MA 02453, USA; dai.sugimoto{at}childrens.harvard.edu

Abstract

Objective The aim of this study was to determine key components in neuromuscular training that optimise ACL injury reduction in female athletes using meta-regression analyses.

Design Systematic review and meta-regression.

Data sources The literature search was performed in PubMed and EBSCO.

Eligibility criteria Inclusion criteria for the current analysis were: (1) documented the number of ACL injuries, (2) employed a neuromuscular training intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective control study design and (5) recruited female athletes as participants. Two independent reviewers extracted studies which met the inclusion criteria. Methodological quality of included study and strength of recommendation were evaluated. Number of ACL injuries and participants in control and intervention groups, age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and status of verbal feedback were extracted.

Results The meta-regression analyses identified age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback as significant predictors of ACL injury reduction (p=0.01 in fixed-effects model, p=0.03 in random-effects model). Inclusion of 1 of the 4 components in neuromuscular training could reduce ACL injury risk by 17.2–17.7% in female athletes. No significant heterogeneity and publication bias effects were detected. Strength of recommendation was rated as A (recommendation based on consistent and good-quality patient-oriented study evidence).

Conclusions Age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback are predictors that influence the optimisation of prophylactic effects of neuromuscular training and the resultant ACL injury reduction in female athletes.

  • Prevention
  • ACL
  • Female
  • Sports medicine
  • Training

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