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Superior compliance with a neuromuscular training programme is associated with fewer ACL injuries and fewer acute knee injuries in female adolescent football players: secondary analysis of an RCT
  1. Martin Hägglund1,
  2. Isam Atroshi2,3,
  3. Philippe Wagner4,
  4. Markus Waldén3,5
  1. 1Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  2. 2Department of Clinical Sciences, Lund University, Lund, Sweden
  3. 3Department of Orthopaedics, Hässleholm-Kristianstad-Ystad Hospitals, Hässleholm, Sweden
  4. 4National Competence Centre for Musculoskeletal Disorders, Lund University, Lund, Sweden
  5. 5Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  1. Correspondence to Dr Martin Hägglund, Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping 581 83, Sweden; martin.hagglund{at}


Background Little is known about the influence of compliance with neuromuscular training (NMT) on the knee injury rate in football.

Aim To evaluate team and player compliance with an NMT programme in adolescent female football and to study the association between compliance and acute knee injury rates.

Methods Prospective cohort study based on a cluster randomised controlled trial on players aged 12–17 years with 184 intervention teams (2471 players) and 157 control teams (2085 players). Exposure and acute time loss knee injuries were recorded. Team and player compliance was recorded by the coaches on a player attendance form. The intervention group was divided into tertiles of compliance. Injury rates were compared by calculating rate ratios (RRs) and 95% CIs using exact Poisson tests with the low-compliance tertile as reference. Seasonal compliance trends were analysed using linear regression.

Results Players in the high-compliance tertile had an 88% reduction in the anterior cruciate ligament (ACL) injury rate (RR 0.12, 95% CI 0.01 to 0.85), whereas the rate in the control group players was not significantly different from those in the low-compliance tertile (RR 0.77, 95% CI 0.27 to 2.21). A significant deterioration occurred in team (b=−3.0% per month, 95% CI −5.2 to −0.8) and player (b=−5.0% per month, 95% CI −7.1 to −2.9) compliance over the season.

Conclusions Players with high compliance with the NMT programme had significantly reduced ACL injury rate compared with players with low compliance. Significant deterioration in team and player compliance occurred over the season.

  • ACL
  • Adolescents
  • Contact Sports
  • Soccer
  • Injury Prevention

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