Systematic Review
Neuromuscular Retraining Intervention Programs: Do They Reduce Noncontact Anterior Cruciate Ligament Injury Rates in Adolescent Female Athletes?

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Purpose

The purpose of this study was to identify neuromuscular training intervention programs that significantly reduced the incidence of noncontact anterior cruciate ligament (ACL) injury rates in female adolescent athletes.

Methods

A systematic search of PubMed was conducted to determine the outcome of ACL neuromuscular retraining programs in a specific population. The inclusion criteria were English language, published from 1994-2013, original clinical trials, all evidence levels, female athletes aged 19 years or younger, and noncontact ACL injury incidence rates determined by athlete-exposures.

Results

Of 694 articles identified, 8 met the inclusion criteria. Three training programs significantly reduced noncontact ACL injury incidence rates in female adolescent athletes. These were the Sportsmetrics, Prevent Injury and Enhance Performance, and Knee Injury Prevention programs. The estimated number of athletes who needed to train to prevent 1 ACL injury in these 3 studies ranged from 70 to 98, and the relative risk reduction ranged from 75% to 100%. Five programs did not significantly reduce noncontact ACL injury incidence rates. The ACL injury incidence rates for control subjects were lower in these studies (0.03 to 0.08 per 1,000 athlete-exposures) than in those investigations that had a significant effect (0.21 to 0.49 per 1,000 athlete-exposures). There was wide variability among all programs in the frequency, duration, and timing of training; how training was conducted, supervised, or controlled; the components of the program; how exposure data were calculated; noncontact ACL injury incidence rates in the control groups; and compliance with training.

Conclusions

Three ACL intervention programs successfully reduced noncontact ACL injury incidence rates in female adolescent athletes. Pooling of data of all ACL intervention programs is not recommended because of numerous methodologic differences among studies.

Level of Evidence

Level II, systematic review of Level I and II studies.

Section snippets

Literature Search

From January 1994 through May 2013, we searched the Medline and Cochrane databases for all published literature using the following key words and phrases: anterior cruciate ligament injury, ACL injury prevention, ACL neuromuscular retraining, and ACL training. Inclusion criteria were English language, clinical trials of all kinds, Level I to Level IV evidence, female adolescent athletes, noncontact ACL injuries, and injury incidence rates determined according to athlete-exposures. The age limit

Literature Search

Our search initially identified 578 original research studies. We also found 116 general review articles, current concepts, commentaries, systematic reviews, and meta-analyses that were reviewed for additional studies but were not included in the final study. A total of 403 articles were excluded because they were off-topic. We reviewed the abstracts and content of the remaining 175 articles, 167 of which were also excluded, as shown in Fig 1. This left 8 articles that were included in this

Discussion

The main finding of this systematic review was that 3 neuromuscular retraining intervention programs significantly reduced the noncontact ACL injury incidence rates in female adolescent athletes. These were the Sportsmetrics program, PEP, and KIPP. The number of athletes who needed to train to prevent 1 ACL injury in these 3 studies ranged from 70 to 98, and the relative risk reduction ranged from 75% to 100%. Although the number of athletes needed to treat appears somewhat high, in our

Conclusions

Three ACL intervention programs successfully reduced noncontact ACL injury incidence rates in female adolescent athletes. Pooling of data of all ACL intervention programs is not recommended because of numerous methodologic differences among studies.

Acknowledgment

Sportsmetrics is a nonprofit injury prevention program administered by the Noyes Knee Institute. The authors thank Tommy Campbell and Stephanie Tutalo Smith for their assistance with athlete training and injury tracking and Marty Levy for statistical consultation.

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