Anterior cruciate ligament injury prevention training in female athletes: a systematic review of injury reduction and results of athletic performance tests

Abstract

Context: Many anterior cruciate ligament (ACL) injury prevention training programs have been published, but few have assessed the effects of training on both ACL injury rates and athletic performance tests.

Objective: To determine if ACL injury prevention programs have a positive influence on both injury rates and athletic performance tests in female athletes.

Data sources: In August 2011, a search was conducted (1995-August 2011) of the PubMed, Science Direct, and CINAHL databases.

Study selection: Selected studies determined the effect of ACL intervention training programs on ACL incidence rates (determined by athlete-exposures) and athletic performance tests, such as isokinetic strength, vertical jump height, speed, agility, and dynamic balance. Because no single article contained both criteria, investigations were cross-referenced to obtain data on both factors from the same training programs.

Data extraction: The authors reviewed the selected studies for cohort population numbers, age, sports, duration of study, program components, duration of training, number of athlete-exposures, ACL injury incidence rates, and results of athletic performance tests.

Results: Initially, 57 studies were identified that described 42 ACL injury prevention training programs. Of these, 17 studies that investigated 5 programs met the inclusion criteria. Two programs significantly reduced ACL injury rates and improved athletic performance tests: Sportsmetrics and the Prevent Injury and Enhance Performance program (PEP). Sportsmetrics produced significant increases in lower extremity and abdominal strength, vertical jump height, estimated maximal aerobic power, speed, and agility. Prevent Injury and Enhance Performance significantly improved isokinetic knee flexion strength but did not improve vertical jump height, speed, or agility. The other 3 programs (Myklebust, the "11," and Knee Ligament Injury Prevention) did not improve both ACL injury rates and athletic performance tests.

Conclusions: Only the Sportsmetrics and PEP ACL intervention training programs had a positive influence on injury reduction and athletic performance tests.

Keywords: anterior cruciate ligament; athletic performance tests; injury prevention.

Figure 1.

Schema for selected studies in the systematic review.

Figure 2.

A significant difference was found in the multistage fitness test in the distribution of female basketball players in the categories shown before and after Sportsmetrics training (P < 0.0001) for estimated VO₂ max (mL·kg⁻¹·min⁻¹): poor, < 31.0; fair, 31 to 34.9; good, 35.0 to 38.9; excellent/superior, ≥ 39.0.

Figure 3.

Statistically significant improvements were found in the mean isokinetic peak torque values for hip abduction, hip extension, and knee flexion in 11 collegiate female basketball players following neuromuscular training based on the Prevent Injury and Enhance Performance program (P < 0.05).

Figure 4.

Training examples from the 2 training programs that had a positive influence on anterior cruciate ligament injury reduction and athletic performance test results in female athletes: Sportsmetrics and Prevent Injury and Enhance Performance. A, barrier hop forward-backward; B, barrier hop side-to-side; C, walking lunge; and D, agility reaction–instructor cued.