Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 Apr;44(4):551-62.
doi: 10.1007/s40279-013-0135-9.

Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses

Dai Sugimoto  1 , Gregory D Myer, Kim D Barber Foss, Timothy E Hewett
Affiliations
Review

Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses

Dai Sugimoto et al. Sports Med. 2014 Apr.

Abstract

Background: Although a series of meta-analyses demonstrated neuromuscular training (NMT) is an effective intervention to reduce anterior cruciate ligament (ACL) injury in female athletes, the potential existence of a dosage effect remains unknown.

Objective: Our objective was to systematically review previously published clinical trials and evaluate potential dosage effects of NMT for ACL injury reduction in female athletes.

Design: This study took the form of a meta- and sub-group analysis.

Setting: The keywords 'knee', 'anterior cruciate ligament', 'ACL', 'prospective', 'neuromuscular', 'training', 'female', and 'prevention' were utilized in PubMed and EBSCO host for studies published between 1995 and May 2012.

Participants: Inclusion criteria set for studies in the current analysis were (i) recruited female athletes as subjects, (ii) documented the number of ACL injuries, (iii) employed an NMT intervention aimed to reduce ACL injuries, (iv) had a control group, (v) used a prospective control trial design, and (vi) provided NMT session duration and frequency information.

Main outcome measures: The number of ACL injuries and female athletes in each group (control and intervention) were compared based on duration, frequency, and volume of NMT via odds ratios (ORs).

Results: A total of 14 studies were reviewed. Analyses that compared the number of ACL injuries with short versus long NMT duration showed greater ACL injury reduction in female athletes who were in the long NMT duration group (OR 0.35, 95% CI 0.23-0.53, p = 0.001) than in those in the short NMT duration group (OR 0.61, 95% CI 0.41-0.90, p = 0.013). Analyses that compared single versus multi NMT frequency indicated greater ACL injury reduction in multi NMT frequency (OR 0.35, 95 % CI 0.23-0.53, p = 0.001) compared with single NMT frequency (OR 0.62, 95% CI 0.41-0.94, p = 0.024). Combining the duration and frequency of NMT programs, an inverse dose-response association emerged among low (OR 0.66, 95% CI 0.43-0.99, p = 0.045), moderate (OR 0.46, 95% CI 0.21-1.03, p = 0.059), and high (OR 0.32, 95% CI 0.19-0.52, p = 0.001) NMT volume categories.

Conclusions: The inverse dose-response association observed in the subgroup analysis suggests that the higher the NMT volume, the greater the prophylactic effectiveness of the NMT program and increased benefit in ACL injury reduction among female athletes.

PubMed Disclaimer

Conflict of interest statement

The authors have no potential conflicts of interest that are directly relevant to the content of this study.

Figures

Figure 1
Figure 1
A meta-analysis of 14 clinical trials – ACL injury
Figure 2
Figure 2
A flow chart of literature review
Figure 3
Figure 3
Subgroup analysis of neuromuscular training (NMT) duration and anterior cruciate ligament injury in 14 clinical trials.
Figure 4
Figure 4
Subgroup analysis of neuromuscular training (NMT) frequency and anterior cruciate ligament injury in 12 clinical trials.
Figure 5
Figure 5
Subgroup analysis of neuromuscular training (NMT) volume and anterior cruciage ligament injury in 12 clinical trials.
Figure 6
Figure 6
A trim and fill plot for testing publication bias.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Messina DF, Farney WC, DeLee JC. The incidence of injury in Texas high school basketball. A prospective study among male and female athletes. Am J of Sports Med. 1999;27:294–299. - PubMed
    1. Gomez E, DeLee JC, Farney WC. Incidence of injury in Texas girls' high school basketball. Am J Sports Med. 1996;24:684–687. - PubMed
    1. Toth AP, Cordasco FA. Anterior cruciate ligament injuries in the female athlete. J Gend Specif Med. 2001;4:25–34. - PubMed
    1. Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train. 1999;34:86–92. - PMC - PubMed
    1. Griffin LY, Albohm MJ, Arendt EA, et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med. 2006;34:1512–1532. - PubMed

MeSH terms