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. 2022 Apr 12;19(8):4648.
doi: 10.3390/ijerph19084648.

Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review

Anmol T Mattu  1 , Brianna Ghali  2 , Vanessa Linton  3 , Alex Zheng  3 , Ian Pike  3   4
Affiliations

Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review

Anmol T Mattu et al. Int J Environ Res Public Health. .

Abstract

Anterior cruciate ligament (ACL) injuries account for a large percentage of knee injuries, disproportionately affecting female athletes. To help health professionals stay current, we performed an umbrella review to evaluate the effectiveness of ACL injury prevention programs in reducing non-contact ACL injury rates, determine the effective components within interventions, and provide clinical recommendations. Twelve databases (Medline, Embase, Cochrane Database of Systematic Reviews, SPORTDiscus, Cumulative Index to Nursing and Allied Health Literature, PEDro, Web of Science Core Collection, Epistemonikos, TRIP, BC Guidelines and Protocols, CPG Infobase, ProQuest Dissertations and Theses Global) were searched in May 2021 to identify relevant systematic reviews and meta-analyses. Four databases were searched again in September 2021 to identify recent primary literature. Non-contact ACL injury data were extracted to calculate incidence rate ratios (IRRs) and these were combined using an inverse variance random-effects model. A qualitative assessment of included reviews was performed. The methodological quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) or Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2). Sixteen reviews and two primary studies met the inclusion criteria. Across 11 primary studies, prevention programs were effective in reducing non-contact ACL injuries by 64% (IRR = 0.36 (95% CI: 0.18-0.70)). A multi-faceted exercise program, beginning in the pre-season and containing at least three exercise types, may be beneficial in reducing ACL injury risk.

Keywords: anterior cruciate ligament (ACL); female athlete; injury prevention; meta-analysis; neuromuscular training; prevention program; youth.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram of the literature search for review articles.
Figure 2
Figure 2
PRISMA flow diagram of the literature search for primary articles.
Figure 3
Figure 3
Quality assessment of the reviews using the AMSTAR 2 tool. RCT: randomized control trial; NSRI: non-randomized studies of interventions.
Figure 4
Figure 4
Main effect meta-analysis: random-effects, inverse variance weighted model. IRR: incidence rate ratio; CI: confidence interval.
Figure 5
Figure 5
Funnel plot for the random-effect estimate.
See this image and copyright information in PMC

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