Reducing knee and anterior cruciate ligament injuries among female athletes: a systematic review of neuromuscular training interventions

There is evidence that neuromuscular training not only decreases the potential biomechanical risk factors for ACL injury, but also decreases knee and, specifically, ACL injury incidence in female athletes. Five of the six interventions in this systematic review demonstrated significant effects on overall knee or ACL injury rates. It appears that plyometric power, biomechanics and technique, strength, balance, and core stability training can induce neuromuscular changes and potential injury prevention effects in female athletes. However, it is unknown which of these components is most effective or whether the effects are combinatorial. Future research should assess the relative efficacy of these interventions alone and in combination to achieve the optimal effect in the most efficient manner possible. Selective combination of neuromuscular training components may provide additive effects, further reducing the risk of ACL injuries in female athletes. Additional research directions include the assessment of relative injury risk using mass neuromuscular screening, the development of more specific injury prevention protocols targeted toward high-risk athletes, and the determination of when these interventions should be implemented. It may be that prepubertal or early pubertal female athletes may have the potential to achieve optimal biomechanical changes and the greatest chance of injury-free sports participation throughout their careers.