title: Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis.
abstract: BACKGROUND
  Clinical trials have demonstrated that preventive neuromuscular training (PNMT) can be effective to reduce ACL injuries in young females. However, the magnitude of the overall effect of PNMT for ACL injury reduction has not reached consensus. In addition, the effects of individual exercises in PNMT that optimise ACL injury reduction are unknown.
  
  
  OBJECTIVE
  The purpose of this project was to systematically review previously published clinical trials and evaluate types of exercises that best support ACL injury reduction in young females.
  
  
  METHODS
  The key words 'knee', 'anterior cruciate ligament', 'ACL', 'prospective', 'neuromuscular', 'training', 'female', and 'prevention' were used for studies published from 1995 to May 2012 in PubMed and EBSCO host.
  
  
  METHODS
  Inclusion criteria for the current analysis were: (1) documented number of ACL injuries, (2) employed a PNMT intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective controlled study design, (5) recruited female athletes and (6) recorded exercises implemented in the PNMT.
  
  
  METHODS
  The number of ACL injuries and female athletes in each group (control and intervention) were extracted. In addition, exercises were categorised into four types and analysed for each investigation.
  
  
  RESULTS
  A total of 14 clinical trials met the inclusion criteria. The subgroup analyses identified fewer ACL injuries in PNMT that focused on strengthening (OR 0.32, 95% CI 0.23 to 0.46, p=0.001), proximal control exercises (OR 0.33, 95% CI 0.23 to 0.47, p=0.001) and multiple exercise interventions (OR 0.32, CI 0.22 to 0.46, p=0.001).
  
  
  CONCLUSIONS
  The current subgroup analyses indicate strengthening, proximal control exercises and multi exercise genres increased efficacy in PNMT intervention designed to reduce ACL injury in young female athletes.
authors.affiliation: The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA College of Health Science, University of Kentucky, Lexington, Kentucky, USA.
authors.forename: Dai
authors.initials: D
authors.lastname: Sugimoto
authors.affiliation: The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Departments of Orthopaedic Surgery, Biomedical Engineering and Rehabilitation Sciences, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Myer
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA.
authors.forename: Kim D Barber
authors.initials: KD
authors.lastname: Foss
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA College of Health Science, University of Kentucky, Lexington, Kentucky, USA Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Departments of Orthopaedic Surgery, Biomedical Engineering and Rehabilitation Sciences, University of Cincinnati, Cincinnati, Ohio, USA Department of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine, Anatomy and Biomedical Engineering, OSU Sports Medicine Sports Health & Performance Institute, The Ohio State University, Columbus, Ohio, USA.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Hewett
mesh_terms: D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000517:prevention & control*; D002986:Clinical Trials as Topic; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000517:prevention & control*; D059385:Plyometric Exercise / Q000379:methods; D004856:Postural Balance / Q000502:physiology; D011446:Prospective Studies; D055070:Resistance Training / Q000379:methods; D040242:Risk Reduction Behavior; D055815:Young Adult
keywords: Evidence based review; Exercise; Intervention effectiveness; Knee ACL