title: Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis.
abstract: OBJECTIVE
  The aim of this study was to determine key components in neuromuscular training that optimise ACL injury reduction in female athletes using meta-regression analyses.
  
  
  METHODS
  Systematic review and meta-regression.
  
  
  METHODS
  The literature search was performed in PubMed and EBSCO.
  
  
  METHODS
  Inclusion criteria for the current analysis were: (1) documented the number of ACL injuries, (2) employed a neuromuscular training intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective control study design and (5) recruited female athletes as participants. Two independent reviewers extracted studies which met the inclusion criteria. Methodological quality of included study and strength of recommendation were evaluated. Number of ACL injuries and participants in control and intervention groups, age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and status of verbal feedback were extracted.
  
  
  RESULTS
  The meta-regression analyses identified age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback as significant predictors of ACL injury reduction (p=0.01 in fixed-effects model, p=0.03 in random-effects model). Inclusion of 1 of the 4 components in neuromuscular training could reduce ACL injury risk by 17.2-17.7% in female athletes. No significant heterogeneity and publication bias effects were detected. Strength of recommendation was rated as A (recommendation based on consistent and good-quality patient-oriented study evidence).
  
  
  CONCLUSIONS
  Age of participants, dosage of neuromuscular training, exercise variations within neuromuscular training and utilisation of verbal feedback are predictors that influence the optimisation of prophylactic effects of neuromuscular training and the resultant ACL injury reduction in 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 Harvard Medical School, Boston, Massachusetts, 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 Human Performance Laboratory, Sports Medicine Biodynamics Center, Cincinnati, Ohio, USA Department of Pediatrics and Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA Department of Orthopaedics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Myer
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Human Performance Laboratory, Sports Medicine Biodynamics Center, Cincinnati, Ohio, USA.
authors.forename: Kim D
authors.initials: KD
authors.lastname: Barber Foss
authors.affiliation: Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pepin
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 Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Lyle J
authors.initials: LJ
authors.lastname: Micheli
authors.affiliation: Biomechanics Laboratories and Sports Medicine Center, Orthopedic Surgery, Physical Medicine & Rehabilitation Physiology & Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Hewett
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries / Q000517:prevention & control*; D056352:Athletes; D001265:Athletic Injuries / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000517:prevention & control*; D064797:Physical Conditioning, Human; D012044:Regression Analysis; D012307:Risk Factors
keywords: ACL; Female; Prevention; Sports medicine; Training