Assessing the Effectiveness of Neuromuscular Training Programs in Reducing the Incidence of Anterior Cruciate Ligament Injuries in Female Athletes: A Systematic Review

Background: Anterior cruciate ligament (ACL) injuries are more common in female athletes because of anatomic and biomechanical factors. These injuries can have detrimental ramifications for the athlete and the health care system. Neuromuscular training programs have been designed to modify risk factors and prevent ACL injuries. Purpose: This systematic review evaluates studies that assess the effectiveness of neuromuscular training programs in reducing ACL injuries in female athletes and provides an update to 2 previously published reviews. Study Design: Systematic review. Methods: Medline, Cochrane, and CINAHL databases were searched for relevant journal articles published from 1995 to 2011. We performed a manual review of relevant articles, authors, and journals, including bibliographies from identified articles. Ten studies were included in this review. Results: Only 2 studies demonstrated a statistically significant decrease in ACL injuries with neuromuscular training programs. Two additional studies showed a statistically significant decrease in subgroup analyses only. Four studies did show a trend toward reduced ACL injuries with neuromuscular training programs but were unable to achieve statistical significance. Neuromuscular training programs utilizing plyometric exercises and a preseason component were the most beneficial. Two studies actually showed an increase in injuries with intervention programs. Conclusion: Neuromuscular training programs may be a useful adjunct to training, but current literature precludes our universal recommendation of them.