Injury risk and prevention in endurance athletes-a systematic review

ACL injury is one of the most common, severe and costly injury in sports. Tremendous research and clinical efforts have been made to prevent ACL injuries through training and injury prevention programs (IPP).

To reduce the ACL injury risk, understanding the effects of IPP on neuromuscular control–related biomechanical risk factors (NBRF) is critical as these factors are the primary contributors to ACL injury. This review aims to find out the best evidence-based IPP to reduce ACL injury risk.

A systematic search of the English literature using PUBMED was performed. Key terms were ACL injury, injury risk, neuromuscular and biomechanical injury risk, injury prevention programs. Inclusion criteria were full-text original RCTs from January, 2016-June, 2021, giving IPP to athletic healthy adult population (18–29 years) playing endurance sports (basketball, football, volleyball etc.) and evaluating at least one NBRF or ACL injury.

The search yielded 8,957 articles. After omitting duplicates and screening the titles and abstracts, 17 full-texts articles were retrieved. Upon reading the full-text articles, four articles involving 1,629 subjects (1583-males, 46-females) met the inclusion criteria. In male footballers, IAI-Programme proved superior in proprioception and CMJ than FIFA11+ while both interventions improved the dynamic postural control. Injury rates were lower in FIFA11+ when compared to control but no difference in the injury rates according the position of play or grass versus turf. For basketballers and volleyballers, strength and plyometric exercises proved favorable. For female soccer, handball, and basketball players, perturbation with plyometric training can reduce ACL injury risk.

This review suggests that existing IPP do benefit the athletes in terms of reducing the risk of ACL injury but more sport specific neuromuscular-control related evaluation IPP for similar biomechanical risk factors may need addressing in the future RCTs, reviews and meta-analysis to conclude the best IPP.