scholarly journals The Influence of Age on the Effectiveness of Neuromuscular Training to Reduce Anterior Cruciate Ligament Injury in Female Athletes

2012 ◽  
Vol 41 (1) ◽  
pp. 203-215 ◽  
Author(s):  
Gregory D. Myer ◽  
Dai Sugimoto ◽  
Staci Thomas ◽  
Timothy E. Hewett
Keyword(s):  
Injury Risk ◽  
Knee Injury ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Acl Injury ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Injury Reduction ◽  
Anterior Cruciate

Background: In female athletes, sports-related injuries to the anterior cruciate ligament (ACL) increase during adolescence and peak in incidence during the mid- to late teens. Although biomechanical investigations indicate that a potential window of opportunity exists for optimal timing for the initiation of integrative neuromuscular training (NMT) in young female athletes, the influence of the timing of initiation of these programs on the efficacy of ACL injury reduction has yet to be evaluated. Hypothesis/Purpose: The purpose of the current report was to systematically review and synthesize the scientific literature regarding the influence of age of NMT implementation on the effectiveness for reduction of ACL injury incidence. The hypothesis tested was that NMT would show a greater effect in younger populations. Study Design: Meta-analysis; Level of evidence 1a. Methods: Data were pooled from 14 clinical trials that met the inclusion criteria of (1) number of ACL injuries reported; (2) NMT program used; (3) female participants were included; (4) investigations used prospective, controlled trials; and (5) age of participants was documented or was obtainable upon contact with the authors. A meta-analysis with odds ratio (OR) was used to compare the ratios of ACL injuries between intervention and control groups among differing age categorizations. Results: A meta-analysis of the 14 included studies demonstrated significantly greater knee injury reduction in female athletes who were categorized in the preventive NMT group compared with those who were in the control group (OR: 0.54; 95% confidence interval [CI]: 0.35, 0.83). Lower ACL injuries in mid-teens (OR 0.28; CI: 0.18, 0.42) compared with late teens (OR 0.48; CI: 0.21, 1.07) and early adults (OR 1.01; CI: 0.62, 1.64) were found in participants undergoing NMT. Conclusion: The findings of this meta-analysis revealed an age-related association between NMT implementation and reduction of ACL incidence. Both biomechanical and the current epidemiological data indicate that the potential window of opportunity for optimized ACL injury risk reduction may be before the onset of neuromuscular deficits and peak knee injury incidence in female athletes. Specifically, it may be optimal to initiate integrative NMT programs during early adolescence, before the period of altered mechanics that increase injury risk.

Epidemiology of Anterior Cruciate Ligament Tears in the National Football League

2021 ◽  
pp. 036354652110101
Author(s):  
Riann M. Palmieri-Smith ◽  
Christina D. Mack ◽  
Robert H. Brophy ◽  
Brett D. Owens ◽  
Mackenzie M. Herzog ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
National Football League ◽  
Cruciate Ligament ◽  
Injury Rate ◽  
Acl Injury ◽  
Well Being ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) tears are common in contact athletics and have a significant effect on the athletic performance and well-being of affected players. The prevalence, timing, and characteristics of ACL tears in National Football League (NFL) athletes are lacking. Purpose: To define the epidemiology of ACL tears among NFL athletes. Study Design: Descriptive epidemiology study. Methods: This retrospective study includes all ACL injuries entered into the NFL injury database through the centralized leaguewide electronic health record system for the 2015-2019 seasons. Results: A total of 314 ACL injuries occurred during the 5-year study period, with a mean of 62 per year. The overall 1-season injury risk of an NFL player sustaining an ACL injury was 1.9% (95% CI, 1.7%-2.1%). Most ACL injuries occurred during games (n = 199), with a higher rate observed in the preseason games as compared with the regular season games (6.1 vs 2.7 per 10,000 player-plays; P < .01). NFL players with ≤3 of experience had a higher preseason injury rate (9.57 ACL tears per 1000 player-seasons) than those with ≥4 years of experience (5.12 ACL tears per 1000 player-seasons; P < .01). NFL athletes playing on special teams had the highest rate of ACL injuries (7.6 per 10,000 player-plays) in comparison with all other player positions. Conclusion: ACL injury incidence was fairly consistent across all years studied and occurred more frequently in players with ≤3 years of NFL experience. Tears were more common during games, special teams play, and the preseason.

Anterior Cruciate Ligament Injury Incidence in Adolescent Athletes: A Systematic Review and Meta-analysis

2020 ◽  
pp. 036354652095961
Author(s):  
Joshua T. Bram ◽  
Lacey C. Magee ◽  
Nishank N. Mehta ◽  
Neeraj M. Patel ◽  
Theodore J. Ganley
Keyword(s):  
Anterior Cruciate Ligament ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Injury Incidence ◽  
Adolescent Athletes ◽  
Male Athletes ◽  
Acl Injuries ◽  
Anterior Cruciate

Background: The incidence of anterior cruciate ligament (ACL) injuries among adolescent athletes is steadily increasing. Identification of the highest risk sports for ACL injuries by sex and competitive setting (ie, practice vs match) is important for targeting injury prevention programs. Purpose: To identify the risk of ACL injuries in adolescent athletes by sport, sex, and setting across a variety of common US and international sports. Study Design: Meta-analysis. Methods: Essentially, 3 online databases (PubMed, Embase, and Cochrane Library) were searched for all studies of ACL injuries per athlete-exposure (AE) or hours of exposure in adolescent athletes. Injuries were then pooled and incidence rates (IRs) reported per 1000 AEs or hours of exposure, with the relative risk (RR) of injuries calculated for sex-comparable sports. IRs per competitive setting (match vs practice) were also calculated. Results: A total of 1235 ACL injuries over 17,824,251 AEs were identified (IR, 0.069 [95% CI, 0.065-0.074]), with 586 of these injuries in girls across 6,986,683 AEs (IR, 0.084 [95% CI, 0.077-0.091]) versus 649 injuries in boys over 10,837,568 AEs (IR, 0.060 [95% CI, 0.055-0.065]). Girls had a higher overall rate of ACL injuries (RR, 1.40 [95% CI, 1.25-1.57]), with the most disproportionate risk observed in basketball (RR, 4.14 [95% CI, 2.98-5.76]). The risk of ACL injuries by sex was highest in girls’ soccer (IR, 0.166 [95% CI, 0.146-0.189]) and boys’ football (IR, 0.101 [95% CI, 0.092-0.111]). ACL injuries were over 8 (RR, 8.54 [95% CI, 6.46-11.30]) and 6 (RR, 6.85 [95% CI, 5.52-8.49]) times more likely to occur in a match versus a practice setting for female and male athletes, respectively. Conclusion: The risk of ACL injuries overall approached nearly 1 per 10,000 AEs for female athletes, who were almost 1.5 times as likely as male athletes to suffer an ACL injury across all adolescent sports. A multisport female athlete was estimated to have a nearly 10% risk of ACL injuries over her entire high school or secondary school career. Specifically, male and female adolescents playing soccer, basketball, lacrosse, and football appeared at particular risk of injuries, a finding that can be used to target an injury intervention.

scholarly journals Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification

2019 ◽  
Vol 54 (5) ◽  
pp. 472-482 ◽  
Author(s):  
Alicia M. Montalvo ◽  
Daniel K. Schneider ◽  
Kate E. Webster ◽  
Laura Yut ◽  
Marc T. Galloway ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Injury Incidence ◽  
Male Athletes ◽  
Acl Injuries ◽  
Sport Type ◽  
Anterior Cruciate

Objective To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact). Data Sources A systematic review was performed using the electronic databases PubMed (1969–January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969–January 20, 2017) and the search terms anterior cruciate ligament AND injury AND (incidence OR prevalence OR epidemiology). Study Selection Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English. Data Extraction Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis. Data Synthesis We conducted IR and IR ratio (IRR) meta-analyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10 000 versus 1.12/10 000 AEs, IRR = 1.14, P = .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21, P = .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49, P = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10 000 versus 0.87/10 000 AEs, IRR = 3.00, P &lt; .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10 000 versus 1.75/10 000 AEs, IRR = 5.51, P &lt; .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories. Conclusions Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports.

Lower Extremity Biomechanical Differences Between Female Dancers and Soccer Players

2020 ◽  
Vol 25 (5) ◽  
pp. 254-257
Author(s):  
Hayley M. Ericksen ◽  
Rachele E. Vogelpohl
Keyword(s):  
Lower Extremity ◽  
National Collegiate Athletic Association ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Acl Injuries ◽  
Jump Landing ◽  
Ankle Eversion ◽  
Anterior Cruciate ◽  
Modern Dancers

Anterior cruciate ligament (ACL) injury in female athletes is common. Team sport athletes experience more ACL injuries than ballet and modern dancers. Examining biomechanical differences between these two groups may help to explain the discrepancy in ACL injury rates. The purpose of this study was to examine lower extremity kinematic differences between collegiate dancers and National Collegiate Athletic Association Division I soccer athletes during a rebound jump-landing task. Peak hip, knee, and ankle kinematics were collected during a jump-landing task. Results showed more knee flexion and less ankle eversion in the dancers compared to the soccer athletes. Differences in training and strategies used during landing may explain the kinematic differences between groups.

scholarly journals Epidemiology of Anterior Cruciate Ligament Injury in Italian First Division Soccer Players

2019 ◽  
Vol 12 (3) ◽  
pp. 279-288 ◽  
Author(s):  
Alberto Grassi ◽  
Luca Macchiarola ◽  
Matteo Filippini ◽  
Gian Andrea Lucidi ◽  
Francesco Della Villa ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Incidence Rate ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Soccer Players ◽  
Injury Incidence ◽  
Acl Injuries ◽  
Professional Soccer ◽  
Incidence Proportion ◽  
Anterior Cruciate

Background: The burden of anterior cruciate ligament (ACL) injury in professional soccer players is particularly relevant as it represents a potentially career-threatening injury. Hypothesis: Our hypotheses were that (1) injury incidence rate would be similar to that reported in the literature, (2) we would identify a uniform distribution of the injuries along the season, and (3) injury incidence rate would be similar in high-ranked and lower ranked teams, based on final placement in the league. Study Design: Descriptive epidemiological study. Level of Evidence: Level 4. Methods: Professional male soccer players participating in the Serie A championship league in 7 consecutive seasons (2011-2012 to 2017-2018) were screened to identify ACL injuries through the online football archive transfermarkt.com . Exposure in matches and training were calculated. Results: There were 84 ACL injuries found (mean player age, 25.3 ± 4.2 years). Overall, 25% of ACL injuries were reruptures (15%) or contralateral injuries (10%). ACL incidence rate was 0.4215 per 1000 hours of play during Serie A matches, 0.0305 per 1000 hours of training (rate ratio [RR], 13.8; 95% CI, 8.4-22.7; P < 0.0001), and 0.0618 per 1000 hours of total play. Injury distribution had a bimodal peak, with the highest number of events in October and March. Alternatively, training injuries peaked in June and July. A significantly higher incidence rate was found for the teams ranked from 1st to 4th place compared with those ranked 5th to 20th (0.1256 vs 0.0559 per 1000 hours of play; RR, 2.2; 95% CI, 1.4-3.6; P = 0.0003). A similar finding was found for injury incidence proportion (3.76% vs 1.64%; P = 0.0003). Conclusion: The overall incidence rate of ACL injuries in Italian Serie A was 0.062 per 1000 hours, with a 14-fold risk in matches compared with training. Relevantly, 25% were second injuries. Most injuries occurred in October and March, and an almost 2-fold incidence rate and incidence proportion were noted in those teams ranked in the first 4 positions of the championship league. Clinical Relevance: Knowing the precise epidemiology of ACL injury in one of the most competitive professional football championship leagues could help delineate fields of research aimed to investigate its risk factors.

scholarly journals The Effect Of Playing Surface On Anterior Cruciate Ligament Injury In NCAA Soccer

2020 ◽  
Vol 8 (3_suppl2) ◽  
pp. 2325967120S0012
Author(s):  
Mark Howard ◽  
Hyunwoo Paco Kang ◽  
Samantha Solaru ◽  
Alexander E. Weber ◽  
Mark F. Rick C
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Soccer Players ◽  
Injury Incidence ◽  
Artificial Turf ◽  
Acl Injuries ◽  
Natural Grass ◽  
Significant Difference ◽  
Anterior Cruciate

Objectives: Previous orthopaedic literature has examined the effect of synthetic playing surfaces on the risk of anterior cruciate ligament (ACL) injury in athletes and produced varying and inconclusive results. The objective of this study was to examine the role of playing surface on the incidence and risk of ACL injury in collegiate soccer athletes. Methods: The NCAA Injury Surveillance Program (ISP) database was queried for ACL injuries for male and female soccer players from the 2004-05 through the 2013-14 seasons at all levels of competition. The number of athlete exposures (AEs), defined as 1 athlete participating in 1 practice or competition in which they were exposed to the possibility of athletic injury, were recorded for grass and synthetic playing surfaces. Both the reported injuries and exposures provided were weighted in order to represent the entire NCAA collegiate soccer population. Normalized ACL incidence rates were calculated as well as 95% confidence intervals (95%CI). Rate ratios comparing competition type amongst both competition and practice were calculated. Results: ACL injuries were more common on grass surfaces (1.16 per 10,000 AEs, 95%CI 1.12-1.20) than artificial turf (0.92 per 10,000 AEs, 95%CI 0.84-1.04). This difference was statistically significant (IRR 1.26, p<0.0001), and driven primarily by the difference in injury incidence during practice. The injury incidence during practice on natural grass (1.18 per 10,000 AEs, 95% CI 1.11-1.26) was significantly greater than the injury incidence rate during practice on artificial turf (0.067 per 10,000 AEs, 95%CI 0.043-0.096). Players were 17.7 times more likely (95%CI 10.6678-27.2187, p<0.0001) to sustain an ACL injury during practice on natural grass when compared to practice on artificial turf. However, there was no significant difference in injury incidence during matches (IRR 0.96, p=0.44), with matches on natural grass (3.35 per 10,000 AEs, 95% CI 3.21-3.51) equivalent to matches on artificial surfaces (3.49 per 10,000 AEs, 95%CI 3.18-3.81). When comparing exposure type, the injury rate was significantly greater during matches (3.38 per 10,000 AEs, 95% CI 3.25-3.52) compared to practices (0.82 per 10,000 AEs, 95%CI 0.77-0.88), with a 4.10-fold increase in ACL injury incidence during matches compared to practice (p<0.0001). Conclusion: Between 2004 and 2014, NCAA soccer players experienced a greater number of ACL injuries on natural grass playing surfaces compared with artificial turf playing surfaces. This difference is driven by injuries during practice, where athletes were nearly 18 times more likely to suffer an ACL injury on grass versus artificial turf. While ACL injuries were more likely during matches compared to practices, no difference in incidence was noted between playing surfaces. Additional study is warranted investigating potential causes for this observed increased risk with soccer practice on grass fields.

scholarly journals Sexual Dimorphisms in Anterior Cruciate Ligament Injury: A Current Concepts Review

2021 ◽  
Vol 9 (12) ◽  
pp. 232596712110253
Author(s):  
Tayt M. Ellison ◽  
Ilexa Flagstaff ◽  
Anthony E. Johnson
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Extrinsic Factors ◽  
Male Athletes ◽  
Acl Injuries ◽  
Sexual Dimorphisms ◽  
Increased Risk ◽  
Anterior Cruciate ◽  
Postsurgical Outcomes

Background: Although most anterior cruciate ligament (ACL) injuries occur in male athletes, female athletes are consistently observed to be at a higher risk for sports-specific ACL injury. Purpose: To provide a thorough review of what is known about the sexual dimorphisms in ACL injury to guide treatment and prevention strategies and future research. Study Design: Narrative review. Methods: We conducted a comprehensive literature search for ACL-related studies published between January 1982 and September 2017 to identify pertinent studies regarding ACL injury epidemiology, prevention strategies, treatment outcomes, and dimorphisms. By performing a broad ACL injury search, we initially identified 11,453 articles. After applying additional qualifiers, we retained articles if they were published in English after 1980 and focused on sex-specific differences in any of 8 different topics: sex-specific reporting, difference in sports, selective training, hormonal effects, genetics, neuromuscular and kinematic control, anatomic differences, and outcomes. Results: A total of 122 articles met the inclusion criteria. In sum, the literature review indicated that female athletes are at significantly higher risk for ACL injuries than are their male counterparts, but the exact reasons for this were not clear. Initial studies focused on intrinsic differences between the sexes, whereas recent studies have shifted to focus on extrinsic factors to explain the increased risk. It is likely both intrinsic and extrinsic factors contribute to this increased risk, but further study is needed. In addition to female patients having an increased risk for ACL injuries, they are less likely than are male patients to undergo reconstructive surgery, and they experience worse postsurgical outcomes. Despite this, reconstructive surgery remains the gold standard when knee stability, return to sports, and high functional outcome scores are the goal, but further research is needed to determine why there is disparity in surgical rates and what surgical techniques optimize postsurgical outcomes for female patients. Conclusion: Male athletes often predominated the research concerning ACL injury and treatment, and although sex-specific reporting is progressing, it has historically been deficient. ACL injuries, prevention techniques, and ACL reconstruction require further research to maximize the health potential of at-risk female athletes.

Femoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy Individuals

2021 ◽  
pp. 036354652110504
Author(s):  
Grégoire Micicoi ◽  
Chistophe Jacquet ◽  
Raghbir Khakha ◽  
Sally LiArno ◽  
Ahmad Faizan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Reference Population ◽  
Acl Injuries ◽  
Notch Width ◽  
Injury Risk Factor ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Background: Anterior cruciate ligament (ACL) injuries are multifactorial events that may be influenced by morphometric parameters. Associations between primary ACL injuries or graft ruptures and both femoral and tibial bony risk factors have been well described in the literature. Purpose: To determine values of femoral and tibial bony morphology that have been associated with ACL injuries in a reference population. Further, to define interindividual variations according to participant demographics and to identify the proportion of participants presenting at least 1 morphological ACL injury risk factor. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography scans of 382 healthy participants were examined. The following bony ACL risk factors were analyzed: notch width index (NWI), lateral femoral condylar index (LFCI), medial posterior plateau tibial angle (MPPTA), and lateral posterior plateau tibial angle (LPPTA). The proportion of this healthy population presenting with at least 1 pathological ACL injury risk factor was determined. A multivariable logistic regression model was constructed to determine the influence of demographic characteristics. Results: According to published thresholds for ACL bony risk factors, 12% of the examined knees exhibited an intercondylar notch width <18.9 mm, 25% had NWI <0.292, 62% exhibited LFCI <0.67, 54% had MPPTA <83.6°, and 15% had LPPTA <81.6°. Only 14.4% of participants exhibited no ACL bony risk factors, whereas 84.5% had between 2 and 4 bony risk factors and 1.1% had all bony risk factors. The multivariate analysis demonstrated that only the intercondylar notch width ( P < .0001) was an independent predictor according to both sex and ethnicity; the LFCI ( P = .012) and MMPTA ( P = .02) were independent predictors according to ethnicity. Conclusion: The precise definition of bony anatomic risk factors for ACL injury remains unclear. Based on published thresholds, 15% to 62% of this reference population would have been considered as being at risk. Large cohort analyses are required to confirm the validity of previously described morphological risk factors and to define which participants may be at risk of primary ACL injury and reinjury after surgical reconstruction.

scholarly journals Prevention of Knee and Anterior Cruciate Ligament Injuries Through the Use of Neuromuscular and Proprioceptive Training: An Evidence-Based Review

2017 ◽  
Vol 52 (12) ◽  
pp. 1171-1172 ◽  
Author(s):  
Lucas Dargo ◽  
Kelsey J. Robinson ◽  
Kenneth E. Games
Keyword(s):  
Anterior Cruciate Ligament ◽  
Lower Limb ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Inclusion Criteria ◽  
Acl Injuries ◽  
Anterior Cruciate Ligament Injuries ◽  
Proprioceptive Training ◽  
Anterior Cruciate

Reference/Citation:  Donnell-Fink LA, Klara K, Collins JE, et al. Effectiveness of knee injury and anterior cruciate ligament tear prevention programs: a meta-analysis. PLoS One. 2015;10(12)e0144063. Clinical Question:  Is neuromuscular and proprioceptive training effective in preventing knee and anterior cruciate ligament (ACL) injuries? Data Sources:  The authors searched CINAHL, Cochrane Central Register of Controlled Trials, MEDLINE/EMBASE, PubMed, and Web of Science databases from 1996 through December 2014 and limited the results to peer-reviewed manuscripts published in English. Search terms for all databases were knee injury OR knee injuries; OR anterior cruciate ligament injury OR anterior cruciate ligament injuries; OR ACL injury OR ACL injuries; OR lower limb injury OR lower limb injuries AND prevention. Study Selection:  Inclusion criteria were (1) English language, (2) published from 1996 through 2014, (3) the intervention used neuromuscular or proprioceptive training to prevent knee or ACL injuries, (4) human participants, (5) the incidence of knee or ACL injury was provided. Data Extraction:  For the articles that met the inclusion criteria, 2 authors worked independently using the Jadad scale to extract the first author, year of publication, title, sport type, participant sex, participant age, country in which the study was conducted, number of participants in the control and intervention groups, intervention characteristics or components, and knee or ACL injury outcome. Main Results:  A total of 24 studies with 1093 participants were included in this review. Intervention efficacy was determined from weighted incidence rate ratios. After the intervention of neuromuscular and proprioceptive training exercises, the incidence ratio (frequency of a disease or injury occurrence in a population over a specific time frame) was calculated at 0.731 (95% confidence interval = 0.614, 0.871) for knee injury and at 0.493 (95% confidence interval = 0.285, 0.854) for ACL injury. This indicated a link between neuromuscular and proprioceptive training programs and injury reduction. No significant correlation was present between more components added to training and a greater decrease in injury to either the knee or ACL. Conclusions:  Neuromuscular and proprioceptive training appeared to decrease the incidence of injury to the knee and specifically the ACL. However, no evidence suggested that a specific group of exercises was better than others.

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