Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review.

Jesús Olivares-Jabalera,Víctor Manuel Soto-Hermoso,Francesco Della Villa,Alberto Fílter-Ruger,Jaime Morente-Sánchez,Thomas Dos’Santos,Bernardo Requena,Jose Afonso

doi:10.3390/ijerph182413351

Abstract

Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.

Highlights

Football is one of the most popular sports, with more than 260 million players around the world [1]
Four studies were randomized-controlled trials (RCT), in which three warm-upbased interventions (i.e., Prevent injury and Enhance Performance (PEP) Program [53], and FIFA 11+ [56,57]) found a protective effect on Anterior cruciate ligament (ACL) injury incidence, while one in which part 2 of FIFA 11+ was performed at the end of the training showed no differences against the traditional FIFA 11+ [58]
Even though a similar reduction (i.e., 43.8%) in injury rates was found in female athletes who participated in neuromuscular training (FIFA 11+ could be considered neuromuscular training) [82], number-needed-to-treat data should not be compared since it is time-dependent [83] and different designs have been used for its calculation (i.e., RCT of one competitive season vs. systematic review with different time windows studies) [56,84]

Summary

Introduction

Football (soccer) is one of the most popular sports, with more than 260 million players around the world [1]. Football is a sport exposed to a high risk of injury, considering that the overall injury incidence is 6.6 injures per 1000 players hours [2]. Given that being exposed to a high number of injuries reduce the chances to sporting success [3], injury management (i.e., mitigation and maximising player availability) is one of the most concerning issues in football clubs. Lower injury incidence rates has been correlated to superior performance (i.e., higher league position, more games won, more goals scored, greater goal difference and total points) in professional football [4], while injuries that cause a high injury burden (i.e., those requiring a high number of days lost, such us ligament sprains and joint injuries to the knee and the ankle) are more likely to.

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