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Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis

Author

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  • Laurel A Donnell-Fink
  • Kristina Klara
  • Jamie E Collins
  • Heidi Y Yang
  • Melissa G Goczalk
  • Jeffrey N Katz
  • Elena Losina

Abstract

Objective: Individuals frequently involved in jumping, pivoting or cutting are at increased risk of knee injury, including anterior cruciate ligament (ACL) tears. We sought to use meta-analytic techniques to establish whether neuromuscular and proprioceptive training is efficacious in preventing knee and ACL injury and to identify factors related to greater efficacy of such programs. Methods: We performed a systematic literature search of studies published in English between 1996 and 2014. Intervention efficacy was ascertained from incidence rate ratios (IRRs) weighted by their precision (1/variance) using a random effects model. Separate analyses were performed for knee and ACL injury. We examined whether year of publication, study quality, or specific components of the intervention were associated with efficacy of the intervention in a meta-regression analysis. Results: Twenty-four studies met the inclusion criteria and were used in the meta-analysis. The mean study sample was 1,093 subjects. Twenty studies reported data on knee injury in general terms and 16 on ACL injury. Maximum Jadad score was 3 (on a 0–5 scale). The summary incidence rate ratio was estimated at 0.731 (95% CI: 0.614, 0.871) for knee injury and 0.493 (95% CI: 0.285, 0.854) for ACL injury, indicating a protective effect of intervention. Meta-regression analysis did not identify specific intervention components associated with greater efficacy but established that later year of publication was associated with more conservative estimates of intervention efficacy. Conclusion: The current meta-analysis provides evidence that neuromuscular and proprioceptive training reduces knee injury in general and ACL injury in particular. Later publication date was associated with higher quality studies and more conservative efficacy estimates. As study quality was generally low, these data suggest that higher quality studies should be implemented to confirm the preventive efficacy of such programs.

Suggested Citation

  • Laurel A Donnell-Fink & Kristina Klara & Jamie E Collins & Heidi Y Yang & Melissa G Goczalk & Jeffrey N Katz & Elena Losina, 2015. "Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-17, December.
    • Handle: RePEc:plo:pone00:0144063
    DOI: 10.1371/journal.pone.0144063
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    References listed on IDEAS

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    1. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
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    1. Anmol T. Mattu & Brianna Ghali & Vanessa Linton & Alex Zheng & Ian Pike, 2022. "Prevention of Non-Contact Anterior Cruciate Ligament Injuries among Youth Female Athletes: An Umbrella Review," IJERPH, MDPI, vol. 19(8), pages 1-29, April.
    2. Marco Andrés García-Luna & Juan Manuel Cortell-Tormo & Miguel García-Jaén & Manuel Ortega-Navarro & Juan Tortosa-Martínez, 2020. "Acute Effects of ACL Injury-Prevention Warm-Up and Soccer-Specific Fatigue Protocol on Dynamic Knee Valgus in Youth Male Soccer Players," IJERPH, MDPI, vol. 17(15), pages 1-14, August.
    3. Kai-Yu Ho & Andrew Murata, 2021. "Asymmetries in Dynamic Valgus Index After Anterior Cruciate Ligament Reconstruction: A Proof-of-Concept Study," IJERPH, MDPI, vol. 18(13), pages 1-9, July.

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