Neuromuscular control training programs and noncontact anterior cruciate ligament injury rates in female athletes: a numbers-needed-to-treat analysis

J Athl Train. 2006 Oct-Dec;41(4):450-6.


Objective: To determine the numbers needed to treat (NNT) and relative risk reduction (RRR) associated with neuromuscular training programs aimed at preventing noncontact anterior cruciate ligament (ACL) injuries in female athletes.

Data sources: We searched PubMed, MEDLINE, SPORT Discus, CINAHL, and Web of Science from 1966 through 2005 using the terms knee, injury, anterior cruciate ligament, ACL, prevention, plyometric, and neuromuscular training.

Study selection: Selected articles were from peer-reviewed journals written in English that described original research studies comparing neuromuscular training programs with control programs to determine the number of noncontact ACL injuries per event exposure or hours of playing time. Five studies met the inclusion criteria and were independently rated by 3 reviewers using the Physiotherapy Evidence Database (PEDro) scale. Consensus PEDro scores ranged from 4 to 7 out of 10.

Data extraction: We used numbers of subjects, ACL injuries, and injury exposure rates to calculate NNT and RRR for each study. The NNT calculations from all studies were based on the number of players across 1 competitive season and were described as NNT benefit or NNT harm.

Data synthesis: All 5 studies demonstrated a prophylactic effect due to the neuromuscular training programs. The pooled NNT estimates showed that 89 individuals (95% confidence interval: 66 to 136) would need to participate in the prophylactic training program to prevent 1 ACL injury over the course of 1 competitive season. Pooled RRR was 70% (95% confidence interval: 54% to 80%) among individuals who participated in the intervention program. One high-quality randomized control trial and 4 medium-quality prospective cohort studies showed mostly consistent findings. Thus, a Strength of Recommendation Taxonomy level of evidence of 1 with a grade B recommendation supports the use of neuromuscular training programs in the prevention of noncontact ACL injuries in female athletes.