Injury prevention programs that include plyometric exercises reduce the incidence of anterior cruciate ligament injury: a systematic review of cluster randomised trials

Wesam Saleh A Al Attar; Jumana M Bakhsh; Ehdaa H Khaledi; Hussain Ghulam; Ross H Sanders

doi:10.1016/j.jphys.2022.09.001

Injury prevention programs that include plyometric exercises reduce the incidence of anterior cruciate ligament injury: a systematic review of cluster randomised trials

J Physiother. 2022 Oct;68(4):255-261. doi: 10.1016/j.jphys.2022.09.001. Epub 2022 Oct 13.

Authors

Wesam Saleh A Al Attar¹, Jumana M Bakhsh², Ehdaa H Khaledi³, Hussain Ghulam⁴, Ross H Sanders⁵

Affiliations

¹ Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia; Discipline of Exercise and Sport Science, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Department of Sport, Exercise and Health, Faculty of Medicine, University of Basel, Basel, Switzerland. Electronic address: wsattar@uqu.edu.sa.
² Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia.
³ Department of Physical Therapy, Faculty of Applied Medical Sciences, Umm Al Qura University, Makkah, Saudi Arabia; Department of Physical Therapy, King Abdullah Medical City, Makkah, Saudi Arabia.
⁴ Department of Physical Therapy, Faculty of Applied Medical Sciences, Najran University, Najran, Saudi Arabia.
⁵ Discipline of Exercise and Sport Science, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia.

PMID: 36244964
DOI: 10.1016/j.jphys.2022.09.001

Abstract

Question: Do injury prevention programs that include plyometric exercises reduce the incidence of anterior cruciate ligament (ACL) injuries in sport?

Design: Systematic review of (cluster) randomised trials with meta-analysis.

Participants: Sporting participants of any age, sex or competition level.

Interventions: The experimental intervention was an injury prevention program that included plyometric exercises. The control intervention was the usual warm-up program, which did not include plyometric exercises.

Outcome measures: Exposure-based ACL injury rates.

Results: The initial search yielded 7,302 articles, of which nine met the inclusion criteria. All nine articles reported cluster randomised trials, providing data on 14,394 participants. The pooled results showed that injury prevention programs that include plyometric exercises reduce the risk of ACL injury by 60% per 1,000 hours of exposure compared with the control group, with an injury risk ratio (IRR) of 0.40 (95% CI 0.26 to 0.63). Data from subgroups of these trials estimated that this preventative effect may be stronger in males (IRR 0.21, 95% CI 0.07 to 0.62) and weaker in females (IRR 0.51, 95% CI 0.30 to 0.87), albeit with less precise estimates. Subgroup analysis also suggested a stronger effect on non-contact ACL injuries (IRR 0.34, 95% CI 0.18 to 0.65), whereas the effect on contact ACL injuries remained uncertain (IRR 0.59, 95% CI 0.15 to 2.30).

Conclusions: Injury prevention programs that incorporate plyometric exercises substantially decrease the risk of ACL injuries more than warm-up programs that do not include plyometric exercises. The preventive effect appears to be stronger among males and in the prevention of ACL injuries that do not involve contact with another player. PROSPERO CRD42020196982.

Keywords: ACL injury; Injury risk reduction; Knee injury; Physical therapy; Sporting injuries.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Anterior Cruciate Ligament Injuries* / prevention & control
Athletic Injuries* / epidemiology
Athletic Injuries* / prevention & control
Female
Humans
Incidence
Knee Injuries*
Male
Plyometric Exercise*
Randomized Controlled Trials as Topic