Injury Prevention Programmes Fail to Change Most Lower Limb Kinematics and Kinetics in Female Team Field and Court Sports: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Abstract

One mechanism by which exercise interventions may be effective in reducing anterior cruciate ligament (ACL) injury risk is through changes in lower limb biomechanics. Understanding how training programmes affect lower-limb kinematics and kinetics may help refine injury prevention programmes. The aim of this systematic review and meta-analysis was to assess the effect of injury prevention programmes on kinematics and kinetics during tasks related to ACL injury in female team field and court sports. Five databases were searched in October 2022. Randomised controlled trials assessing the effect of injury prevention programmes compared with usual training/no training on lower limb kinematics and kinetics in female team field and court sports were eligible for review. Sixteen studies were included. A total of 976 female athletes were included. Most of the studies included interventions with multiple components (12/16). Commonly used components were plyometrics (12/16), strength (8/16), and balance/stability (7/16). Thirteen studies had routine training or sham interventions as the control group and three studies had no training. Very low certainty evidence suggests that injury prevention programmes increase knee flexion angles (mean difference = 3.1° [95% confidence interval 0.8-5.5]); however, very low to low certainty evidence suggests no effect on hip flexion angles/moments, knee flexion moments, hip adduction angles/moments, knee adduction angles/moments, hip internal rotation angles/moments, ankle dorsiflexion angles, and ground reaction forces, compared with usual training/no training. Injury prevention programmes may be effective in increasing knee flexion angles during dynamic landing and cutting tasks but may have no effect on other lower limb biomechanical variables. As such, the benefits of injury prevention programmes may be mediated by factors other than altered biomechanics and/or may happen through other biomechanical measures not included in this review.