Neuromuscular Retraining in Female Adolescent Athletes: Effect on Athletic Performance Indices and Noncontact Anterior Cruciate Ligament Injury Rates

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Abstract: While many anterior cruciate ligament (ACL) prevention programs have been

published, few have achieved significant reductions in injury rates and improvements in

athletic performance indices; both of which may increase compliance and motivation of

athletes to participate. A supervised neuromuscular retraining program (18 sessions) was

developed, aimed at achieving both of these objectives. The changes in neuromuscular indices

were measured after training in 1000 female athletes aged 13–18 years, and the noncontact

ACL injury rate in 700 of these trained athletes was compared with that of 1120 control

athletes. There were significant improvements in the drop-jump test, (p < 0.0001, effect size

[ES] 0.97), the single-leg triple crossover hop (p < 0.0001, ES 0.47), the t-test

(p < 0.0001, ES 0.64), the multi-stage fitness test (p < 0.0001, ES 0.57), hamstring strength

(p < 0.0001), and quadriceps strength (p < 0.01). The trained athletes had a significant

reduction in the noncontact ACL injury incidence rate compared with the controls (1 ACL

injury in 36,724 athlete-exposures [0.03] and 13 ACL injuries in 61,244 exposures [0.21],

respectively, p = 0.03). The neuromuscular retraining program was effective in reducing

noncontact ACL injury rate and improving athletic performance indicators.