Effects of Exercise-Based ACL Injury Prevention Interventions on Knee Motion in Athletes: A Systematic Review and Bayesian Network Meta-Analysis.

OBJECTIVE

To compare the effectiveness of injury prevention programs (IPPs) for improving high-risk knee motion patterns in the context of reducing the risk of noncontact anterior cruciate ligament injury.

DESIGN

Systematic review with Bayesian network meta-analysis. DATA SOURCES: PubMed, Embase, Web of Science, Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were searched until September 10, 2023. ELIGIBILITY CRITERIA: We included randomized controlled trials involving athletes without prior anterior cruciate ligament injury. The trials had to provide data on peak knee flexion and valgus angles, obtained from 2-leg drop vertical jump, single-leg drop vertical jump, or side-step cutting test.

RESULTS

The network meta-analysis synthesized data from 22 randomized controlled trials involving 878 participants, evaluating 12 different IPPs. Results of meta-analyses indicated that, in jumping tests, the external focus instructions (mean difference [MD] = 26; credible interval [CrI] = 7.5, 44; surface under the cumulative ranking curve [SUCRA] = 0.94) and internal focus of attention (MD = 19; CrI = 0.19, 37; SUCRA = 0.81) was effective for increasing peak knee flexion, and core stability training ranked first for reducing knee valgus (MD = -4.40; CrI = -7.7, -1.1; SUCRA = 0.96). None of the IPPs revealed statistically significant effects for the cutting test.

CONCLUSION

The external focus instructions and internal focus of attention increased knee flexion, while core stability exercise reduced knee valgus in jumping tests. Intervention effects were inconsistent for cutting tests. J Orthop Sports Phys Ther 2025;55(2):1-14. Epub 20 December 2024. doi:10.2519/jospt.2024.12720.