Neuromuscular training for preventing knee injuries in female team athletes: a meta-analysis.

OBJECTIVE

To evaluate the efficacy of neuromuscular training (NMT) in preventing knee injuries in female team sport athletes and identify dose-response relationships with intervention complexity, compliance, and session parameters.

METHODS

This review followed the PRISMA 2020 guidelines. Randomized controlled trials on NMT for injury prevention in female team-sport athletes were retrieved from PubMed, Scopus, Web of Science, EMBASE, and the Cochrane Library up to December 2024. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using fixed- or random-effects models depending on heterogeneity. Subgroup analyses examined compliance, session duration, training frequency, and NMT components.

RESULTS

NMT significantly reduced overall knee injury risk by 22% (RR = 0.78, 95% CI: 0.65-0.94, p = 0.008) and ACL injury risk by 50% (RR = 0.50, 95% CI: 0.31-0.81, p = 0.005). Specifically, high compliance (≥75%) was identified as the most effective factor (RR = 0.67, 95% CI: 0.51-0.87, p = 0.004), outperforming program complexity. Sessions lasting longer than 15 min (RR = 0.74, 95% CI: 0.60-0.93, p = 0.008) and delivered 2-3 times per week (RR = 0.87, 95% CI: 0.76-0.99, p = 0.04) showed significant benefits. Moreover, agility (RR = 0.71, 95% CI: 0.56-0.88, p = 0.002) and running mechanics training (RR = 0.80, 95% CI: 0.70-0.93, p = 0.003) were independently associated with injury prevention.

CONCLUSION

NMT reduced knee injury risk in female team sport athletes, with compliance ≥75% indispensable. ≥15-minute sessions delivered 2-3 times weekly can optimise the outcomes. Meanwhile, clinical implementation should prioritize coach-led adherence strategies and evidence-based programs such as FIFA 11+ injury prevention programme (FIFA 11+). Finally, standardising exposure metrics and incorporating sensor-based compliance tracking will enhance scalability.