损伤预防神经肌肉训练(NMT)计划可降低前交叉韧带(ACL)损伤的风险。然而,程序特征的变化限制了描述最有效的实践以优化降低伤害风险的潜力。
为了评估ACLNMT计划中包含的常见和有效的组件,用户友好的工具来评估ACLNMT程序的质量。
系统评价和荟萃分析。
纳入研究需要(1)前瞻性对照试验研究设计,(2)NMT干预旨在减少ACL损伤的发生率,(3)比较组,(4)ACL损伤发生率,(5)女性参与者。提取了以下数据:出版年份,研究设计,样本量和特征,和NMT特征,包括每次锻炼类型和次数,volume,持续时间,培训时间,和实施者培训。分析需要使用随机效应模型的单变量亚组和荟萃回归技术。
荟萃分析中包含了18项研究,共有27231人参加,347受ACL损伤。NMT将ACL损伤的风险从54分之一降低到111分之一(比值比[OR],0.51;95%CI,0.37-0.69])。整个NMT的总体平均训练量为18.17小时(每节24.1分钟,每周2.51次)。针对初中或高中运动员的干预措施降低了受伤风险(OR,0.38;95%CI,0.24-0.60)的程度高于对大学或职业年龄运动员的干预措施(OR,0.65;95%CI,0.48-0.89)。所有干预措施都包括某种形式的实施者培训。在每个疗程中增加着陆稳定性和较低的身体力量锻炼可提高预防效果。建立了基于上述有效成分的元回归模型和简单检查表(斜率=-0.15,P=.0008;截距=0.04,P=.51),以允许从业人员评估其ACLNMT的潜在功效并优化损伤预防效果。
考虑到汇总的证据,我们建议ACLNMT计划针对年轻的运动员,并使用训练有素的实施者,他们将下半身力量练习(即,北欧腿筋,弓箭手,和小腿抬高),特别关注整个运动季节的着陆稳定(跳跃/跳跃和保持)。
临床医生,教练,运动员,父母,和从业者可以使用开发的清单来深入了解他们当前的ACLNMT实践的质量,并可以使用该工具优化未来ACLNMT的编程,以降低ACL损伤风险。
Injury prevention neuromuscular training (NMT) programs reduce the risk for anterior cruciate ligament (ACL) injury. However, variation in program characteristics limits the potential to delineate the most effective practices to optimize injury risk reduction.
To evaluate the common and effective components included in ACL NMT programs and develop an efficient, user-friendly tool to assess the quality of ACL NMT programs.
Systematic review and meta-analysis.
Study inclusion required (1) a prospective controlled trial study design, (2) an NMT intervention aimed to reduce incidence of ACL injury, (3) a comparison group, (4) ACL injury incidence, and (5) female participants. The following data were extracted: year of publication, study design, sample size and characteristics, and NMT characteristics including exercise type and number per session, volume, duration, training time, and implementer training. Analysis entailed both univariate subgroup and meta-regression techniques using random-effects models.
Eighteen studies were included in the meta-analyses, with a total of 27,231 participants, 347 sustaining an ACL injury. NMT reduced the risk for ACL injury from 1 in 54 to 1 in 111 (odds ratio [OR], 0.51; 95% CI, 0.37-0.69]). The overall mean training volume was 18.17 hours for the entire NMT (24.1 minutes per session, 2.51 times per week). Interventions targeting middle school or high school-aged athletes reduced injury risk (OR, 0.38; 95% CI, 0.24-0.60) to a greater degree than did interventions for college- or professional-aged athletes (OR, 0.65; 95% CI, 0.48-0.89). All interventions included some form of implementer training. Increased landing stabilization and lower body strength exercises during each session improved prophylactic benefits. A meta-regression model and simple checklist based on the aforementioned effective components (slope = -0.15, P = .0008; intercept = 0.04, P = .51) were developed to allow practitioners to evaluate the potential efficacy of their ACL NMT and optimize injury prevention effects.
Considering the aggregated evidence, we recommend that ACL NMT programs target younger athletes and use trained implementers who incorporate lower body strength exercises (ie, Nordic hamstrings, lunges, and heel-calf raises) with a specific focus on landing stabilization (jump/hop and hold) throughout their sport seasons.
Clinicians, coaches, athletes, parents, and practitioners can use the developed checklist to gain insight into the quality of their current ACL NMT practices and can use the tool to optimize programming for future ACL NMT to reduce ACL injury risk.