Prevention strategies for lower extremity injury: a systematic review and meta-analyses for the Female, Woman and Girl Athlete Injury Prevention (FAIR) Consensus

Abstract

Objective Examine the effectiveness and unintended consequences of prevention strategies for reducing female/woman/girl athletes’ lower extremity (LE) injuries. Design Systematic review with meta-analyses and Grading of Recommendations, Assessment, Development and Evaluation. Data sources Systematic search of eight data sources. Eligibility Primary data studies with a comparison group(s) investigating injury prevention strategies for sport-related LE injuries with ≥1 female/woman/girl in each study group. Results Across 82 studies—including 48 randomised controlled trials (59%), 16 quasiexperimental studies (20%), 16 cohort studies (20%) and 1 cross-sectional study (1%)—a total of 154 561 participants were included, of whom 84 915 (55%) were females/women/girls. Neuromuscular training (NMT)-based programmes (n=60, 73%) were the most frequently studied intervention, followed by personal protective equipment (PPE) (n=9, 11%), policy/rule change (n=4, 5%) and education (n=6, 7%). The median Downs and Black score for all studies was 17 (range: 5–24). Point estimate from pooled results from nine studies revealed that NMT programmes, which include LE balance, strength, agility and change of direction exercises, with a minimum dose of 10 min two times per week, reduced female/woman/girl athletes’ LE injuries by 19% (0.81, 95% CI 0.61% to 1.08%; low certainty evidence). Point estimate of pooled results from six studies uncovered that NMT reduced ankle sprains by 39% (0.61, 95% CI 0.36% to 1.03%; moderate certainty evidence). NMT significantly reduced anterior cruciate ligament (ACL) injuries by 61% (0.39, 95% CI 0.25% to 0.60%; high certainty evidence). Conclusion NMT programmes can reduce female/woman/girl athletes’ ACL injuries by up to 61% and ankle sprains by 39%, highlighting the need for widespread implementation of NMT programmes. Evidence informing PPE, policy/rule changes and education to prevent female/woman/girl athletes’ LE injuries is needed. PROSPERO registration number CRD42024486715. Data are available upon reasonable request. Deidentified data can be made available upon reasonable request to the corresponding author. Please email the corresponding author with a written proposal outlining the specific research aims and analysis plan and why these specific data are needed. A formal data sharing agreement between institutions will be required.