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

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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.

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