. 2021 Dec 18;18(24):13351. doi: 10.3390/ijerph182413351

Table 5.

Summary of evidence regarding the efficacy of exercise-based interventions on ACL injury incidence and risk factors of ACL injury coming from randomized-controlled trials and nonrandomized studies.

Injury Incidence	Risk Factors of ACL Injury
FIFA 11+ [56,57] and PEP Program [53] appears to be effective at reducing ACL injury incidence. FIFA 11+ still present some pitfalls that restricts its implementation in football teams due to duration, boredom and soreness issues [85,86]. The programme proposed by Krutsch et al. [55] appears to be an effective and feasible option to decrease severe knee injuries, but should be further investigated through a RCT specifically investigating ACL incidence. The high sample size or time needed to permit a high ACL injury occurrence which satisfies statistical power is extremely difficult to achieve [53], and thus, complicating the development of rigorous intervention studies investigating their effect in ACL injury incidence.	FIFA 11+ may be effective by eliciting positive adaptations in terms of balance [60,65] or dynamic stabilization [73], but not in mobility, asymmetry in hop tests [60], fundamental movement patterns [78] or biomechanics of jump landing tasks [59] in adult football players. The core stability programme proposed by Dello Iacono et al. [65] seems to be effective at either improving H/Q ratio and GRF asymmetry during CMJ. The balance programme proposed by Gioftsidou et al. [68] may be effective at eliciting moderate to large improvements in balance. The TM program proposed by Dos’Santos et al [66] appears to be effective at improving both performance and movement quality of cutting actions (main mechanism of ACL injuries [18]). All of the above interventions appear to provide the best effectiveness/feasibility balance to be implemented in the real soccer context, although they should be further explored through low risk of bias RCT designs.

Injury Incidence

Risk Factors of ACL Injury

FIFA 11+ [56,57] and PEP Program [53] appears to be effective at reducing ACL injury incidence.
FIFA 11+ still present some pitfalls that restricts its implementation in football teams due to duration, boredom and soreness issues [85,86].
The programme proposed by Krutsch et al. [55] appears to be an effective and feasible option to decrease severe knee injuries, but should be further investigated through a RCT specifically investigating ACL incidence.
The high sample size or time needed to permit a high ACL injury occurrence which satisfies statistical power is extremely difficult to achieve [53], and thus, complicating the development of rigorous intervention studies investigating their effect in ACL injury incidence.

FIFA 11+ may be effective by eliciting positive adaptations in terms of balance [60,65] or dynamic stabilization [73], but not in mobility, asymmetry in hop tests [60], fundamental movement patterns [78] or biomechanics of jump landing tasks [59] in adult football players.
The core stability programme proposed by Dello Iacono et al. [65] seems to be effective at either improving H/Q ratio and GRF asymmetry during CMJ.
The balance programme proposed by Gioftsidou et al. [68] may be effective at eliciting moderate to large improvements in balance.
The TM program proposed by Dos’Santos et al [66] appears to be effective at improving both performance and movement quality of cutting actions (main mechanism of ACL injuries [18]).
All of the above interventions appear to provide the best effectiveness/feasibility balance to be implemented in the real soccer context, although they should be further explored through low risk of bias RCT designs.

ACL anterior cruciate ligament, CMJ countermovement jump, GRF ground reaction force, H/Q hamstrings to quadriceps, RCT randomized controlled trial, TM technique modification.