Review ArticleOpen Access

Neuromuscular Rehabilitation in the Prevention of Anterior Cruciate Ligament Injury in Children and Adolescents

···
DOI: 10.23958/ijirms/vol10-i06/2079· Pages: 223 - 229· Vol. 10, No. 06, (2025)· Published: June 5, 2025
PDF
Views: 4,256 PDF downloads: 603

Abstract

Introduction: Knee injuries are increasingly common in the pediatric population, with anterior cruciate ligament (ACL) ruptures standing out due to their rising incidence in children and adolescents. These injuries are associated with significant clinical and functional consequences, such as the need for surgical intervention, lengthy rehabilitation, low return-to-sport rates, high re-injury risk, and early-onset osteoarthritis. They may also impact school performance. This study aims to evaluate the effectiveness of neuromuscular training (NMT) programs in preventing ACL injuries in young populations and to identify the most effective protocols, components, and contributing factors. Methods: A systematic review was conducted following PRISMA guidelines using PubMed, Embase, and Web of Science, covering studies from 2014 to 2024. The selection followed the PICO framework, focusing on individuals under 18 years old receiving neuromuscular or proprioceptive training, compared to control groups or studies analyzing biomechanical risk factors. Only peer-reviewed articles in English or Portuguese were included. Two independent reviewers screened studies, extracted data, and assessed quality. Outcomes evaluated were ACL injury incidence and biomechanical risk factors. Results: Of the 64 initially identified articles, 9 met the inclusion criteria3 systematic reviews and 6 original studies. The systematic reviews highlighted significant reductions in ACL injury rates and emphasized the influence of sport type and external factors. The original studies reported improvements in neuromuscular and biomechanical control following NMT protocols. Conclusions: NMT was shown to be effective, particularly when introduced early in youth. Key factors for successful implementation include exercise variety, sensory feedback, and professional supervision. Additionally, unstructured play may contribute to natural protective adaptations. Future research should refine and personalize preventive strategies.

Keywords

Neuromuscular trainingProprioceptionAnterior Cruciate Ligament injuryChildrenAdolescentsPrevention

References

  1. Bulow A, Anderson JE, Leiter JRS, et al. Safety and Effectiveness of a Perturbation-based Neuromuscular Training Program on Dynamic Balance in Adolescent Females: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF SPORTS PHYSICAL THERAPY 2021;16(4):1001-1015, doi:10.26603/001c.25685DOI ↗Google Scholar ↗
  2. Sanders TL, Maradit Kremers H, Bryan AJ, et al. Incidence of Anterior Cruciate Ligament Tears and Reconstruction: A 21-Year Population-Based Study. The American Journal of Sports Medicine 2016;44(6):1502-1507, doi:10.1177/0363546516629944DOI ↗Google Scholar ↗
  3. Gianotti SM, Marshall SW, Hume PA, et al. Incidence of anterior cruciate ligament injury and other knee ligament injuries: A national population-based study. Journal of Science and Medicine in Sport 2009;12(6):622-627, doi:10.1016/j.jsams.2008.07.005DOI ↗Google Scholar ↗
  4. Murray JJ, Renier CM, Ahern JJ, et al. Neuromuscular Training Availability and Efficacy in Preventing Anterior Cruciate Ligament Injury in High School Sports: A Retrospective Cohort Study. Clin J Sport Med 2017;27(6):524-529, doi:10.1097/jsm.0000000000000398DOI ↗Google Scholar ↗
  5. Petushek EJ, Sugimoto D, Stoolmiller M, et al. Evidence-Based Best-Practice Guidelines for Preventing Anterior Cruciate Ligament Injuries in Young Female Athletes: A Systematic Review and Meta-analysis. AMERICAN JOURNAL OF SPORTS MEDICINE 2019;47(7):1744-1753, doi:10.1177/0363546518782460DOI ↗Google Scholar ↗
  6. Lindblom H, Waldén M, Carlfjord S, et al. Limited positive effects on jump-landing technique in girls but not in boys after 8 weeks of injury prevention exercise training in youth football. Knee Surg Sports Traumatol Arthrosc 2020;28(2):528-537, doi:10.1007/s00167-019-05721-xDOI ↗Google Scholar ↗
  7. Noyes FR, Barber-Westin SD. Neuromuscular Retraining Intervention Programs: Do They Reduce Noncontact Anterior Cruciate Ligament Injury Rates in Adolescent Female Athletes? ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY 2014;30(2):245-255, doi:10.1016/j.arthro.2013.10.009DOI ↗Google Scholar ↗
  8. Willadsen EM, Zahn AB, Durall CJ. What Is the Most Effective Training Approach for Preventing Noncontact ACL Injuries in High School-Aged Female Athletes? JOURNAL OF SPORT REHABILITATION 2019;28(1):94-98, doi:10.1123/jsr.2017-0055DOI ↗Google Scholar ↗
  9. Diekfuss JA, Grooms DR, Bonnette S, et al. Real-time biofeedback integrated into neuromuscular training reduces high-risk knee biomechanics and increases functional brain connectivity: A preliminary longitudinal investigation. Psychophysiology 2020;57(5):e13545, doi:10.1111/psyp.13545DOI ↗Google Scholar ↗
  10. Hübscher M, Zech A, Pfeifer K, et al. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc 2010;42(3):413-21, doi:10.1249/MSS.0b013e3181b88d37DOI ↗Google Scholar ↗
  11. García-Luna MA, Cortell-Tormo JM, García-Jaén M, et al. Acute Effects of ACL Injury-Prevention Warm-Up and Soccer-Specific Fatigue Protocol on Dynamic Knee Valgus in Youth Male Soccer Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020;17(15), doi:10.3390/ijerph17155608DOI ↗Google Scholar ↗
  12. Grooms DR, Diekfuss JA, Slutsky-Ganesh AB, et al. Preliminary Report on the Train the Brain Project, Part II: Neuroplasticity of Augmented Neuromuscular Training and Improved Injury-Risk Biomechanics. J Athl Train 2022;57(9-10):911-920, doi:10.4085/1062-6050-0548.21DOI ↗Google Scholar ↗
  13. Larwa J, Stoy C, Chafetz RS, et al. Stiff Landings, Core Stability, and Dynamic Knee Valgus: A Systematic Review on Documented Anterior Cruciate Ligament Ruptures in Male and Female Athletes. Int J Environ Res Public Health 2021;18(7), doi:10.3390/ijerph18073826DOI ↗Google Scholar ↗
  14. Ginsburg KR, Communications atCo, Health atCoPAoCaF. The Importance of Play in Promoting Healthy Child Development and Maintaining Strong Parent-Child Bonds. Pediatrics 2007;119(1):182-191, doi:10.1542/peds.2006-2697DOI ↗Google Scholar ↗
  15. Nijhof SL, Vinkers CH, van Geelen SM, et al. Healthy play, better coping: The importance of play for the development of children in health and disease. Neurosci Biobehav Rev 2018;95(421-429, doi:10.1016/j.neubiorev.2018.09.024DOI ↗Google Scholar ↗
  16. Prins J, van der Wilt F, van der Veen C, et al. Nature play in early childhood education: A systematic review and meta ethnography of qualitative research. Front Psychol 2022;13(995164, doi:10.3389/fpsyg.2022.995164DOI ↗Google Scholar ↗
Author details
Manuel Pina Câmara
Faculdade de Medicina, Universidade de Coimbra, Portugal.
✉ Corresponding Author
👤 View Profile →
João Páscoa Pinheiro, MD, PhD
Faculdade de Medicina, Universidade de Coimbra, Portugal.
👤 View Profile →
Pedro Figueiredo, MD, PhD
Faculdade de Medicina, Universidade de Coimbra, Portugal. Serviço de Medicina Física e Reabilitação - Unidade Local de Saúde de Coimbra, Portugal.
👤 View Profile →
João Paulo Branco, MD, PhD
Faculdade de Medicina, Universidade de Coimbra, Portugal. Serviço de Medicina Física e Reabilitação - Unidade Local de Saúde de Coimbra, Portugal.
👤 View Profile →🔗 Is this you? Claim this publication