Injury risk reduction programs including balance training reduce the incidence of anterior cruciate ligament injuries in soccer players: a systematic review and meta-analysis.

Background: Anterior cruciate ligament (ACL) injuries are exceedingly common among soccer players and severely impact their careers and health. This study evaluates the effects of injury risk reduction programs, including balance training exercises, on the incidence of ACL injuries in soccer players through a meta-analysis. The aim is to promote the health of soccer players, enhance their athletic performance, and provide valuable insights for further research in the field of sports medicine.

Methods: This study strictly adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was conducted through PubMed, EBSCO, and Web of Science databases, covering all entries from the inception of the databases until February 2024.

Results: Eligible studies were individually assessed using the Cochrane Risk of Bias Tool version 2, and the quality of the evidence obtained was rigorously evaluated using the GRADE approach. Data analysis and processing were performed using Stata 18 software. Eight studies were ultimately selected for inclusion in the meta-analysis, encompassing 20,336 participants and 1,512,099 exposure hours, with 190 cases of ACL injuries identified among soccer players. The pooled results indicated that, compared to the control group, groups using injury risk reduction programs that included balance training had a 58% reduction in the overall rate of ACL injuries per 1,000 exposure hours (IRR 0.42, 95% CI: 0.27 to 0.66). The overall study heterogeneity was low, with an Ivalue of 33.3% and a P-value of 0.186. Subgroup analyses showed that in trials involving male participants, the rate of ACL injuries per 1,000 exposure hours was reduced by 50% compared to the control group (IRR 0.50, 95% CI: 0.29 to 0.88), with an I value of 44.8% and P = 0.178. In trials involving female participants, ACL injuries were reduced by 61% (IRR 0.39, 95% CI: 0.24 to 0.62), with an I value of 42.5% and P = 0.157. In trials with participants training less than three times per week, ACL injuries were reduced by 43% per 1,000 exposure hours compared to the control group (IRR 0.57, 95% CI: 0.35 to 0.93), with an I value of 0.00% and P = 0.727. In trials with participants training three times or more per week, ACL injuries were reduced by 57% (IRR 0.43, 95% CI: 0.21 to 0.88), with an I value of 28.2% and P = 0.238. In trials with participants training for 20 min or more per week, the rate of ACL injuries per 1,000 exposure hours was reduced by 50% compared to the control group (IRR 0.50, 95% CI: 0.26 to 0.93), with an I value of 1.2% and P = 0.363. In trials with participants training less than 20 min per week, ACL injuries were reduced by 46% (IRR 0.54, 95% CI: 0.33 to 0.91), with an I value of 0.00% and P = 0.544.

Conclusion: In summary, injury risk reduction programs that include balance training significantly reduce the risk of ACL injuries in soccer players. The reduction in injuries is more pronounced in female athletes, and high-frequency training along with longer-duration interventions further enhance the preventative effects.