{
  "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.",
  "authors": [
    {
      "affiliations": [
        "Department of Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA",
        "Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA"
      ],
      "name": "Garrett S Bullock"
    },
    {
      "affiliations": [
        "Elon University, Elon, North Carolina, USA"
      ],
      "name": "Anu M Räisänen"
    },
    {
      "affiliations": [
        "UNC-Chapel Hill, Chapel Hill, North Carolina, USA"
      ],
      "name": "Chelsea Martin"
    },
    {
      "affiliations": [
        "Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Maitland Martin"
    },
    {
      "affiliations": [
        "Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada",
        "University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Jean-Michel Galarneau"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada",
        "Arthritis Research Canada, Vancouver, British Columbia, Canada"
      ],
      "name": "Jackie L Whittaker"
    },
    {
      "affiliations": [
        "Informatics, Decision-Enhancement, and Analytic Sciences Center of Innovation, George E Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA",
        "Division of Epidemiology, The University of Utah School of Medicine, Salt Lake City, Utah, USA"
      ],
      "name": "Justin M Losciale"
    },
    {
      "affiliations": [
        "Human Performance Lab, Zurich, Switzerland"
      ],
      "name": "Mario Bizzini"
    },
    {
      "affiliations": [
        "Australian Centre for Precision Health and Technology, School of Health Sciences and Social Work, Griffith University–Gold Coast Campus, Gold Coast, Queensland, Australia"
      ],
      "name": "Matthew N Bourne"
    },
    {
      "affiliations": [
        "Department of Medical Education, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar",
        "Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Hendrik Paul Dijkstra"
    },
    {
      "affiliations": [
        "La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia",
        "Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia"
      ],
      "name": "Marc-Olivier Dubé"
    },
    {
      "affiliations": [
        "Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Alix Hayden"
    },
    {
      "affiliations": [
        "La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Victoria, Australia"
      ],
      "name": "Michael Girdwood"
    },
    {
      "affiliations": [
        "Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden"
      ],
      "name": "Martin Hägglund"
    },
    {
      "affiliations": [
        "Discipline of Physiotherapy, School of Allied Health, Australian Catholic University Faculty of Health Sciences, North Sydney, New South Wales, Australia"
      ],
      "name": "Shreya McLeod"
    },
    {
      "affiliations": [
        "Department of Sports, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK",
        "Department of Human Movement Science, Nelson Mandela University, Port Elizabeth, South Africa"
      ],
      "name": "Nonhlanhla Sharon Mkumbuzi"
    },
    {
      "affiliations": [
        "La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia",
        "Australian IOC Research Centre, Melbourne, Victoria, Australia"
      ],
      "name": "Andrea Britt Mosler"
    },
    {
      "affiliations": [
        "School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia"
      ],
      "name": "Myles Calder Murphy"
    },
    {
      "affiliations": [
        "Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway"
      ],
      "name": "Grethe Myklebust"
    },
    {
      "affiliations": [
        "Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway",
        "Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark"
      ],
      "name": "Merete Møller"
    },
    {
      "affiliations": [
        "Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil"
      ],
      "name": "Juliana M Ocarino"
    },
    {
      "affiliations": [
        "Translational Injury Prevention Lab, Physical Therapy and Athletic Training, Saint Louis University, Saint Louis, Missouri, USA"
      ],
      "name": "Oluwatoyosi B A Owoeye"
    },
    {
      "affiliations": [
        "Edinburgh Sports Medicine Research Network, Institute for Sport, PE and Health Sciences, University of Edinburgh, Edinburgh, UK",
        "UK Collaborating Centre on Injury and Illness Prevention in Sport, University of Edinburgh, Edinburgh, UK"
      ],
      "name": "Debbie Palmer"
    },
    {
      "affiliations": [
        "Integrative Neuromuscular Sport Performance Laboratory, University of Calgary, Calgary, Alberta, Canada",
        "Tampere Research Center of Sports Medicine, UKK-instituutti, Tampere, Finland"
      ],
      "name": "Kati Pasanen"
    },
    {
      "affiliations": [
        "La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia"
      ],
      "name": "Ebonie Kendra Rio"
    },
    {
      "affiliations": [
        "Department of Orthopedic Surgery, Copenhagen University Hospital, Rødovre, Denmark"
      ],
      "name": "Kristian Thorborg"
    },
    {
      "affiliations": [
        "General Practice, Erasmus Medical Center, Rotterdam, The Netherlands"
      ],
      "name": "Marienke van Middelkoop"
    },
    {
      "affiliations": [
        "Union of European Football Association, Nyon, Switzerland"
      ],
      "name": "Evert Verhagen"
    },
    {
      "affiliations": [
        "Department of Physical Therapy, Indiana University Indianapolis, Indianapolis, Indiana, USA"
      ],
      "name": "Stuart J Warden"
    },
    {
      "affiliations": [
        "Centre of Medical and Exercise Physiology, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia"
      ],
      "name": "Matthew Whalan"
    },
    {
      "affiliations": [
        "La Trobe University–Bundoora Campus, Bundoora, Victoria, Australia"
      ],
      "name": "Kay M Crossley"
    },
    {
      "affiliations": [
        "Faculty of Kinesiology, Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta, Canada"
      ],
      "name": "Carolyn Emery"
    }
  ],
  "title": "Prevention strategies for lower extremity injury: a systematic review and meta-analyses for the Female, woman and/or girl Athlete Injury pRevention (FAIR) consensus",
  "uid": "f85b4973-586e-55fb-aa1c-a9591fa7e32c"
}