Post Street Orthopaedics and Sports Medicine, San Francisco, California, USA.
Clin J Sport Med. 2013 Sep;23(5):407-8. doi: 10.1097/01.jsm.0000433153.51313.6b.
To evaluate the effectiveness of a neuromuscular warm-up program in preventing acute knee injury in adolescent female football (soccer) players.
Cluster randomized (by team) controlled trial, stratified by geographical district. Sample size was calculated (n = 8118) with 80% power to show a reduction of 50% in an estimated 1.15% annual incidence of anterior cruciate ligament (ACL) injury at P ≤ 0.05.
Clubs in 8 regional districts of the Swedish Football Association, during the 2009 season (April through October).
Female under-14 to under-18 football clubs (ages 12-17 years) were recruited. Reasons for the exclusion of clubs were lack of response, <2 training sessions per week, and the current use of an injury prevention program.
The clubs were randomized to a neuromuscular warm-up intervention (Knäkontroll, SISU Idrottsböcker, Sweden, 2005) or to a control group, who were instructed to continue with their usual training and playing practices. The neuromuscular training program included 6 exercises that focused on knee control and core stability (1- and 2-legged knee squats, a pelvic lift, the bench, the lunge, and jump/landing). The exercises were to be done twice per week and were to take about 15 minutes, after a brief running warm-up. They progressed through 4 levels of difficulty. The team coaches supervised the program after instruction from study therapists.
The primary outcome was the rate of ACL injuries. Diagnosis was confirmed, as appropriate, by a physician and by magnetic resonance imaging. Secondary outcomes were the rates of serious knee injury and any acute knee injury, defined as those with sudden onset during play that led to a player being unable to participate in training or competition. Severe injuries were those that caused absences of >4 weeks. Two study therapists evaluated the injuries. The coaches recorded data, including when the intervention was performed, any injuries, individual playing times, and periods of absence. Assessment of the primary outcome was done by physicians blinded to group assignment.
During 278 298 hours of play, 96 knee injuries occurred in 92 players (intervention group 48, control group 44). The rate did not differ between groups. Of the 21 ACL injuries, 7 occurred in the intervention group and 14 in the control group, giving a rate ratio (RR) of 0.36 (95% confidence interval [CI] 0.15-0.85; P = 0.02). Severe injuries (intervention group 26, control group 31) did not differ between groups. They included 22 collateral or capsular sprains, 21 ACL injuries, 7 patella dislocations or subluxations, 6 meniscal or chondral lesions, and 1 tibial plateau fracture. Compliant players (those who performed ≥ 1 exercise session per week; 1303 players) had a lower rate of ACL injury (RR, 0.17; 95% CI, 0.05-0.57), of severe knee injury (RR, 0.18; 95% CI, 0.07-0.45), and of any acute knee injury (RR, 0.53; 95% CI, 0.30-0.94) than the control group.
A short weekly neuromuscular exercise program reduced the rate of ACL injuries among adolescent female football (soccer) players. Those who were compliant with the intervention had fewer severe knee injuries and fewer injuries overall.
评估神经肌肉热身方案在预防青少年女性足球运动员急性膝伤中的有效性。
按团队（通过团队）进行随机对照试验，按地理区域分层。根据 80%的功效计算样本量（n=8118），以显示在估计每年 1.15%的前交叉韧带（ACL）损伤发生率中降低 50%，置信区间为 P≤0.05。
瑞典足球协会 8 个地区的俱乐部，在 2009 赛季（4 月至 10 月）期间。
招募了 12-17 岁的 14 岁以下至 18 岁以下的女子足球俱乐部。不包括俱乐部的原因是没有回应、每周训练次数少于 2 次，以及当前使用损伤预防方案。
俱乐部被随机分配到神经肌肉热身干预组（Knäkontroll，SISU Idrottsböcker，瑞典，2005 年）或对照组，对照组被指示继续进行常规训练和比赛。神经肌肉训练方案包括 6 项专注于膝关节控制和核心稳定性的练习（单腿和双腿膝关节下蹲、骨盆提升、长凳、下蹲和跳跃/着陆）。这些练习每周进行两次，每次大约需要 15 分钟，在进行简短的跑步热身之后。它们通过 4 个难度级别进行升级。团队教练在研究治疗师的指导下监督该方案。
主要结果是 ACL 损伤的发生率。适当情况下，由医生和磁共振成像（MRI）来确认诊断。次要结果是严重膝关节损伤和任何急性膝关节损伤的发生率，定义为在比赛中突然发生导致运动员无法继续参加训练或比赛的损伤。严重损伤是导致缺席超过 4 周的损伤。两名研究治疗师评估了损伤。教练记录了数据，包括干预措施的执行情况、任何受伤情况、个人比赛时间和缺席时间。对主要结果的评估由对分组分配不知情的医生进行。
在 278 298 小时的比赛中，96 名球员（干预组 48 名，对照组 44 名）发生 92 名球员的 96 次膝伤。两组之间的发生率没有差异。在 21 例 ACL 损伤中，干预组 7 例，对照组 14 例，发生率比为 0.36（95%置信区间[CI]为 0.15-0.85；P=0.02）。严重损伤（干预组 26 例，对照组 31 例）两组之间没有差异。它们包括 22 例外侧或囊韧带扭伤、21 例 ACL 损伤、7 例髌骨脱位或半脱位、6 例半月板或软骨损伤和 1 例胫骨平台骨折。遵守方案的球员（每周至少进行 1 次练习的球员；1303 名球员）ACL 损伤发生率（RR，0.17；95%CI，0.05-0.57）、严重膝关节损伤发生率（RR，0.18；95%CI，0.07-0.45）和任何急性膝关节损伤发生率（RR，0.53；95%CI，0.30-0.94）均低于对照组。
每周进行短暂的神经肌肉运动方案可降低青少年女性足球运动员 ACL 损伤的发生率。遵守该方案的球员严重膝关节损伤和整体损伤更少。
