Silvers-Granelli Holly J, Bizzini Mario, Arundale Amelia, Mandelbaum Bert R, Snyder-Mackler Lynn
Biomechanics and Movement Science Program, University of Delaware, Newark, DE, USA.
Velocity Physical Therapy, 11611 San Vicente Boulevard, GF-1, Los Angeles, CA, 90049, USA.
Clin Orthop Relat Res. 2017 Oct;475(10):2447-2455. doi: 10.1007/s11999-017-5342-5.
The FIFA 11+ injury prevention program has been shown to decrease the risk of soccer injuries in men and women. The program has also been shown to decrease time loss resulting from injury. However, previous studies have not specifically investigated how the program might impact the rate of anterior cruciate ligament (ACL) injury in male soccer players.
QUESTIONS/PURPOSES: The purpose of this study was to examine if the FIFA 11+ injury prevention program can (1) reduce the overall number of ACL injuries in men who play competitive college soccer and whether any potential reduction in rate of ACL injuries differed based on (2) game versus practice setting; (3) player position; (4) level of play (Division I or II); or (5) field type.
This study was a prospective cluster randomized controlled trial, which was conducted in 61 Division I and Division II National Collegiate Athletic Association men's soccer teams over the course of one competitive soccer season. The FIFA 11+ is a 15- to 20-minute on-the-field dynamic warm-up program used before training and games and was utilized as the intervention throughout the entire competitive season. Sixty-five teams were randomized: 34 to the control group (850 players) and 31 to the intervention group (675 players). Four intervention teams did not complete the study and did not submit their data, noting insufficient time to complete the program, reducing the number for per-protocol analysis to 61. Compliance to the FIFA 11+ program, athletic exposures, specific injuries, ACL injuries, and time loss resulting from injury were collected and recorded using a secure Internet-based system. At the end of the season, the data in the injury surveillance system were crosshatched with each individual institution's internal database. At that time, the certified athletic trainer signed off on the injury collection data to confirm their accuracy and completeness.
A lower proportion of athletes in the intervention group experienced knee injuries (25% [34 of 136]) compared with the control group (75% [102 of 136]; relative risk [RR], 0.42; 95% confidence interval [CI], 0.29-0.61; p < 0.001). When the data were stratified for ACL injury, fewer ACL injuries were reported in the intervention group (16% [three of 19]) compared with the control group (84% [16 of 19]), accounting for a 4.25-fold reduction in the likelihood of incurring ACL injury (RR, 0.236; 95% CI, 0.193-0.93; number needed to treat = 70; p < 0.001). With the numbers available, there was no difference between the ACL injury rate within the FIFA 11+ group and the control group with respect to game and practice sessions (games-intervention: 1.055% [three of 15] versus control: 1.80% [12 of 15]; RR, 0.31; 95% CI, 0.09-1.11; p = 0.073 and practices-intervention: 0% [zero of four] versus control: 0.60% [four of four]; RR, 0.14; 95% CI, 0.01-2.59; p = 0.186). With the data that were available, there were no differences in incidence rate (IR) or injury by player position for forwards (IR control = 0.339 versus IR intervention = 0), midfielders (IR control = 0.54 versus IR intervention = 0.227), defenders (IR control = 0.339 versus IR intervention = 0.085), and goalkeepers (IR control = 0.0 versus IR intervention = 0.0) (p = 0.327). There were no differences in the number of ACL injuries for the Division I intervention group (0.70% [two of nine]) compared with the control group (1.05% [seven of nine]; RR, 0.30; CI, 0.06-1.45; p = 0.136). However, there were fewer ACL injuries incurred in the Division II intervention group (0.35% [one of 10]) compared with the control group (1.35% [nine of 10]; RR, 0.12; CI, 0.02-0.93; p = 0.042). There was no difference between the number of ACL injuries in the control group versus in the intervention group that occurred on grass versus turf (Wald chi square [1] = 0.473, b = 0.147, SE = 0.21, p = 0.492). However, there were more ACL injuries that occurred on artificial turf identified in the control group (1.35% [nine of 10]) versus the intervention group (0.35% [one of 10]; RR, 0.14; 95% CI, 0.02-1.10; p = 0.049).
This program, if implemented correctly, has the potential to decrease the rate of ACL injury in competitive soccer players. In addition, this may also enhance the development and dissemination of injury prevention protocols and may mitigate risk to athletes who utilize the program consistently. Further studies are necessary to analyze the cost-effectiveness of the program implementation and to analyze the efficacy of the FIFA 11+ in the female collegiate soccer cohort.
Level I, therapeutic study.
国际足联11+预防损伤计划已被证明可降低男女足球运动员受伤的风险。该计划还被证明可减少因受伤导致的缺赛时间。然而，以往研究尚未具体调查该计划对男性足球运动员前交叉韧带（ACL）损伤发生率的影响。
问题/目的：本研究的目的是检验国际足联11+预防损伤计划能否（1）减少参加大学竞技足球比赛的男性运动员ACL损伤的总数，以及ACL损伤发生率的任何潜在降低是否因（2）比赛与训练环境；（3）球员位置；（4）比赛水平（一级或二级）；或（5）场地类型而有所不同。
本研究是一项前瞻性整群随机对照试验，在61支一级和二级美国国家大学生体育协会男子足球队的一个竞技足球赛季中进行。国际足联11+是一个在训练和比赛前进行的15至20分钟的场上动态热身计划，在整个竞技赛季中用作干预措施。65支球队被随机分组：34支进入对照组（850名球员），31支进入干预组（675名球员）。4支干预组球队未完成研究且未提交数据，称没有足够时间完成该计划，使得符合方案分析的数量减少至61支。使用一个安全的基于互联网的系统收集并记录对国际足联11+计划的依从性、运动暴露、特定损伤、ACL损伤以及因伤导致的缺赛时间。赛季结束时，将损伤监测系统中的数据与每个机构的内部数据库进行交叉核对。此时，认证的运动训练师对损伤收集数据进行签字确认，以确保其准确性和完整性。
与对照组（75%[136人中的102人]）相比，干预组中经历膝关节损伤的运动员比例更低（25%[136人中的34人]）；相对风险（RR）为0.42；95%置信区间（CI）为0.29 - 0.61；p < 0.001）。当对ACL损伤数据进行分层时，干预组报告的ACL损伤较少（16%[19人中的3人]），而对照组为（84%[19人中的16人]），ACL损伤发生可能性降低了4.25倍（RR，0.236；95%CI，0.193 - 0.93；需治疗人数 = 70；p < 0.001）。就现有数据而言，国际足联11+组和对照组在比赛和训练环节的ACL损伤发生率没有差异（比赛 - 干预组：1.055%[15人中的3人]对对照组：1.80%[15人中的12人]；RR，0.31；95%CI，0.09 - 1.11；p = 0.073；训练 - 干预组：0%[4人中的0人]对对照组：0.60%[4人中的4人]；RR，0.14；95%CI，0.01 - 2.59；p = 0.186）。就现有数据而言，前锋（对照组发生率 = 0.339对干预组 = 0）、中场球员（对照组发生率 = 0.54对干预组 = 0.227）、后卫（对照组发生率 = 0.339对干预组 = 0.085）和守门员（对照组发生率 = 0.0对干预组 = 0.0）的发生率或损伤情况在球员位置方面没有差异（p = 0.327）。一级干预组的ACL损伤数量（0.70%[9人中的2人]）与对照组（1.05%[9人中的7人]）相比没有差异（RR，0.30；CI，0.06 - 1.45；p = 0.136）。然而，二级干预组的ACL损伤数量（0.35%[10人中的1人]）少于对照组（1.35%[10人中的9人]；RR，0.12；CI，0.02 - 0.93；p = 0.042）。对照组与干预组在天然草坪与人工草皮上发生的ACL损伤数量没有差异（Wald卡方检验[1] = 0.473，b = 0.147，标准误 = 0.21，p = 0.492）。然而，对照组中在人工草皮上发生的ACL损伤更多（1.35%[10人中的9人]），而干预组为（0.35%[10人中的1人]；RR，0.14；95%CI，0.02 - 1.10；p = 0.049）。
该计划若正确实施，有可能降低竞技足球运动员的ACL损伤发生率。此外，这也可能促进损伤预防方案的发展和传播，并可能降低持续使用该计划的运动员的风险。有必要进一步研究该计划实施的成本效益，并分析国际足联11+在女子大学足球群体中的效果。
一级，治疗性研究。
