Age-related differences in the effectiveness of neuromuscular training for preventing anterior cruciate ligament injuries in athletes: a systematic review and meta-analysis

Objective Anterior cruciate ligament (ACL) injuries are common in competitive sports and may lead to long-term functional impairment and substantial career burden. Neuromuscular training (NMT) has been proposed to reduce the risk of ACL injury; however, whether its preventive effectiveness differs by age remains controversial. This systematic review and meta-analysis quantitatively evaluated the protective effects of NMT across different age groups. Methods Five databases were systematically searched for studies evaluating the effect of NMT on the incidence of ACL injury. Pooled effects were synthesized using random-effects models and reported as odds ratios (ORs) with 95% confidence intervals (CIs). Age-stratified subgroup analyses and meta-regression (using the study-level mean age as a continuous moderator) were conducted to explore potential age-related differences in effectiveness. Results A total of 19 studies met the inclusion criteria and contributed to the primary meta-analysis. The random-effects meta-analysis showed that NMT significantly reduced ACL injury risk (OR = 0.456, 95% CI: 0.331–0.627, p < 0.001; I 2 = 14.9%). In age-stratified analyses, the effect was significant in athletes aged