Age-moderating effects and training characteristics of neuromuscular training for preventing knee injuries: a systematic review and meta-analysis.

Knee injuries are common in sport, and neuromuscular training programs, which combine exercises targeting balance, landing mechanics, strength, and agility, are widely used to try to prevent them. A key open question has been whether these programs work equally well across age groups and whether specific training features matter. This review pooled thirty studies and found that neuromuscular training reduced knee injury risk overall, with protective effects seen in athletes both older and younger than eighteen, and no clear evidence that age changed the benefit. Program characteristics seemed to matter more than age: programs combining three or more training components, and those following a standardized protocol, showed significant risk reduction, while simpler or non-standardized programs did not clearly do so.

However, the authors describe these component and dose-related comparisons as exploratory, and heterogeneity across studies was moderate, so the findings on ideal program structure should be read as suggestive rather than settled.

If you play sport, you may have heard about training programs designed to lower the chance of knee injuries, things like balance work, jump-landing practice, and strength exercises. This review pulled together thirty existing studies to see how well these programs actually work, and whether they help differently depending on a person's age. The overall finding was reassuring in direction: athletes who did neuromuscular training had a lower risk of knee injury than those who did not, and this held true both for athletes under eighteen and those over eighteen, with no clear sign that age changed how much the training helped.

Programs that combined several types of training and followed a set, standardized structure appeared to work better than simpler or looser ones, though the researchers note this particular comparison was more exploratory and less certain. Because this is a summary of many different studies with varying quality and designs, and moderate differences between them, the exact best way to structure a program is still not firmly established.

This is a summary of research, not medical advice. Talk to your own healthcare provider about anything affecting your care.

This meta-analysis addresses whether neuromuscular training reduces knee injury risk consistently across age groups and which program features are associated with stronger effects, questions relevant when adapting injury prevention protocols for younger versus adult athletes. Pooling thirty studies, the analysis found a significant overall reduction in knee injury risk with neuromuscular training (effect estimate 0.670, 95% CI 0.547 to 0.820), with protective effects in both those aged eighteen or younger (0.718) and those older (0.566) and no significant between-subgroup difference, suggesting age itself is not a major moderator based on the studies included, though heterogeneity was moderate (I² = 58.5%). Among training characteristics, multicomponent programs (three or more elements) and standardized protocols showed significant risk reduction, while programs with fewer components or lacking standardization did not reach significance, and the between-subgroup difference for the component count was itself only modestly significant.

Dose patterns (15 to 20 minutes per session, two to three sessions weekly, durations beyond twenty-five weeks) appeared relatively stable but differences between dose subgroups were not statistically significant. The authors explicitly flag these program-structure and dose findings as exploratory, so clinicians should treat them as hypothesis-generating rather than a validated blueprint, particularly given risk-of-bias concerns inherent across the included primary studies.