Effect of the FIFA 11+ on anterior cruciate ligament injury incidence rates in collegiate female football players over three consecutive seasons

BACKGROUND: This non-randomized controlled trial aimed to investigate the preventive effects of the FIFA 11+ on anterior cruciate ligament (ACL) injury incidence rates in collegiate female football players in terms of intervention duration (one-season and over three consecutive seasons). METHODS: A total of 763 collegiate female football players from seven teams belonging to Kanto University Women's Football Association Division 1 during 2013-2015 were included in the study. At the study's start (2013), 235 players from seven teams were assigned to the FIFA 11+ intervention (four teams, n = 115) and control groups (three teams, n = 120). The intervention period was from 2013 to 2015, and the allocated players were followed over three seasons. The one-season effect of the FIFA 11+ was investigated after each season, and the effect of continuous intervention was assessed in players who participated in all three seasons (N.=66 and 62 from the intervention and control groups). RESULTS: The one-season intervention showed no significant differences between the two groups in any season. In contrast, the intervention over three consecutive seasons showed a significantly lower incidence rate of ACL injuries in the intervention group compared to the control group (noncontact injuries: hazard ratio, 0.192 [95% CI, 0.041-0.896]; P=0.036). CONCLUSIONS: These findings suggest that the FIFA 11+ is an effective program for ACL injury prevention in collegiate female football players, and the beneficial effect can be expected when the program is implemented for at least three consecutive seasons.