1 Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
2 Division of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada.
3 McGill University, Montreal, Quebec, Canada.
4 Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada.

Background: Anterior cruciate ligament (ACL) injuries can pose significant challenges for athletes, leading to significant morbidity, loss of playing time, and impaired performance. Neuromuscular training programs, such as the FIFA 11+, have shown promise in reducing the risk of lower extremity injuries in this high-risk population.

Purpose/hypothesis: The purpose of this study was to evaluate the effect of the FIFA 11+ program on lower extremity biomechanics during a drop vertical jump (DVJ) and to determine whether it modifies the athlete's risk of an ACL injury. It was hypothesized that the FIFA 11+ program would positively affect lower limb biomechanics during a DVJ in varsity athletes by decreasing initial coronal (IC) and peak coronal (PC) knee abduction angles while increasing peak sagittal (PS) knee flexion angles.

Study design: Cohort study; Level of evidence, 2.

Methods: A total of 36 collegiate varsity athletes (72 knees) were recruited for this investigation. The intervention group included female and male soccer players who incorporated the FIFA 11+ program into their pregame warm-up. The control group consisted of female hockey players who participated in a "standard" warm-up. The FIFA 11+ program was conducted twice weekly over 10 weeks. Biomechanical data before and after the intervention during DVJs, captured using a motion sensor, were compared between the intervention and control groups.

Results: The intervention group showed a significant reduction in PC angles from high risk to low risk and a significant decrease in PS angles, while IC angles remained unchanged. Conversely, the control group showed a significant increase in IC angles from low risk to high risk, with no notable changes in PC and PS angles.

Conclusion: This study demonstrated that the FIFA 11+ program effectively reduced PC knee abduction angles, with a decrease in this parameter indicating an overall shift from high- to low-risk biomechanics in the intervention group. Additionally, worsening postseason knee biomechanics in the control group highlighted that the injury risk increased throughout the season when a targeted neuromuscular training program was not incorporated into pregame warm-ups. This suggests that the FIFA 11+ program mitigates key biomechanical risk factors for noncontact ACL injuries.