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Implementation of the FIFA 11+ Injury Prevention Program by High School Athletic Teams Did Not Reduce Lower Extremity Injuries: Letter to the Editor

Dear Editor: First and foremost, I would like to commend the authors Slauterbeck et al for their work ‘‘Implementation of the FIFA 111 Injury Prevention Program by High School Athletic Teams Did Not Reduce Lower Extremity Injuries: A Cluster Randomized Controlled Trial,’’ which was published in the October 2019 edition of the American Journal of Sports Medicine. A study of this magnitude takes tremendous organization and effort, and the importance to our understanding of injury prevention cannot be understated. However, I am writing to caution readers in their interpretation of the data provided by this study. The authors randomized high school male and female athletes in a variety of sports to either a standard preparticipation warm-up or the FIFA 111 injury prevention program and sought to determine if this variable affected lower extremity injury rates. Based on their data, they concluded that the FIFA 111 program ‘‘did not demonstrate a reduction in lower extremity injuries in schools randomized to use the FIFA 111 program compared with schools using their usual pre-practice warm-up program.’’ These results deviate substantially from previous level 1 studies on the subject matter, which have demonstrated a substantial benefit from injury prevention programs, including the FIFA 111. When faced with an outlier in the literature, it is incumbent upon surgeons to carefully dissect the methods of such a study to verify its validity. The present study pools all lower extremity injuries into their results, including fractures, bruises, contusions, and hematomas. The reported goal of the FIFA 111 is to reduce lower extremity injury rates. More specifically, this program is designed to reduce noncontact ACL tears through neuromuscular reeducation. The program is not equipped to protect athletes from contact-related trauma and, therefore, studies that include these injuries do not accurately reflect the efficacy of this program. In summation, I believe the present study provides us with an important understanding of the limitations of the FIFA 111 program, rather than its true value. Studies aiming to assess the efficacy of injury prevention programs should remain focused on noncontact knee injuries.