Effects of sportsmetrics training on biomechanical and functional performance outcomes related to ACL injury risk: a systematic review and meta-analysis

Background This meta-analysis aimed to evaluate the effects of SportsMetrics training (SMT) on ACL injury-related biomechanical deficits and functional performance outcomes in athletes. Methods Literature searches were conducted in four databases from inception to May 10, 2026. The RoB 2 and ROBINS-I tools were used to assess the risk of bias, while meta-analyses and sensitivity analyses were performed using CMA 4 software. The GRADE approach was applied to evaluate the quality of evidence. Primary outcomes were dynamic knee valgus (DKV) and the Landing Error Scoring System (LESS). Secondary outcomes included core strength, agility, dynamic balance, speed, and power. Results Nine studies (310 athletes, predominantly female) were included. SMT was associated with changes in surrogate biomechanical outcomes, including DKV (SMD: -1.09, p < 0.0001) and LESS (SMD: -1.08, p < 0.0001), as well as functional performance outcomes: agility, dynamic balance, power, and speed. Core strength (SMD: 0.57, p = 0.154) showed non-significant changes. Conclusions SMT was associated with improvements in several biomechanical and functional outcomes. Higher-quality RCTs and prospective injury registration outcomes are required to confirm these findings. However, the relationship between improvements in these surrogate outcomes and actual ACL injury reduction remains unestablished. Trial registration This study was a priori registered at PROSPERO (CRD420261389110).