Exercise interventions improve landing error scoring system scores in athletes: a systematic review and meta‑analysis

The landing error scoring system (LESS) is a critical tool for evaluating jump-landing biomechanics in athletes, particularly for identifying movement patterns that may increase the risk of non‑contact injuries such as anterior cruciate ligament (ACL) injuries. This systematic review aimed to examine the effects of various exercise interventions on improving LESS scores among athletes. Comprehensive searches of PubMed, Web of Science, Scopus, and Embase were performed from database inception through June 2025. Two independent reviewers screened for studies reporting the effects of exercise interventions on LESS. We extracted data on each study's design, athletic discipline, exercise modality, intervention parameters (duration and session frequency), and participants' demographic characteristics. Study quality was assessed using the Downs & Black checklist. Meta-analyses were conducted in RevMan 5.4 using a random-effects model to calculate mean differences (MD) with 95% confidence intervals (CI) and generate forest plots, and overall evidence certainty was graded via GRADE. Twenty-four trials (total n = 1,153; mean age 15 years; 51.8% female) met inclusion criteria. Intervention categories comprised integrated neuromuscular training (12 studies), SportsMetrics™ training (4 studies), FIFA 11+ (3 studies), TRX-based training (2 studies), and four studies evaluating other exercise interventions. Integrated neuromuscular training yielded significantly lower LESS scores (MD = 2.40; 95% CI 1.17-3.63; P < 0.001; I² = 51%), as did SportsMetrics™ (MD = 2.99; 95% CI 2.07-3.91; P < 0.001; I² = 0%). The results of FIFA 11 + interventions were heterogeneous. Structured multimodal neuromuscular interventions, particularly those incorporating progressive plyometric training, appear effective for improving LESS scores and landing mechanics in athletes. However, the current evidence supports improvements in biomechanical risk markers rather than direct reductions in ACL injury incidence. Future studies should determine whether improvements in LESS scores translate into meaningful reductions in ACL injury risk.