## 4 Discussion
### Changes in the Landing Error Scoring System  
The LESS is a clinical assessment tool that is often used in research to explore the effectiveness of injury prevention programs on the presence of landing movement \"errors\" that have been linked to non-contact ACL injury [45; 46; 61; 62]. In our study, there were significant differences between EG and CG pre- and post-intervention scores (\(p\) = 0.008 and 0.003, respectively). The median pre-intervention LESS scores of the EG (5.00 errors) are similar to typical LESS scores of young female healthy populations [63]. However, the pre-intervention means the LESS scores of the CG are higher (7.33 errors) compared to similar populations [63]. According to the research [48; 63], the LESS scores can be influenced by age, sex, previous injury, or neuromuscular training programs. Both groups in the current study included only females, with similar mean ages (EG: 20.05 \(\pm\) 4.43, CG: 20.04 \(\pm\) 4.88), participating in the same sport and competition level. Only serious knee injuries were tracked over 6 months prior to testing, and previous experiences with neuromuscular training programs were not explored. It is possible that participants in the CG have experienced more knee injuries in the preceding 6 months, had suffered more injuries to other segments of the lower limb, e.g., hip and ankle, and therefore presented with greater high-risk movement patterns according to the LESS. According to the results, the mean difference between pre- and post-intervention LESS scores was greater in the EG compared to the CG (0.50 and 0.17 errors, respectively); however, the difference between pre- and post-intervention scores was not significant in the EG nor in CG (\(p\) = 0.366 and 0.906, respectively). According to the meta-analysis [63], neuromuscular intervention training programs completed two to three times per week and lasting a minimum of six weeks improved significantly and meaningfully LESS scores by 1.2 errors (\(p\) < 0.001) and also were proven to reduce the ACL injury rates [64]. The Knee RugbyWoman injury prevention program explored in this study was performed two times a week for 12 weeks; however, the mean LESS scores did not significantly decrease in the EG. The most effective programs for improving LESS scores emphasized movement control, technique feedback, plyometrics, strength, agility and core stability exercises [45; 62]. Similarly, the meta-analysis exploring the effect of interventional training programs on ACL injury in females highlighted the importance of plyometric and technique feedback [64]. The Knee RugbyWoman program incorporated balance, strength, and psychometric exercises in four different difficulty levels (Table 1). The athletes needed to perform the exercise with a good technique to be able to move to the next difficulty level. However, agility exercises were not included in the Knee RugbyWoman program. Moreover, the effect of the intervention program on LESS scores was explored mainly in non-contact, jumping and cutting sports such as basketball or soccer [63]. These sports differ from rugby, and therefore the LESS testing may not be ideal, given rugby is not a jump-landing sport. Lastly, the LESS screening task used for testing differs from the one suggested by [PERSON] et al. [46]. In this study, the SL CMJ after two steps was used instead of a double-leg vertical jump from a 30-cm box as described in the original protocol [46]. A criticism of the original LESS screening task is that it is not challenging enough or reflective of common sports movements [65; 66]. Therefore, we modified this task to be a more sport-specific alternative, which is common in rugby and was used for LESS testing in previous studies [48; 67]. The current findings could be influenced by the level of performance, age, and gender, the total number of training sessions [14], the overall program duration [32; 68], the frequency [44; 69] or the quality of exercise execution, especially landing [31].