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Heering T, Rolley TL, Lander N, Fox A, Barnett LM, Duncan MJ. Identifying modifiable risk factors and screening strategies associated with anterior cruciate ligament injury risk in children aged 6 to 13 years: A systematic review. J Sports Sci 2023; 41:1337-1362. [PMID: 37930935 DOI: 10.1080/02640414.2023.2268900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 10/03/2023] [Indexed: 11/08/2023]
Abstract
Growing anterior cruciate ligament (ACL) injury incidence is reported in countries across Europe, North America and in Australia for 5-14-year-olds, yet research on injury risk reduction predominantly focuses on populations aged > 13 years. For injury risk reduction, it is crucial to understand (i) which modifiable risk factors are associated with ACL injury in children (6-13 years) and (ii) how these risk factors are assessed. Articles were grouped according to sex/gender and/or maturational/age differences and examined modifiable risk factors during different physical screening tasks. The included articles (n = 40) predominantly examined intrinsic risk factors in girls aged 10-13 years. Factors mechanically linked to increased ACL loading at this age included increased peak knee adductor moments, knee valgus angles, hip and knee extension, and ground reaction forces. Assessment focused on laboratory-based assessments (e.g., motion capture, force plates). This review concluded that modifiable risk factors are present in children aged 6-13 years and that injury risk reduction strategies should be implemented as early as possible regardless of sex/gender. Further, screening strategies need updating to be childhood specific and feasible for the wide community. Additional research on extrinsic risk factors, norm values and children aged 6-9 years could allow for more targeted risk reduction strategies.
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Affiliation(s)
- Theresa Heering
- Centre of Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
- School of Health and Social Development, Deakin University, Victoria, Australia
| | - Tess L Rolley
- School of Exercise and Nutrition Science, Deakin University, Victoria, Australia
| | - Natalie Lander
- Institute for Physical Activity and Nutrition, Deakin University, Victoria, Australia
| | - Aaron Fox
- School of Exercise and Nutrition Science, Deakin University, Victoria, Australia
| | - Lisa M Barnett
- School of Health and Social Development, Deakin University, Victoria, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Victoria, Australia
| | - Michael J Duncan
- Centre of Physical Activity, Sport and Exercise Science, Coventry University, Coventry, UK
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Borges Gomes LA, Alves da Cunha R, Dias Lopes A, Andrelino de Souza F, Cruvinel Costa F, Vicente Andreoli C. Landing Technique and Ankle-dorsiflexion Range of Motion are not Associated with the History of Lower Limb Injuries among Youth Basketball Athletes. Int J Sports Phys Ther 2023; 18:358-367. [PMID: 37020438 PMCID: PMC10069369 DOI: 10.26603/001c.73033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/15/2023] [Indexed: 04/03/2023] Open
Abstract
Background Lower limb injuries generate a significant health burden in basketball. Landing technique and ankle-dorsiflexion range of motion have been suggested as risk factors for lower limb injuries among youth athletes, but studies conducted specifically with basketball athletes are lacking. Hypothesis/Purpose To describe the period prevalence of basketball-related injuries and to examine the association of the history of lower limb injuries with landing technique and ankle-dorsiflexion range of motion asymmetry among youth basketball athletes. Study Design Cross-Sectional Survey. Methods Youth basketball athletes were asked to complete a paper-based survey to investigate personal characteristics, training characteristics and their three-month history of basketball-related injuries. The Landing Error Scoring System and the Weight-Bearing Lunge Test were used to evaluate landing technique and ankle-dorsiflexion range of motion. Binary logistic regression was utilized to examine the association of the investigated variables with the presence of history of lower limb injuries among the athletes. Results A total of 534 athletes participated. The three-month prevalence of basketball-related injuries was 23.2% (95% CI 19.7 - 27), and the majority of the reported injuries affected the lower limbs (69.7%; n=110). Sprains were the most frequent type of injury (29.1%; n=46), and the ankle (30.4%; n=48) and knee (21.5%; n=34) were the most affected anatomic locations. Landing technique (p = 0.105) and ankle-dorsiflexion range of motion asymmetry (p = 0.529) were not associated with the history of lower limb injuries. Conclusion The three-month prevalence of basketball-related injuries was 23.2%. Although ankle sprains were the most frequent injury, landing technique and ankle-dorsiflexion range of motion asymmetry were not associated with the history of lower limb injuries among youth basketball athletes. Level of Evidence 3.
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Affiliation(s)
| | | | - Alexandre Dias Lopes
- Department of Physical Therapy, Movement & Rehabilitation Sciences Northeastern University
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3
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Mifsud B, Stephens JM, Warmenhoven J, Ball N. Curves and kinematics: Relationship between the force-time curve and landing ability. Scand J Med Sci Sports 2023; 33:420-432. [PMID: 36408795 DOI: 10.1111/sms.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
Anterior cruciate ligament (ACL) injuries have a significant impact on athletic performance and long-term quality of life. Force plates and qualitative screening tools are feasible and effective screening methods to identify abnormal movement quality associated with increased injury risk. Comparing qualitative assessments of landing ability with force-time curves, may detect unique differences between safe and high-risk athletic movement patterns. The aim of this study was to determine low- and high-risk landing ability from qualitive landing assessments and to examine the resulting force-time curves using functional principal component analysis (fPCA). Thirty-one healthy academy athletes (10 males and 21 females) completed double- and single-leg dominant and non-dominant jump-landing-rebound tasks. All movements were filmed in multiple-planes, and vertical ground reaction forces (vGRF) were simultaneously collected. The Landing Error Scoring System (LESS) and Single-Leg Landing Error Scoring System (SL-LESS) were used to score landing footage. From these scores, athletes were categorized into low-risk and high-risk groups for further analysis. fPCA was used to examine differences between landing quality groups force-time curves. Compared to high-risk landers, low-risk landers demonstrated significantly longer contact times across all movements. Scores from fPC1 revealed safe and high-risk landing techniques expose athletes to significantly different loading patterns during double- and single-leg dominant movements. A significant positive relationship was observed between fPC1 and LESS scores, however this relationship was not observed in both single-leg landing scores. Where possible incorporating curve analysis methods like fPCA into multi-faceted screening approaches may help practitioners uncover unique insights into athletic loading strategies.
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Affiliation(s)
- Brayden Mifsud
- Faculty of Health, University of Canberra Research Institute for Sport Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia.,ACT Academy of Sport (ACTAS), Bruce, Australian Capital Territory, Australia.,Australian Institute of Sport (AIS), Bruce, Australian Capital Territory, Australia
| | - Jessica M Stephens
- Faculty of Health, University of Canberra Research Institute for Sport Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia.,ACT Academy of Sport (ACTAS), Bruce, Australian Capital Territory, Australia
| | - John Warmenhoven
- Faculty of Health, University of Canberra Research Institute for Sport Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia.,School of Sport, Exercise and Rehabilitation, University of Technology, Sydney, New South Wales, Australia
| | - Nick Ball
- Faculty of Health, University of Canberra Research Institute for Sport Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia
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Olivares-Jabalera J, Fílter-Ruger A, Dos´Santos T, Ortega-Domínguez J, Sánchez-Martínez RR, Soto Hermoso VM, Requena B. Is there association between cutting and jump-landing movement quality in semi-professional football players? Implications for ACL injury risk screening. Phys Ther Sport 2022; 56:15-23. [DOI: 10.1016/j.ptsp.2022.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
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5
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The development of a clinical screening tool to evaluate unilateral landing performance in a healthy population. Phys Ther Sport 2022; 55:309-315. [DOI: 10.1016/j.ptsp.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/22/2022]
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Association Between the Functional Movement Screen and Landing Kinematics in Individuals With and Without Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2022; 31:842-848. [PMID: 35413683 DOI: 10.1123/jsr.2021-0345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to compare functional movement screen (FMS) scores and drop vertical jump (DVJ) kinematics between those with and without anterior cruciate ligament reconstruction (ACLR), and to evaluate the association between FMS composite score and DVJ kinematics. DESIGN Cross-sectional. PARTICIPANTS Sixty individuals with and without a history of ACLR. MAIN OUTCOME MEASURES Composite FMS score and the dorsiflexion, knee-flexion, hip-flexion, knee abduction, hip adduction, and trunk-flexion angles during a DVJ. RESULTS The FMS scores did not differ between groups (P > .05). There were smaller peak and initial contact hip-flexion angles in the ACLR and contralateral limbs compared with controls, and smaller peak dorsiflexion angles in the ACLR compared with contralateral limbs (P < .05). Lower FMS score was associated with a smaller peak dorsiflexion angle, smaller peak knee-flexion angle, and larger peak knee abduction angle in the ACLR limb (ΔR2 = .14-.23); a smaller peak dorsiflexion angle and smaller peak knee-flexion angle in the contralateral limb (ΔR2 = .17-.19); and a smaller peak dorsiflexion angle, smaller peak knee-flexion angle, and larger peak knee abduction angle in the control limb (ΔR2 = .16-.22). CONCLUSION The FMS scores did not differ between groups, but were associated with DVJ kinematics and should be a complementary rather than substitute assessment.
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Aparicio-Sarmiento A, Hernández-García R, Cejudo A, Palao JM, Sainz de Baranda P. Reliability of a Qualitative Instrument to Assess High-Risk Mechanisms during a 90° Change of Direction in Female Football Players. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074143. [PMID: 35409830 PMCID: PMC8999027 DOI: 10.3390/ijerph19074143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/04/2022]
Abstract
Sidestep cuts between 60° and 180° and one-leg landings have been identified as the main mechanisms of ACL injuries in several sports. This study sought to determine intra- and inter-rater reliability of a qualitative tool to assess high-risk movements in a 90° change of direction when the test is applied in a real framework of sport practice. Female footballers from two teams (n = 38) participated in this study and were asked to perform 90° cutting trials to each side, which were simultaneously filmed from a frontal and a sagittal view. A total of 61 cases were selected for 2D qualitative observational analysis by three raters. Poor reliability was found among each pair of raters as well as moderate reliability when the Cutting Movement Assessment Score (CMAS) was given by the same rater at different moments, but with too high a minimum detectable change. On the other hand, raters presented a significant, as well as moderate-to-good intra-rater reliability for most items of the CMAS tool. There was, however, non-significant reliability between observers in rating most check-points of the tool. For these reasons, more objective guidelines and clearer definitions for each criterion within the CMAS, as well as a longer, standardised training period for novel observers, would be highly recommended to improve the reliability of this tool in an applied context with female footballers.
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Affiliation(s)
- Alba Aparicio-Sarmiento
- Research Group “Raquis: Aparato Locomotor y Deporte”, Department of Physical Activity and Sport, Faculty of Sport Sciences, Campus de Excelencia Internacional Mare Nostrum, University of Murcia, 30720 Murcia, Spain; (R.H.-G.); (P.S.d.B.)
- Correspondence: (A.A.-S.); (A.C.); Tel.: +34-868-8886-71 (A.A.-S.); +34-868-8884-30 (A.C.)
| | - Raquel Hernández-García
- Research Group “Raquis: Aparato Locomotor y Deporte”, Department of Physical Activity and Sport, Faculty of Sport Sciences, Campus de Excelencia Internacional Mare Nostrum, University of Murcia, 30720 Murcia, Spain; (R.H.-G.); (P.S.d.B.)
| | - Antonio Cejudo
- Research Group “Raquis: Aparato Locomotor y Deporte”, Department of Physical Activity and Sport, Faculty of Sport Sciences, Campus de Excelencia Internacional Mare Nostrum, University of Murcia, 30720 Murcia, Spain; (R.H.-G.); (P.S.d.B.)
- Correspondence: (A.A.-S.); (A.C.); Tel.: +34-868-8886-71 (A.A.-S.); +34-868-8884-30 (A.C.)
| | - José Manuel Palao
- Scientific Association of Research Groups “Sport Performance Analysis Association”, 30720 Murcia, Spain;
- Department of Health, Exercise Science & Sport Management, University of Wisconsin-Parkside, Kenosha, WI 53144, USA
| | - Pilar Sainz de Baranda
- Research Group “Raquis: Aparato Locomotor y Deporte”, Department of Physical Activity and Sport, Faculty of Sport Sciences, Campus de Excelencia Internacional Mare Nostrum, University of Murcia, 30720 Murcia, Spain; (R.H.-G.); (P.S.d.B.)
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Movement Coordination during Functional Single-Leg Squat Tests in Healthy, Recreational Athletes. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The single-leg squat (SLS) represents a functional movement task for determining leg function. Objective movement analysis is required to evaluate inter-limb symmetry and movement coordination. Therefore, this study aimed to investigate inter-limb symmetry of SLS kinematics and movement coordination using the modified vector coding technique. A 3D motion capture system and electromyography were used to assess SLS execution and muscle activation of hip ab- and adductors of 17 healthy, recreational athletes. Coordination patterns of hip, knee, and ankle joint movement were assessed by the modified vector coding technique. Statistical parametric mapping revealed no significant differences between both legs (p > 0.05). Inter-limb symmetry also appeared in movement coordination (p > 0.05). Additionally, the analysis of movement coordination indicates knee-dominant, in-phase coordination. However, coordination patterns were different between downward movement, change of direction, and upward movement (p < 0.001). Since perturbations during SLS execution, such as moments of imbalance, occur as anti-phase coordination patterns, the analysis of coordination patterns can be used as a new evaluation method for SLS performance. Furthermore, the modified vector coding technique might be helpful to analyze different compensation strategies during the SLS in symptomatic individuals.
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Keller M, Diemer F, Kurz E. [Judging movement quality in patients who sustained a knee ligament injury: a systematic review]. SPORTVERLETZUNG-SPORTSCHADEN 2022; 36:38-48. [PMID: 34983071 DOI: 10.1055/a-1551-4388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Knee joint injury statistics are dominated by ruptures of the capsular ligament structures. Post-traumatic deficits in dynamic movement patterns are assessed quantitatively as well as qualitatively. The aim of this review was to compile tools that are used to assess the quality of movement after knee ligament injuries in adults. METHODS A systematic search for original papers was carried out in the following primary sources: Ovid, PubMed, Scopus and Web of Science. Both conservative and surgical treatment options were considered. PROSPERO registration of the study protocol: CRD42020175359. RESULTS A total of 1153 papers were identified. Eleven original papers from four different working groups were included in this work. All papers assessed the quality of movement in adults after anterior cruciate ligament (ACL) injury. A total of 348 (70 deficient, 278 reconstructed) patients after an ACL injury and 119 adults with an intact ACL were examined in the studies included. CONCLUSION It is possible to assess movement quality after a knee ligament injury with a low temporal and technical effort. The changes recorded result in a functional valgus, which, based on the study results, may be further differentiated into isolated knee valgus, medial collapse or postural collapse.
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Affiliation(s)
| | - Frank Diemer
- DIGOTOR GbR, Fortbildungen für Orthopädische Medizin und Manuelle Therapie, Brackenheim, Germany
| | - Eduard Kurz
- OSINSTITUT ortho & sport, München, Germany.,Universitätsklinikum Halle, Halle (Saale), Germany
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Olivares-Jabalera J, Fílter-Ruger A, Dos’Santos T, Afonso J, Della Villa F, Morente-Sánchez J, Soto-Hermoso VM, Requena B. Exercise-Based Training Strategies to Reduce the Incidence or Mitigate the Risk Factors of Anterior Cruciate Ligament Injury in Adult Football (Soccer) Players: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13351. [PMID: 34948963 PMCID: PMC8704173 DOI: 10.3390/ijerph182413351] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 01/12/2023]
Abstract
Anterior cruciate ligament (ACL) is one of the most concerning injuries for football players. The aim of this review is to investigate the effects of exercise-based interventions targeting at reducing ACL injury rate or mitigating risk factors of ACL injury in adult football players. Following PRISMA guidelines, a systematic search was conducted in CINAHL, Cochrane Library, PubMed, Scopus, SPORTDiscus and Web of Science. Studies assessing the effect of exercise-based interventions in ACL injury incidence or modifiable risk factors in adult football players were included. 29 studies evaluating 4502 male and 1589 female players were included (15 RCT, 8 NRCT, 6 single-arm): 14 included warm-up, 7 resistance training, 4 mixed training, 3 balance, 1 core stability and 1 technique modification interventions. 6 out of 29 studies investigated the effect of interventions on ACL injury incidence, while the remaining 23 investigated their effect on risk factors. Only 21% and 13% studies evaluating risk of injury variables reported reliability measures and/or smallest worthwhile change data. Warm-up, core stability, balance and technique modification appear effective and feasible interventions to be included in football teams. However, the use of more ecologically valid tests and individually tailored interventions targeting specific ACL injury mechanisms are required.
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Affiliation(s)
- Jesús Olivares-Jabalera
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
| | | | - Thomas Dos’Santos
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
- Department of Sport and Exercise Sciences, Musculoskeletal Science and Sports Medicine Research Centre, All Saints Building, Manchester Campus John Dalton Building, Manchester Campus, Manchester Metropolitan University, Manchester M15 6BH, UK
- Manchester Institute of Sport 2.01, Manchester Metropolitan University, Manchester M1 7EL, UK
| | - Jose Afonso
- Centre for Research, Education, Innovation and Intervention in Sport, Faculty of Sports of the University of Porto, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal;
| | - Francesco Della Villa
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, 40132 Bologna, Italy;
| | | | - Víctor Manuel Soto-Hermoso
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
| | - Bernardo Requena
- HUMAN Lab, Sport and Health University Research Institute (iMUDS), University of Granada, 18016 Granada, Spain; (V.M.S.-H.); (B.R.)
- FSI Sport Research Lab, 18016 Granada, Spain; (A.F.-R.); (T.D.); (J.M.-S.)
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Herman DC, Pritchard KA, Cosby NL, Selkow NM. Effect of Strength Training on Jump-Landing Biomechanics in Adolescent Females. Sports Health 2021; 14:69-76. [PMID: 34751052 DOI: 10.1177/19417381211056089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Sex-based differences in neuromuscular characteristics relevant to anterior cruciate ligament (ACL) injury risk may arise as compensation for divergent strength development during puberty. Strength training during this period may prevent the development of these undesirable neuromuscular characteristics. HYPOTHESIS Strength-trained middle school girls will have improved jump-landing biomechanics compared with control participants. STUDY DESIGN Cohort study. LEVEL OF EVIDENCE Level 3. METHODS Maximum voluntary isometric contraction in hip extension and abduction and knee extension and flexion as well as Landing Error Scoring System (LESS) scores were collected for healthy female middle school students of grades 6 to 8. Strength-training participants (STR: N = 30; height, 1.63 ± 0.07 m; mass, 48.1 ± 7.6 kg; age, 12.5 ± 1.0 y) were matched with control participants (CON: N = 30; height, 1.60 ± 0.09 m; mass, 47.2 ± 8.9 kg; age, 12.6 ± 0.9 y). The training consisted of a 6-month strength-training program administered through a gym class curriculum that targeted the lower extremity. A repeated-measures mixed-model analysis of variance was used for comparisons between groups and across time (α = 0.05). Stepwise linear regression was used to examine the relationship between strength change and LESS score change. RESULTS Strength values (N·m/kg) increased across time and to a greater degree in STR for hip extension (baseline 3.98 ± 1.15 vs follow-up 4.77 ± 1.80), hip abduction (4.22 ± 1.09 vs 5.13 ± 2.55), and knee flexion (3.27 ± 0.62 vs 3.64 ± 1.40) compared with CON. LESS grades significantly decreased across time in STR (5.58 ± 1.21 vs 4.86 ± 1.44) and were significantly lower than CON (5.98 ± 1.42) at follow-up (P < 0.001). The change in hip extension and knee extension strength explained 67% of the variance (P < 0.001) in the LESS change score in the STR group. CONCLUSION A school-based strength-training program that focused on hip and knee musculature significantly improved jump-landing biomechanics (as determined by LESS) relevant to ACL injury risk. Further investigation using different strength-training approaches in this age group is warranted. CLINICAL RELEVANCE Strength training during adolescence holds promise as an injury prevention program. The use of a school-based approach is novel and may represent a robust opportunity for injury prevention programs, as physical education class is often mandatory in this age group.
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Affiliation(s)
- Daniel C Herman
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Davis, California
| | | | - Nicole L Cosby
- College of Health Sciences, Point Loma Nazarene University, San Diego, California
| | - Noelle M Selkow
- School of Kinesiology and Recreation, Illinois State University, Normal, Illinois
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12
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Rowell S, Relph N. The Landing Error Scoring System (LESS) and Lower Limb Power Profiles in Elite Rugby Union Players. Int J Sports Phys Ther 2021; 16:1286-1294. [PMID: 34631249 PMCID: PMC8486412 DOI: 10.26603/001c.27632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Landing Error Scoring System (LESS) is a clinical test that assesses landing biomechanics during a drop-jump task. Performance measures such as jump height, power, contact time and reactive strength index are used commonly in athletic populations. Comparing results from the LESS against these performance measures has not been reported in elite rugby union. PURPOSE To report i.) normative LESS scores for elite rugby union players ii.) correlations between LESS scores and performance measures and iii.) differences in performance measures between LESS scoring groups. A secondary purpose was to report the intra- and inter-rater reliability of the LESS test when used in elite rugby union players. # Study DesignCross-sectional design. METHODS Thirty-six male, elite rugby union players participated. Each participant completed three trials of the LESS and performance measures were recorded concurrently using the OptojumpTM. LESS trials were scored independently by the authors. Statistical analyses were used to confirm reliability, data normality, and between group differences (p<0.05). RESULTS The LESS test is a reliable testing tool in elite rugby union players (excellent intra- (ICC=0.96) and inter-rater (ICC=0.94) reliability). One player demonstrated an excellent LESS score, six players had good scores, eight players moderate scores and the majority of the group, 21 players, scored poorly. LESS scores were correlated to contact time (r = -0.461, p = 0.005) only. Participants with moderate to poor LESS scores (a score ≤5) produced greater power (p=0.036, η2 = 0.139), contact time (p=0.002, η2 = 0.268) and reactive strength index (p=0.016, η2 = 0.180). There were no differences in jump height (p=0.842) between players scoring excellent to good and moderate to poor. CONCLUSION The results of the current study demonstrate excellent intra- and inter-rater reliability for the LESS, supporting its use as a clinical assessment tool in elite rugby union players. The majority of players presented with moderate to poor LESS scores, indicating an area of concern in this population. Participants scoring moderate to poor in the LESS recorded significantly higher power and reactive strength index, increased contact time but not jump height. This suggests participants with high-risk landing biomechanics may also produce higher performance measures, but these do not necessarily result in an improved jump height.
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Hanzlíková I, Hébert-Losier K. Clinical Implications of Landing Distance on Landing Error Scoring System Scores. J Athl Train 2021; 56:572-577. [PMID: 34375981 DOI: 10.4085/1062-6050-068-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT The Landing Error Scoring System (LESS) screens for risk of noncontact anterior cruciate ligament injury. The LESS requires individuals to jump forward from a 30-cm box to a distance of 50% of their body height. However, different landing distances have been cited in the scientific literature. OBJECTIVE To examine whether landing distance influences LESS outcomes. DESIGN Cross-sectional study. SETTING Laboratory. PARTICIPANTS OR OTHER PARTICIPANTS Seventy young active individuals (34 males, 36 females). INTERVENTION(S) Participants performed 3 × 30-cm jump-landing tasks under 2 landing conditions in randomized order: (1) 50% of body height (d50%), (2) self-selected distance (dss). MAIN OUTCOME MEASURE(S) Mean LESS scores, proportions of individuals categorized at high (LESS: ≥ 5 errors) and low (LESS: < 5 errors) injury risk, and landing distances were compared between conditions using generalized estimating equations. Consistency of risk categorization was examined using odds ratios (ORs) and McNemar tests. McNemar and Wilcoxon signed rank tests were used to compare the occurrence of specific LESS errors. RESULTS Participants landed closer to the box under the dss condition (difference = -23.28 [95% CI = -20.73, -25.81]%, P < .001). Group mean LESS scores (difference = -0.01 [95% CI = -0.59, 0.57] error, P = .969) and risk categorization (OR = 0.94 [95% CI = 0.47, 1.88], P = .859) were similar between conditions. However, individual-level risk categorization was inconsistent in 33% of participants, as was the occurrence of specific errors. CONCLUSIONS Using dss during the LESS might lead to different LESS errors and risk categorizations at an individual level than using d50%. Given that individual LESS scores are of primary interest in clinical and sport settings and the injury-risk threshold has not been validated for dss, we recommend use of the original LESS protocol. When only group mean LESS scores or proportions of at-risk individuals are of interest, using dss is feasible to facilitate the testing of large cohorts.
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Affiliation(s)
- Ivana Hanzlíková
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, New Zealand
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, New Zealand
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Molinaro L, Taborri J, Santospagnuolo A, Vetrano M, Vulpiani MC, Rossi S. Sensor-Based Indices for the Prediction and Monitoring of Anterior Cruciate Ligament Injury: Reliability Analysis and a Case Study in Basketball. SENSORS 2021; 21:s21165341. [PMID: 34450783 PMCID: PMC8398404 DOI: 10.3390/s21165341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
The possibility of measuring predictive factors to discriminate athletes at higher risk of anterior cruciate ligament (ACL) injury still represents an open research question. We performed an observational study with thirteen female basketball players who performed monopodalic jumps and single-leg squat tests. One of them suffered from an ACL injury after the first test session. Data gathered from twelve participants, who did not suffer from ACL injury, were used for a reliability analysis. Parameters related to leg stability, load absorption capability and leg mobility showed good-to-excellent reliability. Path length, root mean square of the acceleration and leg angle with respect to the vertical axis revealed themselves as possible predictive factors to identify athletes at higher risk. Results confirm that six months after reconstruction represents the correct time for these athletes to return to playing. Furthermore, the training of leg mobility and load absorption capability could allow athletes to reduce the probability of new injuries.
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Affiliation(s)
- Luca Molinaro
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy; (L.M.); (J.T.)
| | - Juri Taborri
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy; (L.M.); (J.T.)
| | - Adriano Santospagnuolo
- Physical Medicine and Rehabilitation Unit, Sant ‘Andrea Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (A.S.); (M.V.)
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Sant ‘Andrea Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (A.S.); (M.V.)
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sant ‘Andrea Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (A.S.); (M.V.)
- Sports Medicine Institute CONI Rome, 00197 Rome, Italy;
| | - Stefano Rossi
- Department of Economics, Engineering, Society and Business Organization (DEIM), University of Tuscia, 01100 Viterbo, Italy; (L.M.); (J.T.)
- Correspondence: ; Tel.: +39-07-6135-7049
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15
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Colyer S, Miles JJ, Crump FJ, Hall-Martinez JP, Little GS, Mallabone J, Chapman AJ, Cumming SP. Association between biological maturation and anterior cruciate ligament injury risk factors during cutting. J Sports Med Phys Fitness 2021; 62:1078-1087. [PMID: 34275261 DOI: 10.23736/s0022-4707.21.12590-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescent females are particularly susceptible to suffering anterior cruciate ligament (ACL) injuries, likely influenced by well-established maturational changes. This study investigated ACL biomechanical injury risk factors and their association with biological maturation in females. METHODS Thirty-five adolescent females (15 ± 1 yr) completed a series of maximum-effort 90° unanticipated cutting manoeuvres. Established biomechanical ACL injury risk factors (including external knee abduction moments, knee abduction, hip abduction, knee flexion, ground reaction force) were derived from an optoelectronic motion analysis system and force platforms, with inter-limb asymmetries in these risk factors also computed. Biological maturation (percentage of predicted adult stature) was assessed using validated regression equations, incorporating anthropometric measures of participants and their biological parents. RESULTS Significant bilateral asymmetries were observed with higher peak external knee abduction moments, higher ground reaction forces and less knee flexion (from 0-18% and 30-39% of contact) during the non-dominant vs. dominant cuts (effect sizes = 0.36, 0.63 and 0.50, respectively). Maturation did not appear to influence these asymmetries; however, less hip abduction was observed (e.g. 21-51% of contact for dominant cuts) in more biologically-mature females. CONCLUSIONS These results highlight a potential maturationrelated change in cutting technique that may explain the apparent heightened ACL injury risk in this population. As females mature, training targeted at neuromuscular control of hip abductor (e.g. gluteal) muscle groups could potentially mitigate ACL injury risk.
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Affiliation(s)
- Steffi Colyer
- Department for Health, University of Bath, Bath, UK -
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16
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Drop Jump? Single-Leg Squat? Not if You Aim to Predict Anterior Cruciate Ligament Injury From Real-Time Clinical Assessment: A Prospective Cohort Study Involving 880 Elite Female Athletes. J Orthop Sports Phys Ther 2021; 51:372-378. [PMID: 34192883 DOI: 10.2519/jospt.2021.10170] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine whether visually assessed performances of the single-leg squat (SLS) and vertical drop jump (VDJ) were associated with future noncontact anterior cruciate ligament (ACL) injury. DESIGN Prognostic accuracy cohort study. METHODS Elite female handball and football (soccer) athletes (n = 880) were tested from 2007 to 2014 and tracked through 2015. Trained physical therapists visually rated each leg during a SLS and overall control during a VDJ. Receiver operating characteristic curve, Pearson chi-square, and logistic regression analyses were used to determine the prognostic accuracy of the 2 screening tests. RESULTS Sixty-five noncontact ACL injuries occurred during the follow-up period. Fourteen percent of athletes who sustained an ACL injury had poor SLS performance, compared to 17% of the noninjured athletes (P = .52 and .67 for hip and knee ratings, respectively). Side-to-side asymmetry in the SLS was not different between injured and noninjured athletes (P = .10 and .99 for hip and knee asymmetry, respectively). Twenty-one percent of athletes who sustained an ACL injury had a poor VDJ rating, compared to 27% of the noninjured athletes (P = .09). Furthermore, area under the curve values ranged from 0.43 to 0.54 for the SLS and VDJ, demonstrating no to poor prognostic accuracy. CONCLUSION Neither SLS nor VDJ test performance distinguished between athletes who sustained a subsequent noncontact ACL injury and those who did not. J Orthop Sports Phys Ther 2021;51(7):372-378. doi:10.2519/jospt.2021.10170.
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Integrating neurocognitive challenges into injury prevention training: A clinical commentary. Phys Ther Sport 2021; 51:8-16. [PMID: 34153635 PMCID: PMC8380712 DOI: 10.1016/j.ptsp.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 12/28/2022]
Abstract
Despite the efforts of many traditional lower extremity injury prevention programs (IPP), the incidence of anterior cruciate ligament injuries in young athletes continues to rise. Current best practices for IPPs include training lower extremity neuromuscular control and movement quality during cutting, jumping, and pivoting. Emerging evidence indicates neurocognition may contribute to injury incidence and injury risk biomechanics. Therefore, IPP outcomes may improve if clinicians also consider neurocognitive contributions to neuromuscular control and athletic performance. A substantial barrier to neurocognitive challenge integration during injury prevention training in the group setting is the lack of structured neuromuscular and neurocognitive progressions. Therefore, our aim is to provide clinicians with a defined framework and recommendations from clinical experience for how to implement neurocognitive challenges within group IPPs that requires minimal extra time and resources. This clinical commentary proposes a three-phase model adopted from motor learning literature to simultaneously progress neuromuscular and neurocognitive challenges through a structured IPP.
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18
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Fältström A, Hägglund M, Hedevik H, Kvist J. Poor Validity of Functional Performance Tests to Predict Knee Injury in Female Soccer Players With or Without Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:1441-1450. [PMID: 33844590 DOI: 10.1177/03635465211002541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Various tests have been developed to evaluate athletes' functional performance and for use as screening tools for injury prediction. Further validation of their accuracy to predict injury is needed. PURPOSE To investigate the validity of predetermined cutoffs used to differentiate between high- and low-risk players in different functional performance tests to predict (1) anterior cruciate ligament (ACL) injury or (2) severe traumatic knee injury in a cohort of female soccer players with a primary unilateral ACL reconstruction and a cohort of knee-healthy players. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 117 active female soccer players (mean age ± SD, 20 ± 2 years) an average of 19 ± 9 months after ACL reconstruction and 119 knee-healthy players (age, 19 ± 3 years) were prospectively followed up for 2 years for new knee injuries. At baseline, all players underwent tests to assess postural control (Star Excursion Balance Test), hop performance (single-leg hop for distance, side hop), and movement asymmetries in the lower limbs and trunk (drop vertical jump [DVJ], tuck jump). The predictive validity of the test cutoffs to identify players who would sustain an ACL injury or a severe traumatic knee injury (absence from soccer play, >28 days) was assessed. The risk ratio (RR), area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated. RESULTS A total of 46 players (39%) with ACL reconstruction sustained 48 severe knee injuries, including 28 ACL ruptures. Of the knee-healthy players, 13 (11%) sustained 14 severe knee injuries, including 8 ACL ruptures. No association was found between the predetermined functional performance test cutoffs and the risk of a new ACL injury or severe knee injury in players with ACL reconstruction. In knee-healthy players, the only variable associated with future ACL injury was ≥6.5 cm knee valgus in the frontal plane (any knee) in the DVJ (RR, 4.93; 95% CI, 1.04-23.40; P = .045), but with only fair predictive validity (AUC, 0.7; sensitivity, 0.75; specificity, 0.65). CONCLUSION In our cohorts of female soccer players, the validity of commonly used functional performance tests to predict new knee injuries was poor. Only knee valgus during the DVJ was associated with new ACL injuries in knee-healthy players, but with only fair predictive validity.
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Affiliation(s)
- Anne Fältström
- Region Jönköping County, Rehabilitation Centre, Ryhov County Hospital, Jönköping, Sweden.,Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Martin Hägglund
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Henrik Hedevik
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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19
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Stern BD, Hegedus EJ, Lai YC. State dependence: Does a prior injury predict a future injury? Phys Ther Sport 2021; 49:8-14. [PMID: 33550203 DOI: 10.1016/j.ptsp.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/20/2022]
Abstract
The sports medicine literature is filled with associations between injury and causal factors. However, those results have been inconsistent. We're left wondering which of our athletes might need more attention and where our efforts might be best spent. Resistance to injury is the result of interaction between many variables. These variables are interdependent with dynamic relationships which can be sometimes correlated, at times anti-correlated and from time to time show no relationship with injury risk. Relationships we may have seen yesterday do not necessarily hold true for today and we should not use those to infer what will happen. This perspective piece builds on prior works and describes how the complex interaction between injury determinants presents in other systems, why determinants are not stable and instead vary over time due to internal and external forcing and why our prediction ability remains limited even when determinants are identified. Patterns built from frequent time series data in conjunction with nonlinear dynamical methods can offer us a new approach to thinking about injury prediction.
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Affiliation(s)
- Benjamin D Stern
- Department of Outpatient Rehabilitation, HonorHealth, Scottsdale, AZ, USA.
| | - Eric J Hegedus
- Physical Therapy Program, School of Medicine, Tufts University, Boston, MA, USA
| | - Ying-Cheng Lai
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, AZ, USA
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Cooke R, Rushton A, Martin J, Herrington L, Heneghan NR. Practicability of lower extremity functional performance tests and their measurement properties in elite athletes: protocol for a systematic review. BMJ Open 2020; 10:e042975. [PMID: 33371047 PMCID: PMC7757441 DOI: 10.1136/bmjopen-2020-042975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Lower extremity injury (LEI) is highly prevalent and its occurrence increases the risk of future injury in athletic populations. Identifying athletes at risk of injury is the key to target injury-prevention programmes. Functional performance tests (FPT) assess an athlete's ability to produce and accept forces during movement tasks reflective of those experienced in sport, and are used to identify deficits in physical qualities or neuromuscular control. This review aims to identify FPT which have potential to predict LEI and assess their measurement properties associated with reliability, validity, responsiveness and practicability (interpretability and feasibility). METHODS/ANALYSIS This protocol will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol and the COnsensus-based Standards for the selection of health Measurement INstruments Methodology. The search strategy has two stages: stage 1 will identify lower limb FPT used in athletic populations; and stage 2 will assess the measurement properties of the identified FPT. A sensitive search strategy will use MEDLINE, EMBASE, CINHAL and SPORTdiscus databases; from inception to June 2020. Hand searching reference lists, key journals and grey literature will be completed. One reviewer will complete search 1 and data extraction. Two reviewers will complete the search, data extraction and risk-of-bias assessment for search 2. Evidence will be pooled or summarised by individual measurement property by each individual study and grouped by FPT. Meta-analysis using a random effects model with subgroup analysis will be performed where possible. Pooled or summarised results for each FPT in relation to each measurement property will be rated against the criteria for good measurement properties. Two reviewers will assess the overall body of evidence per measurement property per FPT using the modified Grading of Recommendations, Assessment, Development and Evaluation guidelines. This review will enable clinicians to make an informed choice when selecting FPT. ETHICS AND DISSEMINATION No ethical approval is required for this review and the results will be disseminated through peer-reviewed publications and submitted for conference presentation. PROSPERO REGISTRATION NUMBER CRD42020188932.
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Affiliation(s)
- Rosalyn Cooke
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - James Martin
- Institute of Applied Health Research, Public Health Building, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Lee Herrington
- School of Health and Society, University of Salford, Salford, UK
| | - Nicola R Heneghan
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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21
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Pedley JS, Lloyd RS, Read PJ, Moore IS, De Ste Croix M, Myer GD, Oliver JL. Utility of Kinetic and Kinematic Jumping and Landing Variables as Predictors of Injury Risk: A Systematic Review. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42978-020-00090-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Abstract
Purpose
Jump-landing assessments provide a means to quantify an individual’s ability to attenuate ground reaction forces, generate lower limb explosive power and maintain joint alignment. In order to identify risk factors that can be targeted through appropriate training interventions, it is necessary to establish which (scalar) objective kinetic, kinematic, and performance measures are most associated with lower-extremity injury.
Methods
Online searches of MEDLINE, SCOPUS, EBSCOHost, SPORTDiscus and PubMed databases were completed for all articles published before March 2020 in accordance with PRISMA guidelines.
Results
40 articles investigating nine jump-landing assessments were included in this review. The 79% of studies using drop jump (n = 14) observed an association with future injury, while only 8% of countermovement jump studies (n = 13) observed an association with injury risk. The 57% of studies using unilateral assessments found associations with risk of injury (n = 14). Studies using performance measures (jump height/distance) as outcome measure were only associated with injury risk in 30% of cases. However, those using kinetic and/or kinematic analyses (knee abduction moment, knee valgus angle, knee separation distance, peak ground reaction force) found associations with injury in 89% of studies.
Conclusion
The landing element of jump-landing assessments appears to be superior for identifying individuals at greater risk of injury; likely due to a closer representation of the injury mechanism. Consequently, jump-landing assessments that involve attenuation of impact forces such as the drop jump appear most suited for this purpose but should involve assessment of frontal plane knee motion and ground reaction forces.
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22
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Hearn DW, Frank BS, Padua DA. Use of double leg injury screening to assess single leg biomechanical risk variables. Phys Ther Sport 2020; 47:40-45. [PMID: 33152587 DOI: 10.1016/j.ptsp.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this article was to determine if differences in kinematic and kinetic variables observed in a double-leg screen carried over to a single-leg task. DESIGN We used a case-control design with grouping based on performance during a double-leg jump landing. SETTING All participants were selected from a large university setting and testing was performed in a biomechanics laboratory. PARTICIPANTS Participants were females between 18 and 25 years of age with at least high school varsity experience in one or more of the following sports: soccer, lacrosse, field hockey, rugby, basketball, or team handball. MAIN OUTCOME MEASURES Primary outcome measures were knee angles in the frontal and sagittal planes as well as vertical ground reaction force (vGRF). RESULTS There were significant between group differences in peak knee flexion and knee flexion displacement during both the double and single-leg tasks, however between group differences for peak knee valgus and knee valgus displacement noted in the double-leg task were not observed in the single-leg task. vGRF was significantly different in the single-leg task but not the double-leg task. CONCLUSION A double leg screening may not provide complete identification of risk of injury during sports requiring single leg tasks.
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Affiliation(s)
- Darren W Hearn
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina, Chapel Hill, NC.
| | - Barnett S Frank
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina, Chapel Hill, NC
| | - Darin A Padua
- Department of Exercise and Sport Science, MOTION Science Institute, University of North Carolina, Chapel Hill, NC.
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The effects of joint hypermobility syndrome on the kinematics and kinetics of the vertical jump test. J Electromyogr Kinesiol 2020; 55:102483. [PMID: 33080434 DOI: 10.1016/j.jelekin.2020.102483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/17/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Biomechanical impairments are not apparent during walking in people with Joint Hypermobility Syndrome (JHS). This research explored biomechanical alterations during a higher intensity task, vertical jumping. MATERIALS AND METHODS This cross-sectional study compared a JHS group (n = 29) to a healthy control group (n = 30). Joint kinematics and kinetics were recorded using a Qualisys motion capture system synchronized with a Kistler platform. Independent sample t-tests and standardised mean differences (SMD) were used for statistical analysis. RESULTS No significant statistical or clinical differences were found between groups in joint kinematics and jump height (p ≥ 0.01). Sagittal hip and knee peak power generation were statistically lower in the JHS group during the compression phase (p ≤ 0.01), but not clinically relevant (SMD < 0.5). Clinically relevant reductions were found in the JHS group knee and ankle peak moments during the compression phase, and hip and knee peak power generation during the push phase (SMD ≥ 0.5), although these were not statistically significant (p ≥ 0.01). CONCLUSION The JHS group achieved a similar jump height but with some biomechanical alterations. Further understanding of the joint biomechanical behavior could help to optimize management strategies for JHS, potentially focusing on neuromuscular control and strength/power training.
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There Is No Relationship Between Lower Extremity Alignment During Unilateral and Bilateral Drop Jumps and the Risk of Knee or Ankle Injury: A Prospective Study. J Orthop Sports Phys Ther 2020; 50:267-274. [PMID: 32272029 DOI: 10.2519/jospt.2020.9247] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the association between lower extremity alignment during unilateral and bilateral drop jump tests and the risk of acute noncontact knee or ankle injuries in young team sport athletes. DESIGN Prospective cohort study. METHODS A 2-dimensional video analysis was used to measure the frontal plane knee projection angle in the single-leg vertical drop jump (VDJ) and the bilateral VDJ in young team sport athletes. Out of the 364 athletes (187 male, 177 female), 189 played basketball and 175 played floorball. RESULTS Six male athletes sustained knee injuries and 23 sustained ankle injuries. Frontal plane knee projection angle in the single-leg VDJ or the bilateral VDJ was not associated with ankle injuries among male athletes. No statistical analysis was performed for the knee injuries. Among female athletes, 28 sustained knee and 41 sustained ankle injuries. Frontal plane knee projection angle during the single-leg VDJ or the bilateral VDJ was not a risk factor for knee or ankle injuries. CONCLUSION Lower extremity alignment during unilateral and bilateral drop jump tests was not associated with future noncontact knee or ankle injuries among young team sport athletes. The findings should be interpreted cautiously due to the small number of injuries. J Orthop Sports Phys Ther 2020;50(5):267-274. doi:10.2519/jospt.2020.9247.
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Schwartz O, Talmy T, Olsen CH, Dudkiewicz I. The Landing Error Scoring System Real-Time test as a predictive tool for knee injuries: A historical cohort study. Clin Biomech (Bristol, Avon) 2020; 73:115-121. [PMID: 31982808 DOI: 10.1016/j.clinbiomech.2020.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the value of the Landing error score system - real time test as a predictive tool for knee injuries among combat soldiers in the Israeli defense forces. METHODS All 2474 Israeli defense forces' combat soldiers enrolled at the Israeli defense forces Injury Prevention and Rehabilitation Center were included. A retrospective cohort study was conducted. The predictive variable assessed was the landing error score system - real time score. The three main outcome variables were the incidence of overuse knee injuries, the meniscal injury, and the anterior cruciate ligament injury. Receiver operator characteristic analysis was performed to evaluate the test's potential as a predictive tool and in order to establish optimal cutoff scores. RESULTS The area under the curve of the receiver operation curves demonstrated no predictive value of the landing error score system - real time test for all three outcome variables (knee injuries: area under the curve 0.526, 95% confidence interval 0.498, 0.554, anterior cruciate ligament injuries: area under the curve 0.496, 95% confidence interval 0.337, 0.656, meniscus injuries: area under the curve 0.515, 95% confidence interval 0.454, 0.576). INTERPRETATION Based on the results of this study, the landing error score system - real time test has no predictive value for knee overuse injuries, meniscal injuries, and anterior cruciate ligament injuries. However, due to the small number of cases of anterior cruciate ligament injuries, the predictive value for anterior cruciate ligament injuries of this test should be further investigated.
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Affiliation(s)
- Oren Schwartz
- Department of Day Care and Pain Unit, Reuth Rehabilitation Center, 2 Hachail Ave., Tel Aviv 6772829, Israel.
| | - Tomer Talmy
- IDF Medical Forces Headquarters, 1 Aharon Kazir St., Ramat-Gan 5262000, Israel
| | - Cara H Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20895, USA.
| | - Israel Dudkiewicz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Rehabilitation, Sheba Medical Center, 2 Sheba Road, Tel Hashomer, Ramat Gan 5262100, Israel.
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Temporal kinematic differences throughout single and double-leg forward landings. J Biomech 2020; 99:109559. [PMID: 31874706 DOI: 10.1016/j.jbiomech.2019.109559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 01/13/2023]
Abstract
Screening methods for anterior cruciate ligament (ACL) injuries often involve double-leg landings, though the majority of ACL injuries occur during single-leg landings. Differences in kinematic temporal characteristics between single-leg and double-leg landings are poorly understood. The purpose of this study was to examine discrete and temporal kinematics associated with functional valgus collapse during single-leg and double-leg landings (LANDSL and LANDDL). Three-dimensional kinematics were obtained during the landing phases of LANDSL and LANDDL in ninety participants (45 females: 20.1 ± 1.7 yr, 165.2 ± 7.6 cm, 68.6 ± 13.1 kg; 45 males: 20.7 ± 2.0 yr, 177.7 ± 8.5 cm, 82.8 ± 16.3 kg). Peak joint angles and time series curves for frontal and transverse plane hip and knee kinematics were analyzed with an RMANOVA (discrete variables) and Statistical Parametric Mapping (SPM) paired t-tests (time series). LANDSL elicited greater knee abduction than LANDDL from 0 to 35% (0-73 ms) but greater knee adduction from 54 to 100% (112-207 ms). Peak knee abduction was 2.0° greater during LANDDL than during LANDSL (p < .001). LANDSL elicited greater hip adduction than LANDDL from 2 to 33% (4-69 ms) and greater hip abduction from 49 to 100% (102-207 ms). Peak hip adduction was 4.6° greater during LANDSL than during LANDDL (p < .001). LANDSL elicited less knee internal rotation from 0 to 3% and greater hip internal rotation from 52 to 75% of the landing phase. Peak transverse plane joint angles did not differ between tasks. During the time frame in which ACL injuries are thought to occur, LANDSL elicited frontal plane knee and hip movement consistent with risky biomechanics. Researchers and clinicians should be cognizant of how a chosen screening task alters observed kinematic effects.
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Hanzlíková I, Hébert-Losier K. Is the Landing Error Scoring System Reliable and Valid? A Systematic Review. Sports Health 2020; 12:181-188. [PMID: 31961778 DOI: 10.1177/1941738119886593] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
CONTEXT The Landing Error Scoring System (LESS) is a clinical tool often used in research and practice to identify athletes presenting high injury-risk biomechanical patterns during a jump-landing task. OBJECTIVE To systematically review the literature addressing the psychometric properties of the LESS. DATA SOURCES Three electronic databases (PubMed, Web of Science, and Scopus) were searched on March 28, 2018, using the term "Landing Error Scoring System." STUDY SELECTION All studies using the LESS as main outcome measure and addressing its reliability, validity against motion capture system, and predictive validity were included. Original English-language studies published in peer-reviewed journals were reviewed. Studies using modified versions of the LESS were excluded. STUDY DESIGN Systematic literature review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Study design, population, LESS testing procedures, LESS scores, statistical analysis, and main results were extracted from studies using a standardized template. RESULTS Ten studies met inclusion criteria and were appraised using Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. The overall LESS score demonstrated good-to-excellent intrarater (intraclass correlation coefficient [ICC], 0.82-0.99), interrater (ICC, 0.83-0.92), and intersession reliability (ICC, 0.81). The validity of the overall LESS score against 3-dimensional jump-landing biomechanics was good when individuals were divided into 4 quartiles based on LESS scores. The validity of individual LESS items versus 3-dimensional motion capture data was moderate-to-excellent for most of the items addressing key risk factors for anterior cruciate ligament (ACL) injury. The predictive value of the LESS for ACL and other noncontact lower-extremity injuries remains uncertain based on the current scientific evidence. CONCLUSION The LESS is a reliable screening tool. However, further work is needed to improve the LESS validity against motion capture system and confirm its predictive validity for ACL and other noncontact lower-extremity injuries.
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Affiliation(s)
- Ivana Hanzlíková
- Division of Health, Engineering, Computing and Science, School of Health, Sport and Human Performance, University of Waikato, Tauranga, New Zealand
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, School of Health, Sport and Human Performance, University of Waikato, Tauranga, New Zealand
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Hunnicutt JL, Jayanthi NA, Labib SA. Editorial Commentary: Considering Fatigue When Assessing Athletes for Dynamic Knee Valgus: Is This the Next Big Step in Identifying Anterior Cruciate Ligament Injury Risk? Arthroscopy 2020; 36:223-224. [PMID: 31864580 DOI: 10.1016/j.arthro.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 02/02/2023]
Abstract
Excessive dynamic knee valgus during jumping is a poor movement strategy that has been well-documented as a risk factor for anterior cruciate ligament injury. Yet, there has been little progress in the translation of findings from high-tech motion capture laboratories to clinically applicable settings. One barrier to widespread use is expensive technology that requires time; therefore, field-based efficient assessment tools that can be used by several types of clinicians are desperately needed. Further, fatigue can influence dynamic knee valgus and should be considered when assessing or conditioning athletes.
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Dos’Santos T, McBurnie A, Donelon T, Thomas C, Comfort P, Jones PA. A qualitative screening tool to identify athletes with ‘high-risk’ movement mechanics during cutting: The cutting movement assessment score (CMAS). Phys Ther Sport 2019; 38:152-161. [DOI: 10.1016/j.ptsp.2019.05.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 01/14/2023]
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Bulat M, Korkmaz Can N, Arslan YZ, Herzog W. Musculoskeletal Simulation Tools for Understanding Mechanisms of Lower-Limb Sports Injuries. Curr Sports Med Rep 2019; 18:210-216. [DOI: 10.1249/jsr.0000000000000601] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Harriss J, Khan A, Song K, Register-Mihalik JK, Wikstrom EA. Clinical movement assessments do not differ between collegiate athletes with and without chronic ankle instability. Phys Ther Sport 2019; 36:22-27. [PMID: 30611027 DOI: 10.1016/j.ptsp.2018.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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Fox AS, Bonacci J, Saunders N. The relationship between performance of a single-leg squat and leap landing task: moving towards a netball-specific anterior cruciate ligament (ACL) injury risk screening method. Sports Biomech 2018; 19:493-509. [DOI: 10.1080/14763141.2018.1498535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Aaron S. Fox
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Jason Bonacci
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Natalie Saunders
- Centre for Sports Research, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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Dos'Santos T, Comfort P, Jones PA. Average of trial peaks versus peak of average profile: impact on change of direction biomechanics. Sports Biomech 2018; 19:483-492. [PMID: 30124388 DOI: 10.1080/14763141.2018.1497197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The aims of this study were twofold: firstly, to compare lower limb kinematic and kinetic variables during a sprint and 90° cutting task between two averaging methods of obtaining discrete data (peak of average profile vs. average of individual trial peaks); secondly, to determine the effect of averaging methods on participant ranking of each variable within a group. Twenty-two participants, from multiple sports, performed a 90° cut, whereby lower limb kinematics and kinetics were assessed via 3D motion and ground reaction force (GRF) analysis. Six of the eight dependent variables (vertical and horizontal GRF; hip flexor, knee flexor, and knee abduction moments, and knee abduction angle) were significantly greater (p ≤ 0.001, g = 0.10-0.37, 2.74-10.40%) when expressed as an average of trial peaks compared to peak of average profiles. Trivial (g ≤ 0.04) and minimal differences (≤ 0.94%) were observed in peak hip and knee flexion angle between averaging methods. Very strong correlations (ρ ≥ 0.901, p < 0.001) were observed for rankings of participants between averaging methods for all variables. Practitioners and researchers should obtain discrete data based on the average of trial peaks because it is not influenced by misalignments and variations in trial peak locations, in contrast to the peak from average profile.
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Affiliation(s)
- Thomas Dos'Santos
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford , Greater Manchester, UK
| | - Paul Comfort
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford , Greater Manchester, UK
| | - Paul A Jones
- Human Performance Laboratory, Directorate of Sport, Exercise, and Physiotherapy, University of Salford , Greater Manchester, UK
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Leporace G, Tannure M, Zeitoune G, Metsavaht L, Marocolo M, Souto Maior A. Association between knee-to-hip flexion ratio during single-leg vertical landings, and strength and range of motion in professional soccer players. Sports Biomech 2018; 19:411-420. [DOI: 10.1080/14763141.2018.1494207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Gustavo Leporace
- Department of Research in Biomechanics, Institute Brazil of Technologies in Health, Rio de Janeiro, Brazil
| | - Marcio Tannure
- Performance Excellence Center, Flamengo Sport Club, Rio de Janeiro, Brazil
| | - Gabriel Zeitoune
- Department of Research in Biomechanics, Institute Brazil of Technologies in Health, Rio de Janeiro, Brazil
- Biomedical Engineering Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Metsavaht
- Department of Research in Biomechanics, Institute Brazil of Technologies in Health, Rio de Janeiro, Brazil
| | - Moacir Marocolo
- Department of Physiology, Institute of Biological Sciences, Universidade Federal de Juiz de Fora, Minas Gerais, Brazil
| | - Alex Souto Maior
- Department of Rehabilitation Sciences, University Augusto Mota, Rio de Janeiro, Brazil
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Fox AS, Bonacci J, McLean SG, Saunders N. Efficacy of ACL injury risk screening methods in identifying high-risk landing patterns during a sport-specific task. Scand J Med Sci Sports 2016; 27:525-534. [PMID: 27292768 DOI: 10.1111/sms.12715] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 12/24/2022]
Abstract
Screening methods sensitive to movement strategies that increase anterior cruciate ligament (ACL) loads are likely to be effective in identifying athletes at-risk of ACL injury. Current ACL injury risk screening methods are yet to be evaluated for their ability to identify athletes' who exhibit high-risk lower limb mechanics during sport-specific maneuvers associated with ACL injury occurrences. The purpose of this study was to examine the efficacy of two ACL injury risk screening methods in identifying high-risk lower limb mechanics during a sport-specific landing task. Thirty-two female athletes were screened using the Landing Error Scoring System (LESS) and Tuck Jump Assessment. Participants' also completed a sport-specific landing task, during which three-dimensional kinematic and kinetic data were collected. One-dimensional statistical parametric mapping was used to examine the relationships between screening method scores, and the three-dimensional hip and knee joint rotation and moment data from the sport-specific landing. Higher LESS scores were associated with reduced knee flexion from 30 to 57 ms after initial contact (P = 0.003) during the sport-specific landing; however, no additional relationships were found. These findings suggest the LESS and Tuck Jump Assessment may have minimal applicability in identifying athletes' who exhibit high-risk landing postures in the sport-specific task examined.
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Affiliation(s)
- A S Fox
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - J Bonacci
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
| | - S G McLean
- Human Innovation, Fitbit, San Francisco, California, USA
| | - N Saunders
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria, Australia
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