The effect of performance demands on lower extremity biomechanics during landing and cutting tasks

Players in the Women's National Basketball Association Are More Likely to Tear Their Anterior Cruciate Ligament if They Are a Guard, Forward, or Driving to the Basket: A Case-Control Study

The Women's National Basketball Association (WNBA) has grown in popularity since its induction in 1996. Furthermore, it is well known that female athletes are at an increased risk of anterior cruciate ligament (ACL) tears compared with their male counterparts. The purpose was to examine the player positions and player movements during basketball games and practices that contribute to ACL tears in WNBA players. Player position and demographics from WNBA players who suffered an ACL tear from 1996 to 2021 were collected from publicly available sources. Entertainment and Sports Programming Network news reports and video analysis were reviewed to determine what movements each player was performing when the injury occurred. Injured players were matched with two noninjured players by age, position, height, and league experience. Performance statistics were collected one season prior to injury and compared with the matched controls. A total of 62 WNBA players with ACL injuries were identified with an average age of 26.7 (±3.9) years. More guards and forward were seen in the injured cohort and more players were injured while driving to the basket (p < 0.05). ACL injuries occurred more commonly during games than in practice (p < 0.05). Compared with controlled match cohort, the players who suffered ACL tears started more games (p = 0.007), had higher minutes played per game (p = 0.003), more field goals per game (p = 0.04), more field goal attempts per game (p = 0.03), more 3-point attempts per game (p = 0.04), more rebounds per game (p = 0.04), more steals per game (p = 0.02), and more points per game (p = 0.02). WNBA guards and forward were more likely to tear their ACL, especially while driving to the basket during real game play. Additionally, players with higher playing times, rebounds, and steals per game had higher rates of ACL tears. However, there was no impact on their performance on season statistics after returning to sport. LEVEL OF EVIDENCE:  III.

Increased Visual Attentional Demands Alter Lower Extremity Sidestep Cutting Kinematics in Male Basketball Players

Background

In basketball, changing direction is one of the primary mechanisms of anterior cruciate ligament (ACL) injury, often occurring within complex game situations with high cognitive demands. It is unknown how visual attention affects sidestep cutting kinematics during the entire energy absorption phase of the cut in an ecologically valid environment.

Purpose

The purpose of this research was to study the effect of added cognitive load, in the form of increased visual attentional demands, on sidestep cutting kinematics during the energy absorption phase of the cut in an ecologically valid environment.

Study Design

Crossover Study.

Methods

Fifteen male basketball players (aged 22.1 ± 2.3) performed ten sidestep cutting movements without (BASE) and with (VIS) a visual attention dual task. 3D kinematics of the hip, knee and ankle were recorded utilizing Xsens IMU motion capture. Temporal kinematics were analyzed using Statistical Parametric Mapping. Discrete time point kinematics were additionally analyzed at initial contact (IC) and at peak knee flexion utilizing paired t-tests. Effect sizes were calculated.

Results

Hip flexion was significantly reduced in the VIS condition compared to the BASE condition (p<0.01), including at IC (VIS 35.0° ± 7.2°, BASE 40.7° ± 4.9°, p=0.02, d=0.92) and peak (VIS 37.8° ± 9.7°, BASE 45.5° ± 6.9°, p=0.001, d=0.90). Knee flexion was significantly reduced in the VIS condition, in comparison to the BASE condition (p<0.01), at peak (VIS 59.9° ± 7.5°, BASE 64.1° ± 7.4°, p=0.001, d=0.55).

Conclusion

The addition of visual attention during sidestep cutting altered lower limb kinematics, which may increase ACL injury risk. It is suggested that ACL injury risk screening and prevention should include sidestep cutting with visual attentional demands, in order to mimic the cognitive demands of the sports environment.

Level of Evidence

3.

Lower limbs kinematic analysis during a jump landing task in soccer players with unilateral anterior cruciate ligament reconstruction

BACKGROUND

Fatigue leads to an acute decline in muscle strength, altered patterns of lower extremity muscle activation, changes in hip and knee kinematics. In terms of the effects of fatigue on knee joint kinematics during plyometric training, there is still a lack of knowledge regarding kinematic differences between athletes who passed the ACL reconstructions rehabilitation period and healthy athletes. Therefore, this study aimed to compare lower limb joint kinematic parameters between reconstructed cruciate ligament and healthy control soccer players during jump landing in a fatigued setting.

METHODS

Lower limb kinematic parameters were recorded in 20 professional soccer players (age, 24.95 ± 2.92 years; body mass, 77.20 ± 12.88 kg; height, 1.77 ± 3.19 m) during jump landing task before and after the fatigue protocol. The control group consisted of healthy subjects and the experimental group consisted of subjects with ACL reconstruction by thigh transplantation. Kinematic data was recorded with 4 cameras to measure lower limb angles at first foot contact and maximum range of motion.

RESULTS

The results showed that before fatigue, there was only a significant difference between the two groups in the maximum range of motion of the non-involved hip joint (P = 0.022) and angle of the involved hip at first contact (P = 0.049). In other data on joint range of motion or initial contact angle, no significant difference was observed between the two groups (P > 0.05). After fatigue protocol, there was a significant difference in initial foot contact in non-involved (P = 0.030), and involved (P = 0.020) hip joint angles between the two groups. However, no significant difference in initial contact angle or range of motion of other joints was observed between the groups.

CONCLUSIONS

This study shows that plyometric fatigue does not contribute to numerous changes in contact angles and range of motion in lower extremity joints in healthy soccer players and those with a history of cruciate ligament repairs.

Biomechanical Analysis of Injury Risk in Two High-Altitude Landing Positions Using Xsens Inertial Units and EMG Sensors

High-altitude landing maneuvers can pose a significant injury risk, particularly when performed with different landing techniques. This study aims to compare the biomechanical parameters and injury risks associated with two landing positions-staggered foot landing and simultaneous bilateral landing-using Xsens inertial units and electromyography (EMG) sensors. A total of 26 university students (13 males, 13 females) participated in this study. Kinematic data were collected using inertial measurement units (IMUs), muscle activity was recorded with EMG, and ground reaction forces were captured using 3D force plates. The data were processed and analyzed using the AnyBody modeling system to simulate joint forces, moments, and muscle activation. This study found that simultaneous bilateral landing exhibited greater hip flexion-extension, knee flexion-extension, and ankle inversion. Vertical joint forces were also significantly higher in the hip, knee, and ankle during simultaneous bilateral landing. Staggered foot landing showed higher muscle forces in the gluteus maximus, iliopsoas, and quadriceps femoris (p < 0.001). The EMG analysis revealed significant differences in the biceps femoris (p = 0.008) and quadriceps femoris (p < 0.001). These findings suggest that simultaneous bilateral landing increases joint load, while staggered foot landing increases muscle activation, which may lead to different injury risks between the two techniques.

Biomechanic Differences Between Anticipated and Unanticipated Volleyball Block Jump: Implications for Lower Limb Injury Risk

Volleyball is a high-intensity sport characterized by repetitive jumping, sudden directional changes, and overhead movements, all of which significantly increase the risk of injuries, particularly to the shoulders, knees, and ankles. Despite the frequency of injuries caused by actions like blocking and spiking, there has been limited research focused on the specific biomechanical risk factors unique to volleyball. This study aimed to investigate the lower limb biomechanics during block jumps in both the dominant and non-dominant directions, under both anticipated and unanticipated conditions, in fifteen elite male volleyball players. Kinematic and kinetic data from the ankle, knee, and hip joints were recorded. Our results revealed statistically significant differences between the dominant and non-dominant directions at the ankle, knee, and hip joints. The non-dominant direction exhibited a greater ankle dorsiflexion angle and velocity, as well as higher knee flexion angle, velocity, moment, power, and abduction moment, along with increased hip flexion angle and power. Additionally, unanticipated movements led to increases in vertical ground reaction force (vGRF), hip extension moment, and flexion power, while ankle dorsiflexion plantarflexion velocity and knee flexion power decreased. It appears that movements in the dominant direction were stiffer and less cushioned, potentially increasing the risk of injury. While the non-dominant direction provided better shock absorption, it also elevated the knee valgus moment, which could increase the load on the knee. Furthermore, in unanticipated situations, athletes with short reaction times, unable to quickly adjust their automated movement patterns, faced a higher risk of limb overuse, thereby increasing the likelihood of injury. In practice, coaches should consider differences in limb coordination and movement direction, incorporating unilateral preventive exercises to reduce the risk of injury.

Effective Prevention and Rehabilitation Strategies to Mitigate Non-Contact Anterior Cruciate Ligament Injuries: A Narrative Review

Non-contact anterior cruciate ligament injuries (NC-ACLs) represent a significant concern in sports medicine, particularly among athletes and physically active individuals. These injuries not only result in immediate functional impairment but also predispose individuals to long-term issues such as recurrent instability and early-onset osteoarthritis. This narrative review examines the biomechanical, neuromuscular, and environmental factors that contribute to the high incidence of NC-ACLs and evaluates the effectiveness of current prevention and rehabilitation strategies. The review identifies key risk factors, including improper landing mechanics, deficits in neuromuscular control, and muscle imbalances, which are pivotal in the etiology of NC-ACLs. Prevention programs that incorporate plyometric exercises, strength training, and neuromuscular education have shown efficacy in reducing injury rates. Rehabilitation protocols that emphasize a gradual return to sport, focusing on pain management, restoration of range of motion, and progressive strengthening, are critical for successful recovery and prevention of re-injury. The evidence suggests that an integrated approach, combining prevention and rehabilitation strategies tailored to the individual, is essential for minimizing NC-ACL risk and improving outcomes in affected populations.

The relationship between executed cut angle and speed with lower extremity joint angles during unanticipated side-step cutting in soccer players

BACKGROUND

Certain movements patterns have been indicated in knee injuries during cutting while running tasks. Differences in the executed cut angle (ECA) could partially account for group differences in joint kinematics previously observed, including sex differences.

RESEARCH QUESTION

Are there relationships between joint angles with entry speed and ECA during side-step cutting in soccer players?

METHODS

This cross-sectional study recruited 21 (10 females) soccer players. Participants completed 45° unanticipated side-step cuts in both directions. Kinematic data were captured with a 12 camera motion capture system with 46 reflective markers placed on the participants. Peak joint angles were determined during the stance phase of the cutting task. Entry speed and ECA were determined from pelvis markers. Hierarchical linear models examined relationships between angles, entry speed, and ECA, after accounting for age, sex, and leg preference. Regression coefficients with 95 % confidence intervals were reported and statistical significance (p<0.05) were examined using the Wald statistic.

RESULTS

The mean ECA (24.6°) was lower than the intended 45° angle. Peak joint angles were significantly related to both ECA and entry speed. Specifically, an increase in ECA by 10° (i.e., sharper cuts) would increase hip internal rotation and ankle plantarflexion by 1.8-2.1°, and decrease hip adduction, knee abduction and ankle eversion by 1.3-2.4°. Faster entry speeds by 0.5 m/s would increase hip flexion, hip internal rotation and knee extension angles by 1.8-3.8°, and decrease knee abduction by 2.6°.

SIGNIFICANCE

Studies evaluating cutting while running should consider ECA and entry speed in their design. Potential differences could confound between-group comparisons of joint angles, including when comparing sexes, and impact interpretations of injury risk.

Comparing Sagittal-Plane Biomechanics of Drop Jump Landing in Athletes With and Without Knee Osteoarthritis 2-Year Post-Anterior Cruciate Ligament Reconstruction

The study aimed to determine differences in sagittal-plane joint biomechanics between athletes with and without knee osteoarthritis (OA) during drop vertical jump 2 years after anterior cruciate ligament reconstruction (ACLR). Forty-one athletes with ACLR completed motion analysis testing during drop vertical jump from 30 cm. Sagittal-plane peak joint angles and moments and joint contributions to total support moment (TSM) were calculated during first landing. Medial compartment knee OA of the reconstructed knee was evaluated using Kellgren-Lawrence scores (ACLR group: Kellgren-Lawrence <2; ACLR-OA group: Kellgren-Lawrence ≥2). The ACLR-OA group (n = 13) had higher hip and lower knee contributions in the surgical limb than the ACLR group and their nonsurgical limb. Further, the ACLR-OA group had higher peak hip extension moment than the ACLR group (P = .024). The ACLR-OA group had significantly lower peak knee extension and ankle plantar flexion moments and TSM (P ≤ .032) than ACLR group. The ACLR-OA group landed with increased hip extension moment, decreased knee extension and ankle plantar flexion moments and TSM, and decreased knee and increased hip contributions to TSM compared with ACLR group. The ACLR-OA group may have adopted movement patterns to decrease knee load and compensated by shifting the load to the hip. Clinicians may incorporate tailored rehabilitation programs that mitigate the decreased knee load to minimize the risk of knee OA after ACLR.

Effect of changes in motor skill induced by educational video program to decrease lower-limb joint load during cutting maneuvers: based on musculoskeletal modeling

BACKGROUND

This study investigated the effects of changes in motor skills from an educational video program on the kinematic and kinetic variables of the lower extremity joints and knee ligament load.

METHODS

Twenty male participants (age: 22.2 ± 2.60 y; height: 1.70 ± 6.2 m; weight: 65.4 ± 7.01 kg; BMI: 23.32 ± 2.49 [Formula: see text]) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their foot on the force plate, and perform the cutting maneuver on the left. The educational video program for cutting maneuvers consisted of preparatory posture, foot landing orientation, gaze and trunk directions, soft landing, and eversion angle. The measured variables were the angle, angular velocity of lower extremity joints, ground reaction force (GRF), moment, and anterior cruciate ligament (ACL) and medial collateral ligament (MCL) forces through musculoskeletal modeling.

RESULTS

After the video feedback, the hip joint angles increased in flexion, abduction, and external rotation (p < 0.05), and the angular velocity increased in extension (p < 0.05). The ankle joint angles increased in dorsiflexion (p < 0.05), and the angular velocity decreased in dorsiflexion (p < 0.05) but increased in abduction (p < 0.05). The GRF increased in the anterior-posterior and medial-lateral directions and decreased vertically (p < 0.05). The hip joint moments decreased in extension and external rotation (p < 0.05) but increased in adduction (p < 0.05). The knee joint moments were decreased in extension, adduction, and external rotation (p < 0.05). The abduction moment of the ankle joint decreased (p < 0.001). There were differences in the support zone corresponding to 64‒87% of the hip frontal moment (p < 0.001) and 32‒100% of the hip horizontal moment (p < 0.001) and differences corresponding to 32‒100% of the knee frontal moment and 21‒100% of the knee horizontal moment (p < 0.001). The GRF varied in the support zone at 44‒95% in the medial-lateral direction and at 17‒43% and 73‒100% in the vertical direction (p < 0.001).

CONCLUSIONS

Injury prevention feedback reduced the load on the lower extremity joints during cutting maneuvers, which reduced the knee ligament load, mainly on the MCL.

Influence of the Menstrual Cycle and Training on the Performance of a Perturbed Single-Leg Squatting Task in Female Collegiate Athletes

Background

Anterior cruciate ligament (ACL) injuries often occur when an athlete experiences an unexpected disruption, or perturbation, during sports. ACL injury rates may also be influenced by the menstrual cycle.

Purpose

To determine whether training adaptations to knee control and muscle activity during a perturbed single-leg squatting (SLS) task depend on menstrual cycle phase in female athletes.

Study Design

Controlled laboratory study.

Methods

A total of 21 healthy female collegiate athletes (current or former [<3 years]) who competed in 9 different sports performed an SLS task in which they attempted to match their knee position (user signal) to a target signal. The protocol consisted of a 9-condition pretest, 5 sets of 3 training trials, and a 9-condition posttest. One perturbation was delivered in each condition by altering the resistance of the device. Sagittal knee control (absolute error between the target signal and user signal) was assessed using a potentiometer. Muscle activity during perturbed squat cycles was normalized to maximal activation and to corresponding muscle activity during unperturbed squat cycles (%unperturbed) within the same test condition. Athletes performed the protocol during a distinct menstrual cycle phase (early follicular [EF], late follicular [LF], midluteal [ML]). Two-way mixed analysis of variance was used to determine the effects of the menstrual cycle and training on knee control and muscle activity during task performance. Venous blood was collected for hormonal analysis, and a series of health questionnaires and anthropometric measures were also assessed to determine differences among the menstrual cycle groups.

Results

After training, athletes demonstrated better knee control during the perturbed squat cycles (lower absolute error, P < .001) and greater soleus feedback responses to the perturbation (%unperturbed, P = .035). Better knee control was demonstrated in the ML phase versus the EF phase during unperturbed and perturbed squat cycles (P < .039 for both). Quadriceps activation was greater in the ML phase compared with the EF and LF phases, both immediately before and after the perturbation (P < .001 for all).

Conclusion

Athletes learned to improve knee control during the perturbed performance regardless of menstrual cycle phase. The best knee control and greatest quadriceps activation during the perturbed squatting task was found in the ML phase.

Clinical Relevance

These findings may correspond to a lower incidence of ACL injury in the luteal phase and alterations in exercise performance across the menstrual cycle.

Unanticipated mid-flight external trunk perturbation increased frontal plane ACL loading variables during sidestep cuttings

Unanticipated trunk perturbation is commonly observed when anterior cruciate ligament (ACL) injuries occur during direction-changing manoeuvres. This study aimed to quantify the effect of mid-flight medial-lateral external trunk perturbation directions/locations on ACL loading variables during sidestep cuttings. Thirty-two recreational athletes performed sidestep cuttings under combinations of three perturbation directions (no-perturbation, ipsilateral-perturbation, and contralateral-perturbation relative to the cutting leg) and two perturbation locations (upper-trunk versus lower-trunk). The pushing perturbation was created by customised devices releasing a slam ball to contact participants near maximum jump height prior to cutting. Perturbation generally resulted in greater peak vertical ground reaction force and slower cutting velocity. Upper-trunk contralateral perturbation showed the greatest lateral trunk bending away from the travel direction, greatest peak knee flexion and abduction angles, and greatest peak internal knee adduction moments compared to other conditions. Such increased ACL loading variables were likely due to the increased lateral trunk bending and whole-body horizontal velocity away from the cutting direction caused by the contralateral perturbation act at the upper trunk. The findings may help understand the mechanisms of indirect contact ACL injuries and develop effective cutting techniques for ACL injury prevention.

Increased knee torsional misalignment associated with femoral torsion is related to non-contact anterior cruciate ligament injury: a case-control study

BACKGROUND

Altered axial biomechanics of the knee are recognized as a risk factor for non-contact anterior cruciate ligament (ACL) injury. However, the relationship of knee and segmental torsion to non-contact ACL and combined anterolateral ligament (ALL) injury is unclear. This study aims to determine the relationship of knee and segmental torsion to non-contact ACL injury and to explore their relationship with ALL injuries.

METHODS

We divided 122 patients with arthroscopically confirmed non-contact ACL injuries into an ACL injury group (isolated ACL injury, 63 patients) and an ACL + ALL injury group (ACL combined with ALL injury,59 patients). Additionally, 90 normal patients with similar age, gender and body mass index (BMI) were matched as a control group. The tibial tubercle-trochlear groove (TT-TG) distance, distal femoral torsion (DFT), posterior femoral condylar torsion (PFCT) and proximal tibial torsion (PTT) were measured using magnetic resonance imaging (MRI). We assessed the differences between the groups using an independent samples t test and utilized receiver operating characteristic (ROC) curves to determine the cut-off value for the increased risk of ACL injury.

RESULTS

In patients with ACL injury, the measurements of the TT-TG (11.8 ± 3.1 mm), DFT (7.7° ± 3.5°) and PFCT (3.6° ± 1.3°) were significantly higher compared to the control group (9.1 ± 2.4 mm, 6.3° ± 2.7° and 2.8° ± 1.3°, respectively; P < 0.05), but the PTT did not differ between the two groups. The TT-TG, DFT and PFCT were not significantly larger in patients combined with ALL injury. ROC curve analysis revealed ACL injury is associated with TT-TG, DFT and PFCT.

CONCLUSIONS

Knee torsional alignment is associated with ACL injury, predominantly in the distal femur rather than the proximal tibia. However, its correlation with ALL injury remains unclear. These findings may help identify patients at high risk for non-contact ACL injury and inform the development of targeted prevention and treatment strategies.

Deceleration Profiles Between the Penultimate and Final Steps of Planned and Reactive Side-Step Cutting

CONTEXT

Noncontact anterior cruciate ligament injury often occurs during rapid deceleration and change-of-direction maneuvers. These activities require an athlete to generate braking forces to slow down the center of mass and change direction in a dynamic environment. During preplanned cutting, athletes can use the penultimate step for braking before changing direction, resulting in less braking demand during the final step. During reactive cutting, athletes use different preparatory movement strategies during the penultimate step when planning time is limited. However, possible differences in the deceleration profile between the penultimate and final steps of preplanned and reactive side-step cuts remain unknown.

OBJECTIVE

To comprehensively evaluate deceleration during the penultimate and final steps of preplanned and reactive cutting.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

Thirty-six women (age = 20.9 ± 1.7 years, height = 1.66 ± 0.07 m, mass = 62.4 ± 8.7 kg).

INTERVENTION

Participants completed 90° side-step cutting maneuvers under preplanned and reactive conditions.

MAIN OUTCOME MEASURE(S)

Approach velocity, velocity at initial contact, and cutting angle were compared between conditions. Stance time, deceleration time, and biomechanical indicators of deceleration were assessed during the penultimate and final steps of preplanned and reactive 90° cuts. Separate repeated-measures analysis-of-variance models were used to assess the influence of step, condition, and their interaction on the biomechanical indicators of deceleration.

RESULTS

Approach velocity (P = .69) and velocity at initial contact of the penultimate step (P = .33) did not differ between conditions. During reactive cutting, participants achieved a smaller cutting angle (P < .001). We identified a significant step-by-condition interaction for all biomechanical indicators of deceleration (P values < .05).

CONCLUSIONS

A lack of planning time resulted in less penultimate step braking and greater final step braking during reactive cutting. As a result, participants exhibited a decreased cutting angle and longer stance time during the final step of reactive cutting. Improving an athlete's ability to respond to an external stimulus may facilitate a more effective penultimate step braking strategy that decreases the braking demand during the final step of reactive cutting.

Trends in Anterior Cruciate Ligament Injury and Recovery in Professional Snowboarders: The Extreme Sport of Snowboardcross

Introduction  An anterior cruciate ligament (ACL) tear is a devastating injury for athletes that is predominantly low energy and non-contact in nature. ACL tears are one of the most well-researched injuries in sports, however, scant research has been done on competitive snowboarders. Boardercross is a relatively new sport introduced to the Winter Olympics in 2006. Initially, it entailed four snowboarders racing head-to-head down a course of obstacles in a race to the finish, with the top two riders advancing to the next rounds. It has since expanded to six racers traveling up to 60 mph and jumps up to 100 feet in length in a head-to-head race to the finish. This extreme sport puts its athletes at risk for serious injury, requiring investigation. Purpose Investigate the prevalence of ACL tears in the extreme sport of boardercross, evaluate sport-specific factors that may put athletes at higher risk, and report return to sport data. Methods An expedited IRB approval was obtained. A survey was distributed to athletes via e-mail to national/regional coaches of countries with competitive boardercross teams. Professional coaches distributed the survey and secondarily distributed it to athletes. Results Sixty-six competitive snowboardcross athletes responded to the email surveys 48.5% of respondents had torn their ACL at least once in their career. Of the female respondents, 55.6% suffered at least one ACL tear, and 43.6% of male respondents suffered at least one ACL tear. 31.2% suffered more than one ACL tear during their career. Of those who tore their ACL, 91.3% (p <0.001) tore their front leg. 100.0% of the respondent athletes returned to sport post-ACL reconstruction. Conclusion Professional boardercross racers are at a higher risk of tearing their ACL than other winter sport athletes, including alpine skiers. A predominance of ACL injuries occurred on the front leg during landing from an aerial maneuver. All respondent athletes returned to the sport after injury, with approximately half returning within six months. Although no statistical significance was achieved, the data provided trends on risk factors related to ACL injuries among snowboardcross athletes.

Biomechanics and situational patterns associated with anterior cruciate ligament injuries in the National Basketball Association (NBA)

OBJECTIVES

Perform a comprehensive video analysis of all anterior cruciate ligament (ACL) injuries in National Basketball Association (NBA) athletes from 2006 to 2022 to determine the associated biomechanics, injury mechanism and game situation.

METHODS

NBA players diagnosed with an ACL tear from 2006 to 2022 were identified and videos of each injury evaluated by two reviewers. Visual evaluation included assessment of joint kinematics at three time points: initial contact of the injured leg with the ground (IC), 33 milliseconds later (IC+33) and 66 milliseconds later (IC+66). Game situation was assessed qualitatively.

RESULTS

Videos of 38 out of 47 (80.9%) ACL tears were obtained. 9 injuries were non-contact, while 29 involved indirect contact. Between IC and IC+33, average knee valgus increased from 5.1° to 12.0° and knee flexion increased from 12.6° to 32.6°. At all time points, the majority of injuries involved trunk tilt and rotation towards the injured leg, hip abduction and neutral foot rotation. The most common game situations for injury included the first step when attacking the basket following picking up the ball (n=13), landing following contact in the air (n=11) and jump stop (n=5).

CONCLUSION

Three major mechanisms predominate ACL tears in NBA players: the first step following picking up the ball when attacking, landing and jump stops. None of the injuries reviewed demonstrated direct contact to the knee, emphasising the importance of body kinematics in this injury pattern. The increase in knee valgus and knee flexion between IC and IC+33 should be noted as a possible precipitant to injury.

Neuromuscular Response during Different Side-Cutting Maneuvers and Its Influence on the Risk of Knee Injuries

BACKGROUND

The objective of this study was to investigate the impact of a customized exercise program on electromyographic (EMG) variables during side-cutting maneuvers.

METHODS

Fifty-seven physically active volunteers were recruited and randomized into two groups: a control group (CG) and an experimental group (EG). The CG maintained their regular physical activity, while the EG followed an individualized, integrated exercise regimen that included strength, neuromuscular, proprioceptive, eccentric training, and whole-body vibration (WBV) exercises, lasting for 12 weeks. EMG-Root Means Square (RMS) values for the quadriceps (Q) and hamstrings (H) were measured immediately following initial foot contact at 50, 100, 150, and 200 milliseconds. Changes in EMG activity were evaluated before and after a twelve-week intervention, and the effect size (ES, 90% confidence limit [90%CL]) was calculated.

RESULTS

The results showed that the EG participants exhibited enhanced co-contraction as measured by the hamstring/quadriceps ratio (H/Q ratio) during both open and cross-cutting side maneuvers after the twelve-week intervention.

CONCLUSION

Furthermore, the customized, integrated exercise program that combined strength, neuromuscular, proprioceptive, eccentric training, and WBV exercises were could potentially serve as a beneficial neuromuscular and biomechanical strategy for addressing knee injury risk in non-professional, physically active populations at high risk for such injuries.

Effects of shoe collar types on ankle and knee biomechanics characteristics when performing the side-step cutting task

This study aimed to examine the effect of football shoes with different collar types on ankle and knee kinematic and kinetics features during 45° and 135° side-step cutting tasks. Fifteen healthy college football players volunteered for the study. Each participant was instructed to perform side-step cutting tasks with high, low, and no collar football shoes. The kinematic and ground reaction force data were measured using a Vicon motion capture system and a Kistler force plate, respectively. Two-way MANOVAs with repeated measures were used to examine the effect of shoe collar type and task conditions. There were no interaction effects. The high collar football shoe showed decreased ankle range of motion in the sagittal plane (p = 0.010) and peak ankle external rotation moment (p = 0.009) compared to the no collar football shoe. The high (p = 0.025) and low (p = 0.029) collar football shoes presented greater peak ankle external rotation angles than the no collar football shoe. These results imply that football shoes with high collars made of high intensity knitted fabric could be used to restrict ankle joint movement, with potential implications for decreasing the risk of ankle sprain injuries in football players.

Biomechanical fidelity of athletic training using virtual reality head-mounted display: the case of preplanned and unplanned sidestepping

Virtual reality has recently been recognised as an effective tool for investigating visual-perceptual tasks. To develop a sport-specific virtual environment with realistic locomotion, it is crucial to examine the effect of using virtual reality devices on athletes performing intense and complex movements. Twelve collegiate football players were instructed to perform pre-planned and unplanned sidestepping in both environments with the same dimension and experimental setup in the virtual environment as in the real one. Analysis of the performance and knee biomechanical parameters showed that movements performed in the two environments were generally comparable. Consistent changes in approach velocity and knee angle/moment under unplanned conditions (compared with preplanned conditions) were also found in the virtual environment as in the real one, except for the significantly larger peak flexion angle (p < .05) observed in the virtual environment. Interestingly, half of the participants changed from producing abduction to adduction moment at the weight acceptance phase in the preplanned condition (p < .05). These findings suggested that while it is generally feasible to use virtual reality head-mounted displays for designated experiments and training, the effect of wearing virtual reality devices could be somewhat subject-specific.

Kinetic energy absorption differences during drop jump between athletes with and without radiological signs of knee osteoarthritis: Two years post anterior cruciate ligament reconstruction

BACKGROUND

Patients demonstrate decreased knee loading and energy absorption after anterior cruciate ligament reconstruction (ACLR). This study aimed to determine the differences in the contribution of joints to the absorbed energy between athletes with and without radiological signs of knee OA 2 years after ACLR during drop jump (DJ) landing from 20, 30, and 40 cm.

METHODS

Forty-one (level I/II) athletes 2 years after ACLR participated in this cross-sectional study and completed motion analysis testing of DJ. Proportional contribution of the joints (foot, ankle, knee, and hip) to the absorbed energy were computed. Posterior-anterior bent-knee radiographs were completed and graded in the medial compartment of the reconstructed knee using the Kellgren-Lawrence (KL) system (OA group: KL ≥2; Non-OA group: KL<2) RESULTS: Thirteen (31.7%) athletes showed radiological signs of knee OA in the medial compartment. There was a significant joint-by-group-by-limb interaction for the contribution of joints to absorbed energy during DJ 40 cm (p ≤ 0.019) and a joint-by-group interaction for the contribution of joints during DJ 20 cm (p = 0.018). The OA group had a lower involved knee (p = 0.043) and higher involved hip contributions (p = 0.014) compared to the Non-OA group, and the non-involved knee (p = 0.007). While the Non-OA group had a lower involved ankle contribution (p = 0.045) compared to their non-involved ankle during DJ 40 cm. The OA group also had higher involved hip contribution than the Non-OA group (p = 0.010), lower involved knee (p = 0.002), and higher involved hip contribution than the non-involved limb during DJ 20 cm.

SIGNIFICANCE

The OA group may have adopted a compensatory pattern characterized by a decreased involved knee and increased involved hip to attenuate absorbed energy compared to the Non-OA group and their non-involved limb. The contribution of joints to the absorbed energy during DJ landing might be used as an assessment tool to identify patients with radiological signs of knee OA after ACLR.

Perceptual-Cognitive Tasks Affect Landing Performance of Soccer Players at Different Levels of Fatigue

Background

There is a possible interaction between the underlying mechanisms of perceptual-cognitive tasks and motor control. For example, landing biomechanics changed during perceptual-cognitive tasks undertaken at different levels of fatigue of the athlete. Thus, this study explored the effect of perception-cognitive tasks interventions on male soccer players' landing mechanisms at different levels of fatigue.

Methods

Perceptual-cognitive tasks during games were simulated using classic multiple object tracking (MOT) paradigms, and 15 male soccer players completed MOT tasks under nonfatigue (NF), moderate fatigue (MF), and severe fatigue (SF). Landing-associated indicators were collected and calculated using a Vicon and force measuring platform.

Results

Level of fatigue and MOT task significantly affected hip and knee flexion angles, hip and knee extension moments, and vertical ground reaction force. Specifically, hip and knee flexion angles were significantly higher in MOT than non-MOT tasks at all levels of fatigue. In NF state, hip and knee extension moments were significantly smaller during MOT than non-MOT tasks. In SF state, the hip extension moment was larger during MOT than non-MOT tasks. In both MF and SF states, vertical ground reaction force was significantly higher in MOT than non-MOT tasks.

Conclusion

Although soccer players landed cautiously when not fatigued, they were significantly less able to do this and handle challenging perceptual-cognitive task movements when fatigued. Thus, landing performance is affected by perceptual-cognitive task interference in fatigue conditions.

Hip external rotation isometric torque for soccer, basketball, and volleyball athletes: normative data and asymmetry index

BACKGROUND

Deficits in strength of the hip external rotators (ER) affect trunk, hip, and knee movement patterns, potentially contributing to injury in athletes.

OBJECTIVES

To provide normative data on isometric torque for hip ER in athletes of three distinct sports and to determine if isometric torque for the hip ER and torque asymmetry between legs differ among sports and between sexes.

METHODS

Basketball, soccer, and volleyball athletes (n=451) were evaluated. Hip ER torque was quantified bilaterally with athletes in prone and 90° of knee flexion using a hand-held dynamometer.

RESULTS

Data are expressed as mean and 95% confidence interval. Hip ER torque values in Nm/kg for the dominant and non-dominant limbs were, respectively, 0.46 (0.44, 0.48) and 0.42 (0.40, 0.44) for male soccer athletes; 0.35 (0.32, 0.37) and 0.27 (0.25, 0.29) for male basketball athletes; and 0.37 (0.34, 0.39) and 0.35 (0.32, 0.37) for male volleyball athletes. Hip ER torque in Nm/kg for the female volleyball athletes was 0.29 (0.26, 0.33) for the dominant and 0.29 (0.25, 0.32) for the non-dominant limb. The Limb Symmetry Index for male soccer, basketball, and volleyball players was, respectively, 94% (91, 97), 81% (75, 87), and 95% (91, 99). For female volleyball players the Limb Asymmetry Index was 102% (95, 108). Male volleyball athletes showed higher torque values than female volleyball athletes.

CONCLUSIONS

This study reported normative values for hip ER isometric torque of youth athletes. Clinicians can use the reported data as reference to identify torque deficits in athletes of the three reported sports.

Tendency of Driving to the Basket Is Associated With Increased Risk of Anterior Cruciate Ligament Tears in National Basketball Association Players: A Cohort Study

Background:

Driving to the basket in basketball involves acceleration, deceleration, and lateral movements, which may expose players to increased anterior cruciate ligament (ACL) injury risk. It is unknown whether players who heavily rely on driving have decreased performance on returning to play after ACL reconstruction (ACLR).

Hypothesis:

Players with a greater tendency to drive to the basket would be more likely to tear their ACL versus noninjured controls and would experience decreased performance when returning to play after ACLR.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Season-level performance statistics and ACL injuries were aggregated for National Basketball Association (NBA) seasons between 1980 and 2017 from publicly available sources. Players’ tendency to drive was calculated using 49 common season-level performance metrics. Each ACL-injured player was matched with 2 noninjured control players by age, league experience, and style of play metrics. Points, playing minutes, driving, and 3-point shooting tendencies were compared between players with ACL injuries and matched controls. Independent-samples t test was utilized for comparisons.

Results:

Of 86 players with a total of 96 ACL tears identified in the NBA, 50 players were included in the final analysis. Players who experienced an ACL tear had a higher career-average drive tendency than controls (P = .047). Players with career-average drive tendency ≥1 standard deviation above the mean were more likely to tear their ACL than players with drive tendency <1 standard deviation (5.2% vs 2.7%; P = .026). There was no significant difference in total postinjury career points (P = .164) or career minutes (P = .237) between cases and controls. There was also no significant change in drive tendency (P = .152) or 3-point shooting tendency (P = .508) after return to sport compared with controls.

Conclusion:

NBA players with increased drive tendency were more likely to tear their ACL. However, players who were able to return after ACLR did not underperform compared with controls and did not alter their style of play compared with the normal changes seen with age. This information can be used to target players with certain playing styles for ACL injury prevention programs.

Trunk Angle Modulates Feedforward and Feedback Control during Single-Limb Squatting

Trunk positioning and unexpected perturbations are high-risk conditions at the time of anterior cruciate ligament injury. The influence of trunk positioning on motor control responses to perturbation during dynamic performance is not known. We tested the influence of trunk position on feedforward and feedback control during unexpected perturbations while performing a novel single-limb squatting task. We also assessed the degree that feedforward control was predictive of feedback responses. In the flexed trunk condition, there were increased quadriceps (p < 0.026) and gluteus medius long-latency reflexes (p < 0.001) and greater quadriceps-to-hamstrings co-contraction during feedforward (p = 0.017) and feedback (p = 0.007) time bins. Soleus long-latency reflexes increased more than 100% from feedforward muscle activity regardless of trunk condition. Feedforward muscle activity differentially predicted long-latency reflex responses depending on the muscle (R²: 0.47-0.97). These findings support the concept that trunk positioning influences motor control responses to perturbation and that feedback responses may be invariant to the feedforward control strategy.

Wearing Cushioning Shoes Reduce Load Rates More Effectively in Post-Fatigue than in Pre-Fatigue during Landings

Simple Summary

Athlete experience high impact forces during landing, which is a contributing factor to injury risk potentials. As a potential factor of affecting the impact force, previous study of the effects of footwear cushioning effect on landing biomechanics were inconsistent. Furthermore, limited efforts have been exerted on the relationship between footwear cushioning and fatigue. In this study, the footwear cushioning effects on bipedal landing biomechanics before and after acute exercise-induced fatigue protocol were explored. The results of this study suggest that footwear cushioning can reduce landing-related rearfoot impact forces regardless of fatigue conditions. In a situation where the neuromuscular activity is reduced or absent, e.g., post-fatigue, wearing better cushioning shoes show superior attenuation, as indicated by low forefoot and rearfoot impacts.

Abstract

Purpose: this study aimed to investigate the footwear cushioning effects on impact forces and joint kinematics of the lower extremity during bipedal drop landings before and after acute exercise-induced fatigue protocol. Methods: in this case, 15 male collegiate basketball athletes performed drop landings from a 60 cm platform wearing highly-cushioned shoes (HS) and less cushioned shoes (control shoes, CS) before and after acute fatigue-inducing exercises (i.e., shuttle run combined with multiple vertical jumps). Force plates and motion capturing systems were synchronised to measure ground reaction forces and kinematic data during drop landings. Maximum jump height was analysed with one-way ANOVA. Two-way repeated measure ANOVAs were performed on each of the tested variables to examine if there was significant main effects of shoe and fatigue as well as the interaction. The significance level was set to 0.05. Results: rearfoot peak impact forces and loading rates significantly reduced when the participants wore HS in pre- and post-fatigue conditions. The peak loading rates in forefoot significantly reduced when HS were worn in post-fatigue. Compared with pre-fatigue, wearing HS contributed to with 24% and 13% reduction in forefoot and rearfoot peak loading rates, respectively, and the occurrence times of first and second peak impact forces and loading rates were much later. In the post-fatigue, a significant increase in the initial contact and minimum angles of the ankle were observed in HS compared with CS. Conclusion: these findings suggest that footwear cushioning can reduce landing-related rearfoot impact forces regardless of fatigue conditions. In a situation where the neuromuscular activity is reduced or absent such as post-fatigue wearing better cushioning shoes show superior attenuation, as indicated by lower forefoot and rearfoot impacts.

The Efficacy of Brief School-Based Exercise Programs in Improving Pubertal Bone Mass and Physical Fitness: A Randomized Controlled Trial

PURPOSE

To examine the effects of three types of school-based exercises on bone health and physical fitness function in Chinese boys and girls.

METHODS

One hundred and seventy-four Chinese boys and girls were randomly assigned into four groups: (1) sham exercise (ShEx); (2) high-impact exercise (HiEx); (3) high-impact exercise with various directions (HiExVi); and (4) high-intensity interval exercise (HiInEx). Speed of sound (SOS) and physical fitness parameters were determined before and after six-month intervention.

RESULTS

At the end of six-month intervention, participants in all groups show an increment of SOS compared with the baseline (p < 0.05), and the changes were higher in HiEx (mean: 38.878 m/s, 95% CI: 32.885~44.872, p = 0.001) and HiExVi groups (49.317 m/s, 42.737~55.897, p < 0.001) compared with ShEx group (20.049 m/s, 13.751~26.346). Six-month exercise training generated a reduction of percent of body fat (PBF) and waist-hip ratio (WHR) (p < 0.05). The decrease of PBF was greater in HiExVi (-1.222%, -1.820~-0.624, p = 0.012) and HiInEx groups (-1.395%, -1.809~-0.982, p = 0.003), whereas the reduction of WHR was larger in HiEx (-0.026, -0.039~-0.014, p = 0.009), HiExVi (-0.024, -0.036~-0.012, p = 0.021), and HiInEx groups (-0.035, -0.046~-0.024, p < 0.001) compared with ShEx group. Balance function (BLF), vital capacity (VC), standing long jump (SLJ), and sit up (SU) increased in all intervention groups (p < 0.05). The BLF increased in HiEx (6.332 s, 4.136~8.528, p = 0.001), HiExVi (10.489 s, 8.934~12.045, p < 0.001), and HiInEx groups (9.103 s, 7.430~10.776, p < 0.001) showed a greater change than that of ShEx group (1.727 s, 0.684~2.770). The increment of VC (273.049 mL, 199.510~346.587, p < 0.001) and SU (2.537 times/min, 0.639~4.435, p = 0.017) was higher in HiInEx group, whereas the accrual in SLJ was larger in HiExVi (7.488 cm, 4.936~10.040, p = 0.007) compared with ShEx group (58.902 mL, 7.990~109.814; -0.463 times/min, -2.003~1.077; 1.488 cm, -0.654~3.630).

CONCLUSION

The brief school-based exercises were effective in improving schoolchildren's health, but they showed different effects, with HiEx mostly improving bone health, HiInEx largely benefiting physical fitness function, and HiExVi enhancing both bone and physical fitness.

Explosive Quadriceps Strength Symmetry and Landing Mechanics Limb Symmetry After Anterior Cruciate Ligament Reconstruction in Females

CONTEXT

Emerging evidence suggests that a lower quadriceps rate of torque development (RTD) after anterior cruciate ligament (ACL) reconstruction (ACLR) may be associated with altered landing mechanics. However, the influence of quadriceps RTD magnitude and limb symmetry on landing mechanics limb symmetry remains unknown.

OBJECTIVE

To assess the influence of quadriceps RTD magnitude and limb symmetry on limb symmetry in sagittal-plane landing mechanics during functional landing tasks in females with or without ACLR.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PATIENTS OR OTHER PARTICIPANTS

A total of 19 females with ACLR (age = 19.21 ± 1.81 years, height = 164.12 ± 6.97 cm, mass = 63.79 ± 7.59 kg, time after surgery = 20.05 ± 9.50 months) and 19 females serving as controls (age = 21.11 ± 3.28 years, height = 167.26 ± 7.26 cm, mass = 67.28 ± 9.25 kg).

MAIN OUTCOME MEASURE(S)

Landing mechanics were assessed during a double-legged (DL) jump-landing task, a single-legged jump-landing task, and a side-cutting task. Quadriceps RTD was collected during isometric muscle contractions. Separate stepwise multiple linear regression models were used to determine the variance in limb symmetry in the sagittal-plane knee moment at initial contact, peak vertical ground reaction force, and loading rate that could be explained by quadriceps RTD magnitude or limb symmetry, group (ACLR or control), and their interaction.

RESULTS

In the ACLR group, greater limb symmetry in quadriceps RTD was associated with greater symmetry in sagittal-plane knee moment at initial contact during the DL task (P = .004). Peak vertical ground reaction force and loading rate could not be predicted by quadriceps RTD magnitude or limb symmetry, group, or their interaction during any task.

CONCLUSIONS

Developing greater symmetry but not magnitude in quadriceps RTD likely enabled more symmetric sagittal-plane knee landing mechanics during the DL task in the ACLR group and thus may reduce the risk of a second ACL injury. Such a protective effect was not found during the single-legged or side-cutting tasks, which may indicate that these tasks do not allow for the compensatory landing mechanism of shifting load to the uninvolved limb that was possible during the DL task.

IMU-based knee flexion, abduction and internal rotation estimation during drop landing and cutting tasks

Anterior cruciate ligament (ACL) injury is a common and severe knee injury in sports. Knee flexion, abduction and internal rotation angles are considered crucial biomechanical indicators of the ACL injury risk but currently are computed in a laboratory with an optical motion capture. This paper introduces an inertial measurement unit (IMU) based algorithm for knee flexion, abduction and internal rotation estimation during ACL injury risk assessment tests, including drop landing and cutting tasks. This algorithm includes a special two-step complementary-based orientation filter and a special single-pose sensor-to-segment calibration procedure. Fourteen healthy subjects performed double-leg, single-leg drop landing and cutting tasks. Each subject wore four IMUs and reflective marker clusters on their thighs and shanks. For the presented knee angles algorithm with an empirical initial segment orientation, the root mean square errors (RMSEs) of the estimated continuous knee flexion, abduction and internal rotation cross all the movement tasks were 1.07°, 2.87° and 2.64°, and RMSEs of the peak knee flexion and peak knee abduction errors were 1.22° and 3.82°. The knee angles algorithm was capable of estimating knee abduction and internal rotation angles during drop landing and cutting tasks, and knee flexion estimation was substantially more accurate than previously reported approaches. Additionally, we found that for the presented algorithm, the accuracy of initial segment orientation was a critical factor for knee abduction and internal rotation estimations. The presented IMU-based knee angles algorithm could serve as a foundation to enable in-field biomechanical ACL injury risk assessment.

Estimation of forces on anterior cruciate ligament in dynamic activities

In this work, a nonlinear strain rate dependent plugin developed for the OpenSim® platform was used to estimate the instantaneous strain rate (ISR) and the forces on the ACL's anteromedial (aACL) and posterolateral (pACL) bundles during walking and sudden change of direction of running termed as 'plant-and-cut' (PC). The authors obtained the kinematics data for walking via optical motion capture. PC movements, along with running kinematics, were obtained from the literature. A nonlinear plugin developed for ligaments was interfaced with OpenSim® platform to simulate walking and PC motions with a flexed knee and an extended knee. PC phase is sandwiched between an approach phase and take-off phase and was studied at various event velocities (1.8, 3, and 4.2 m s^-1), and angles of PC (23°, 34°, and 45°) as encountered in adult ball games. In both cases of PC-with-extended knee and PC-with-flexed-knee, the maximum forces on both the ACL bundles were observed after the take-off phase. A maximum force of ~ 35 N kg^-1 of body weight (BW) was observed on aACL after the take-off phase for an event velocity of 4.2 m s^-1. In the posterolateral bundle (pACL), the maximum forces (~ 40 N kg^-1 of BW) were observed towards the end of the mid-swing phase (after the take-off phase) for the various combinations of the parameters studied. The forces observed in the simulation of PC-with-flexed-knee and PC-with-extended-knee has resulted in magnitude higher than sustainable by the adults. This study is novel in attempting to incorporate differing rates-of-strain that have been shown to alter soft tissue properties into the OpenSim® musculoskeletal model. The proposed model can be used by researchers to predict the forces during various kinematic activities for other soft tissues.

Biomechanical Determinants of Performance and Injury Risk During Cutting: A Performance-Injury Conflict?

BACKGROUND

Most cutting biomechanical studies investigate performance and knee joint load determinants independently. This is surprising because cutting is an important action linked to performance and non-contact anterior cruciate ligament (ACL) injuries. The aim of this study was to investigate the relationship between cutting biomechanics and cutting performance (completion time, ground contact time [GCT], exit velocity) and surrogates of non-contact ACL injury risk (knee abduction [KAM] and internal rotation [KIRM] moments) during 90° cutting.

DESIGN

Mixed, cross-sectional study following an associative design. 61 males from multidirectional sports performed six 90° pre-planned cutting trials, whereby lower-limb and trunk kinetics and kinematics were evaluated using three-dimensional (3D) motion and ground reaction force analysis over the penultimate (PFC) and final foot contact (FFC). Pearson's and Spearman's correlations were used to explore the relationships between biomechanical variables and cutting performance and injury risk variables. Stepwise regression analysis was also performed.

RESULTS

Faster cutting performance was associated (p ≤ 0.05) with greater centre of mass (COM) velocities at key instances of the cut (r or ρ = 0.533-0.752), greater peak and mean propulsive forces (r or ρ = 0.449-0.651), shorter FFC GCTs (r or ρ = 0.569-0.581), greater FFC and PFC braking forces (r = 0.430-0.551), smaller hip and knee flexion range of motion (r or ρ = 0.406-0.670), greater knee flexion moments (KFMs) (r = 0.482), and greater internal foot progression angles (r = - 0.411). Stepwise multiple regression analysis revealed that exit velocity, peak resultant propulsive force, PFC mean horizontal braking force, and initial foot progression angle together could explain 64% (r = 0.801, adjusted 61.6%, p = 0.048) of the variation in completion time. Greater peak KAMs were associated with greater COM velocities at key instances of the cut (r or ρ = - 0.491 to - 0.551), greater peak knee abduction angles (KAA) (r = - 0.468), and greater FFC braking forces (r = 0.434-0.497). Incidentally, faster completion times were associated with greater peak KAMs (r = - 0.412) and KIRMs (r = 0.539). Stepwise multiple regression analysis revealed that FFC mean vertical braking force and peak KAA together could explain 43% (r = 0.652, adjusted 40.6%, p < 0.001) of the variation peak KAM.

CONCLUSION

Techniques and mechanics associated with faster cutting (i.e. faster COM velocities, greater FFC braking forces in short GCTs, greater KFMs, smaller hip and knee flexion, and greater internal foot progression angles) are in direct conflict with safer cutting mechanics (i.e. reduced knee joint loading, thus ACL injury risk), and support the "performance-injury conflict" concept during cutting. Practitioners should be conscious of this conflict when instructing cutting techniques to optimise performance while minimising knee joint loading, and should, therefore, ensure that their athletes have the physical capacity (i.e. neuromuscular control, co-contraction, and rapid force production) to tolerate and support the knee joint loading during cutting.

Whole-Body Change-of-Direction Task Execution Asymmetries After Anterior Cruciate Ligament Reconstruction

Cutting maneuvers can be executed at a range of angles and speeds, and these whole-body task descriptors are closely associated with lower-limb mechanical loading. Asymmetries in angle and speed when changing direction off the operated and nonoperated limbs after anterior cruciate ligament reconstruction may therefore influence the interpretation of interlimb differences in joint-level biomechanical parameters. The authors hypothesized that athletes would reduce center-of-mass heading angle deflection and body rotation during the change-of-direction stance phase when cutting from the operated limb, and would compensate for this by orienting their center-of-mass trajectory more toward the new intended direction of travel prior to touchdown. A total of 144 male athletes 8 to 10 months after anterior cruciate ligament reconstruction performed a maximum-effort sidestep cutting maneuver while kinematic, kinetic, and ground reaction force data were recorded. Peak ground reaction force and knee joint moments were lower when cutting from the operated limb. Center-of-mass heading angle deflection during stance phase was reduced for cuts performed from the operated limb and was negatively correlated with heading angle at touchdown. Between-limb differences in body orientation and horizontal velocity at touchdown were also observed. These systematic asymmetries in cut execution may require consideration when interpreting joint-level interlimb asymmetries after anterior cruciate ligament reconstruction and are suggestive of the use of anticipatory control to co-optimize task achievement and mechanical loading.

Tracking Quantitative Characteristics of Cutting Maneuvers with Wearable Movement Sensors during Competitive Women's Ultimate Frisbee Games

(1) Ultimate frisbee involves frequent cutting motions, which have a high risk of anterior cruciate ligament (ACL) injury, especially for female players. This study investigated the in-game cutting maneuvers performed by female ultimate frisbee athletes to understand the movements that could put them at risk of ACL injury. (2) Lower-body kinematics and movement around the field were reconstructed from wearable lower-body inertial sensors worn by 12 female players during 16 league-sanctioned ultimate frisbee games. (3) 422 cuts were identified from speed and direction change criteria. The mean cut had approach speed of 3.4 m/s, approach acceleration of 3.1 m/s², cut angle of 94 degrees, and ground-contact knee flexion of 34 degrees. Shallow cuts from 30 to 90 degrees were most common. Speed and acceleration did not change based on cut angle. Players on more competitive teams had higher speed and acceleration and reduced knee flexion during cutting. (4) This study demonstrates that a lower-body set of wearable inertial sensors can successfully track an athlete’s motion during real games, producing detailed biomechanical metrics of behavior and performance. These in-game measurements can be used to specify controlled cutting movements in future laboratory studies. These studies should prioritize higher-level players since they may exhibit higher-risk cutting behavior.

Use of the lower extremity functional test to predict injury risk in active athletes

BACKGROUND

The purpose of the current study was to assess the reliability and validity of the lower extremity functional test (LEFT) for predicting low back and lower limb injury in active athletes.

METHODS

Seventy athletes (45M, 25F; mean age: 21±2 years) from seven different sports volunteered. The LEFT was a battery of five weight-bearing functional movements involving different movement planes, directions, modes, and at varying intensities. Both legs were assessed in a random order and each athlete was given both movement quality and associated symptom scores. Intratester, intrarater and inter-rater reliability were evaluated. Participants were followed up for 12 months, and their exposure to sport and subsequent injuries were recorded. Independent samples t-tests were performed to determine if a significant difference existed in LEFT scores between injured and non-injured athletes. Receiver operating characteristic (ROC) curve analysis was employed to assess the instrument's capacity to predict injury.

RESULTS

The intratester reliability ICC2, 1 was 0.875. The ICC2, 3 of intrarater reliability was 0.953 and the inter-rater reliability was 0.949, respectively. Nineteen participants had an injury in the low back or lower limb within the following 12 months. Injured athletes had significant lower movement quality and symptom scores of the LEFT than non-injured (t=4.278, P=0.000, Cohen's d=1.2; t=3.654, P=0.001, Cohen's d=1.3, respectively). When movement quality or symptom score alone was included in the ROC analysis, the area under the ROC curve (AUC) scores were 0.772 (P=0.000, 95% CI: 0.653-0.891) and 0.771 (P=0.001, 95% CI: 0.638-0.905), respectively. When movement quality and symptom scores were combined to predict injury, the AUC discrimination score was 0.853 (P=0.000, 95% CI: 0.754-0.953), resulting in 85.3% of cases being correctly predicted as low back or lower limb injured/noninjured.

CONCLUSIONS

The findings from the current study suggest that the LEFT appears to be a reliable and valid functional assessment tool for predicting low back or lower limb injury risk in these college athletes, especially when movement quality and symptom scores were used in combination.

Mechanical Differences Between Adolescents and Adults During Two Landing Phases of a Drop Jump Task

Moir, GL, Munford, SN, Snyder, BW, and Davis, SE. Mechanical differences between adolescents and adults during two landing phases of a drop jump task. J Strength Cond Res XX(X): 000-000, 2020-The mechanical differences between the first and second landing phases of a drop jump (DJ) task performed by adolescent and adult male players were investigated. Eleven adolescent basketball players (age: 16.5 ± 0.7 years) and 11 resistance-trained adults (age: 22.3 ± 1.9 years) performed DJs from a height of 0.40 m. Force plates and a 3-dimensional motion analysis system were used to determine mechanical variables, including landing velocity, normalized vertical stiffness, normalized peak impact force, and work as well as mechanical characteristics of the hip, knee, and ankle joints during the absorption phase of each landing. The adolescents produced greater peak impact forces (mean difference [xDiff] = 42 N·kg; effect size [ES] = 1.15) and vertical stiffness (xDiff = 126 N·kg·m; ES = 1.28) during shorter absorption phases (xDiff = 0.09 seconds; ES = 2.67) compared with the adults, despite their lower landing velocities (xDiff = 0.21 m·s; ES = 1.37). Furthermore, the adolescents generated greater peak extensor joint moments at the lower-body joints compared with the adults (xDiff = 2.3 N·m·kg; ES = 1.17), but they did not effectively modulate the energy absorbed by the joint moments in response to the changing demands of the landing tasks. The assessment of the biomechanical characteristics of the 2 landing phases associated with a DJ task revealed that adolescent male basketball players adopt neuromuscular strategies that may increase the risk of incurring musculoskeletal injuries compared with resistance-trained adults.

Kinematic Analyses of Parkour Landings from as High as 2.7 Meters

Developing effective landing strategies has implications for both injury prevention and performance training. The purpose was to quantify the kinematics of Parkour practitioners’ landings from three heights utilizing four techniques. Seventeen male and three female Parkour practitioners landed from 0.9, 1.8, and 2.7 m utilizing the squat, forward, roll, and stiff landing techniques when three-dimensional kinematics were collected. The stiff landing demonstrated the shortest landing time, and the roll landing showed the longest landing time for 1.8 and 2.7 m. Roll landings demonstrated the greatest forward velocities at initial contact and at the end of the landing. Stiff landings showed the greatest changes in vertical velocity during the early landing, while roll landings showed the least changes for 0.9 and 1.8 m. Both roll and stiff landings generally resulted in decreased changes in horizontal velocity during the early landing compared to squat and forward landings. The four landing techniques also demonstrated different lower extremity joint angles. Stiff landings may increase injury risk because of the quick decrease of vertical velocities. Roll landings allow individuals to decrease vertical and horizontal velocities over a longer time, which is likely to decrease the peak loading imposed on the lower extremities.

Exploring the Justifications for Selecting a Drop Landing Task to Assess Injury Biomechanics: A Narrative Review and Analysis of Landings Performed by Female Netball Players

When assessing biomechanics in a laboratory setting, task selection is critical to the production of accurate and meaningful data. The injury biomechanics of landing is commonly investigated in a laboratory setting using a drop landing task. However, why this task is so frequently chosen is unclear. Therefore, this narrative review aimed to (1) identify the justification/s provided within the published literature as to why a drop landing task was selected to investigate the injury biomechanics of landing in sport and (2) use current research evidence, supplemented by a new set of biomechanical data, to evaluate whether the justifications are supported. To achieve this, a comprehensive literature search using Scopus, PubMed, and SPORTDiscus online databases was conducted for studies that had collected biomechanical data relating to sport injuries using a drop landing task. In addition, kinematic and kinetic data were collected from female netball players during drop landings and maximum-effort countermovement jumps from the ground to grab a suspended ball. The literature search returned a total of 149 articles that were reviewed to determine the justification for selecting a drop landing task. Of these, 54% provided no explicit justification to explain why a drop landing task was chosen, and 15% stated it was selected because it had been used in previous research. Other reasons included that the drop landing provides high experimental control (16%), is a functional sports task (11%), and is a dynamic task (6%). Evidence in the literature suggests that the biomechanical data produced with drop landings may not be as externally valid as more sport-specific tasks. Biomechanical data showed that the drop landing may not control center of mass fall height any better than maximum-effort countermovement jumps from the ground. Further, the frequently used step-off technique to initiate drop landings resulted in kinematic and kinetic asymmetries between lower limbs, which would otherwise be symmetrical when performing a countermovement jump from the ground. Researchers should consider the limitations of a drop landing task and endeavor to improve the laboratory tasks used to collect biomechanical data to examine the injury biomechanics of landing.

Eccentric Resistance Training in Youth: Perspectives for Long-Term Athletic Development

The purpose of this narrative review is to discuss the role of eccentric resistance training in youth and how this training modality can be utilized within long-term physical development. Current literature on responses to eccentric exercise in youth has demonstrated that potential concerns, such as fatigue and muscle damage, compared to adults are not supported. Considering the importance of resistance training for youth athletes and the benefits of eccentric training in enhancing strength, power, speed, and resistance to injury, its inclusion throughout youth may be warranted. In this review we provide a brief overview of the physiological responses to exercise in youth with specific reference to the different responses to eccentric resistance training between children, adolescents, and adults. Thereafter, we discuss the importance of ensuring that force absorption qualities are trained throughout youth and how these may be influenced by growth and maturation. In particular, we propose practical methods on how eccentric resistance training methods can be implemented in youth via the inclusion of efficient landing mechanics, eccentric hamstrings strengthening and flywheel inertia training. This article proposes that the use of eccentric resistance training in youth should be considered a necessity to help develop both physical qualities that underpin sporting performance, as well as reducing injury risk. However, as with any other training modality implemented within youth, careful consideration should be given in accordance with an individual's maturity status, training history and technical competency as well as being underpinned by current long-term physical development guidelines.