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Gopinatth V, Smith MV, Matava MJ, Brophy RH, Knapik DM. Most Anterior Cruciate Ligament Injuries in Professional Athletes Occur Without Contact to the Injured Knee: A Systematic Review of Video Analysis Studies. Arthroscopy 2024:S0749-8063(24)00275-5. [PMID: 38663569 DOI: 10.1016/j.arthro.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To systematically review studies using video analyses to evaluate anterior cruciate ligament (ACL) injury mechanisms in athletes during sport to better understand risk factors and the potential for injury prevention. METHODS A literature search was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines statement using SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through June 2023. Inclusion criteria included studies reporting on ACL injury mechanisms occurring in athletes based on video analysis. Athlete demographics, injury mechanisms, position of the lower extremity, and activity at the time of injury were recorded. RESULTS A total of 13 studies, consisting of 542 athletes, met inclusion criteria. Most athletes competed at the professional level (91%, n = 495/542), with 79% (n = 422/536) of athletes being male. The most common sports were soccer (33%, n = 178/542) and American football (26%, n = 140/542). The most common injury mechanism was noncontact in 42.9% (n = 230/536) of athletes, followed by indirect contact (32.6%, n = 175/536) and direct contact (22.4%, n = 120/536). The most common position of injury was with a planted foot (91.7%, n = 110/120), full or near-full knee extension (84.4%, n = 49/58), and axial loading (81.3%, n = 87/107). Injuries commonly involved a deceleration/shift in momentum (50.4%, n = 123/244) or pivoting maneuver (36.1%, n = 77/213). At the time of injury, the knee commonly fell into valgus (76.8%, n = 225/293) with associated internal (53.5%, n = 46/86) or external tibiofemoral rotation (57.7%, n = 101/175). CONCLUSIONS Most ACL injuries, when evaluated by video analysis, involve professional athletes participating in soccer and American football. The most common injury mechanism occurred without contact with the knee in extension during a deceleration or momentum shift, with resultant valgus and rotational force across the knee. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Varun Gopinatth
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A..
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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Patterson BE, Crossley KM, Haberfield MJ, Mosler AB, Cowan SM, Lawrence J, Rath D, Livingstone N, Barton CJ, Bruder AM, Donaldson A. Injury prevention for women and girls playing Australian Football: programme cocreation, dissemination and early adopter coach feedback. BMJ Open Sport Exerc Med 2024; 10:e001711. [PMID: 38511168 PMCID: PMC10952969 DOI: 10.1136/bmjsem-2023-001711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Background Adherence to injury prevention programmes may improve with greater end-user involvement and application of implementation frameworks during development. We describe the cocreation, initial dissemination and feedback from programme early adopters (coaches), to develop the first evidence-informed injury prevention programme for women playing community Australian Football (Prep-to-Play). Methods We used a pragmatic seven-step process for developing sports injury prevention programmes to (1) gain organisational support, (2) compile research evidence, (3) consult experts, (4) engage end-users, (5) test programme acceptability, (6) evaluate against theory and (7) gain early adopter feedback. All Australian Football-registered coaches of women's/girls' teams were sent a postseason survey to determine initial awareness, adoption and implementation (steps 5 and 6). Purposively selected coaches were invited to interviews/focus groups (step 7) to identify competency, organisational and leadership implementation drivers with a deductive thematic analysis applied. Results Prep-to-Play was cocreated using previous efficacious programmes and expert input (steps 1-4), and disseminated via the national sporting organisation in preseason 2019 to all registered coaches (step 5). 343 coaches (90 women) completed the postseason survey and 22 coaches (5 women) participated in an interview (n=9) or focus group (n=13) (steps 6 and 7). 268 coaches (78%) were aware of Prep-to-Play. Of those aware, 218 (81%) had used (at least one element) Prep-to-Play, and 143 (53%) used it at least twice per week. Competency drivers included local expert-delivered face-to-face workshops complimented by online content and ongoing support. Organisational drivers included coach education integrated into existing league/club. Leadership drivers included compulsory injury prevention education integrated into coach reaccreditation processes or incentivisation via recognition (eg, professional development points). Conclusions Cocreation and organisational support resulted in high programme awareness and adoption. However, high fidelity implementation and maintenance may need to be facilitated by competency, organisational and leadership drivers. Responsibility should be shared among all stakeholders.
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Affiliation(s)
- Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa J Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Sallie M Cowan
- La Trobe Sport and Exercise Medicine Research Centre, Australian IOC Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Julia Lawrence
- National Coaching Department, Australian Football League, Melbourne, Victoria, Australia
| | - David Rath
- Coaching Innovation and Development, Australian Football League, Melbourne, Victoria, Australia
| | - Nicole Livingstone
- Women's Football Department, Australian Football League, Melbourne, Victoria, Australia
| | - Christian J Barton
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Andrea M Bruder
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Alex Donaldson
- Centre for Sport and Social Impact, School of Business, La Trobe University, Bundoora, Victoria, Australia
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Farley JB, O’Hara M, Keogh JWL, Woods CT, Rathbone E, Milne N. Relationships between physical fitness characteristics, technical skill attributes, and sports injury in female Australian football players. PLoS One 2024; 19:e0298267. [PMID: 38386636 PMCID: PMC10883547 DOI: 10.1371/journal.pone.0298267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVES To explore the relationships between physical fitness and i) technical skills and ii) time-loss from Australian football injury in female players across the talent and participation pathways. METHODS This study uses a subset of data from two cross-sectional and one prospective cohort studies. A total of 223 female Australian football players across five competition levels (elite/non-elite senior, high-level junior, and non-elite junior (14-17 years)/(10-13 years)) were included in this study. Comprehensive physical fitness assessments and modified Australian football kicking and handballing tests were conducted in the 2018/19 pre-seasons. During the respective competitive in-season, time-loss injuries were recorded by team personnel. Stepwise multiple linear regressions were performed to determine the relationship between physical fitness and kicking and handballing scores. Cox proportional regressions were conducted to identify physical fitness factors associated with injury. RESULTS Increased running vertical jump height, greater hip abduction strength, and faster timed 6 m hop speed demonstrated a relationship with kicking accuracy when adjusted for years of Australian football playing experience (adjusted R2 = 0.522, p < 0.001). Faster agility time and increased lean mass were associated with better handballing accuracy (adjusted R2 = 0.221, p < 0.001). Multivariate Cox regression revealed an increased risk for sustaining a time-loss injury in less agile players (adjusted HR 2.41, 95% CI 1.23, 4.73, p = 0.010). However, this relationship no longer remained when adjusted for age and years of Australian football experience (adjusted HR 1.68, 95% CI 0.81, 3.50, p = 0.166). CONCLUSIONS Physical fitness may be a significant factor contributing to development of Australian football technical skills in female players. However, its role is unclear in protecting against injury risk in this athlete population. Further research is needed to explore the multifactorial and complex phenomenon of talent development and injury risk reduction in female Australian football players.
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Affiliation(s)
- Jessica B. Farley
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD, Australia
| | - Miranda O’Hara
- Brisbane Lions Women’s Australian Football Club, Brisbane, QLD, Australia
- Restore Function Physiotherapy, Greenslopes, QLD, Australia
| | - Justin W. L. Keogh
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD, Australia
- Sports Performance Research Centre New Zealand, AUT University, Auckland, New Zealand
- Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Carl T. Woods
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Evelyne Rathbone
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD, Australia
| | - Nikki Milne
- Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD, Australia
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Bruder AM, Patterson BE, Crossley KM, Mosler AB, Haberfield MJ, Hägglund M, Culvenor AG, Cowan SM, Donaldson A. If we build it together, will they use it? A mixed-methods study evaluating the implementation of Prep-to-Play PRO: an injury prevention programme for women's elite Australian Football. Br J Sports Med 2024; 58:213-221. [PMID: 38216324 DOI: 10.1136/bjsports-2023-107518] [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] [Accepted: 12/12/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVES We evaluated the implementation of Prep-to-Play PRO, an injury prevention programme for women's elite Australian Football League (AFLW). METHODS The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) of Prep-to-Play PRO were assessed based on the proportion of AFLW players and/or staff who: were aware of the programme (R), believed it may reduce anterior cruciate ligament injury (E), attempted to implement any/all programme components (A), implemented all intended components as practically as possible (I) and intended future programme implementation (M). Quantitative and qualitative data were triangulated to assess 58 RE-AIM items (evidence of yes/no/unsure/no evidence) and the 5 RE-AIM dimensions (fully achieved=evidence of yes on >50% dimension items, partially achieved=50% of items evidence of yes and 50% unsure or 50% mix of unsure and unanswered, or not met=evidence of yes on <50% dimension items). RESULTS Multiple sources including AFLW training observations (n=7 total), post-implementation surveys (141 players, 25 staff), semistructured interviews (19 players, 13 staff) and internal programme records (9 staff) contributed to the RE-AIM assessment. After the 2019 season, 8 of 10 (80%) AFLW clubs fully met all five RE-AIM dimensions. All 10 clubs participating in the AFLW fully achieved the reach (R) dimension. One club partially achieved the implementation (I) dimension, and one club partially achieved the effectiveness (E) and adoption (A) dimensions. CONCLUSION The Prep-to-Play PRO injury prevention programme for the AFLW achieved high implementation, possibly due to the programme's deliberately flexible approach coupled with our pragmatic definition of implementation. Engaging key stakeholders at multiple ecological levels (organisation, coaches, athletes) throughout programme development and implementation likely enhanced programme implementation.
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Affiliation(s)
- Andrea M Bruder
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Melissa J Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Martin Hägglund
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Sallie M Cowan
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Australian IOC Research Centre, Melbourne, Victoria, Australia
| | - Alex Donaldson
- Centre for Sport and Social Impact, La Trobe University, Melbourne, Victoria, Australia
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Hoenig T, Rahlf L, Wilke J, Krauß I, Dalos D, Willwacher S, Mai P, Hollander K, Fohrmann D, Krosshaug T, Gronwald T. Appraising the Methodological Quality of Sports Injury Video Analysis Studies: The QA-SIVAS Scale. Sports Med 2024; 54:203-211. [PMID: 37632664 PMCID: PMC10799118 DOI: 10.1007/s40279-023-01907-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND Video analysis (VA) is commonly used in the assessment of sports injuries and has received considerable research interest. Until now, no tool has been available for the assessment of study quality. Therefore, the objective of this study was to develop and evaluate a valid instrument that reliably assesses the methodological quality of VA studies. METHODS The Quality Appraisal for Sports Injury Video Analysis Studies (QA-SIVAS) scale was developed using a modified Delphi approach including expert consensus and pilot testing. Reliability was examined through intraclass correlation coefficient (ICC3,1) and free-marginal kappa statistics by three independent raters. Construct validity was investigated by comparing QA-SIVAS with expert ratings by using Kendall's tau analysis. Rating time was studied by applying the scale to 21 studies and computing the mean time for rating per study article. RESULTS The QA-SIVAS scale consists of an 18-item checklist addressing the study design, data source, conduct, report, and discussion of VA studies in sports injury research. Inter- and intra-rater reliability were excellent with ICCs > 0.97. Expert ratings revealed a high construct validity (0.71; p < 0.001). Mean rating time was 10 ± 2 min per article. CONCLUSION QA-SIVAS is a reliable and valid instrument that can be easily applied to sports injury research. Future studies in the field of VA should adhere to standardized methodological criteria and strict quality guidelines.
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Affiliation(s)
- Tim Hoenig
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lina Rahlf
- Department of Exercise Physiology, Institute of Sports Science, Europa-Universität Flensburg, Flensburg, Germany
| | - Jan Wilke
- Department of Movement Sciences, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Inga Krauß
- Department of Sports Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Dimitris Dalos
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- UKE Athleticum, Center for Sports Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Steffen Willwacher
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
| | - Patrick Mai
- Institute for Advanced Biomechanics and Motion Studies, Offenburg University of Applied Sciences, Offenburg, Germany
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Dominik Fohrmann
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Tron Krosshaug
- Department of Sports Medicine, Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany.
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Rolley T, Gill SD, Keast M, Reade T, Page R, Bonacci J, Stella J, Johnson B, Fox A. Anticipatory effects on side-step cutting biomechanics in Women's Australian Football League players. BMJ Open Sport Exerc Med 2023; 9:e001587. [PMID: 37342786 PMCID: PMC10277520 DOI: 10.1136/bmjsem-2023-001587] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Abstract
Objectives Reactive side-step cutting manoeuvres are linked to anterior cruciate ligament (ACL) injuries in Women's Australian Football League (AFLW) matches. We explored knee joint moments and ground reaction forces (GRFs) in AFLW players when performing anticipated and unanticipated side-stepping. Methods Sixteen AFLW players (age=25.3±4.2 years; height=1.71±0.06 m; mass=68.4±4.7 kg) completed anticipated and unanticipated side-stepping trials during which full-body three-dimensional kinematics and kinetics were recorded. One-dimensional statistical parametric mapping paired t-tests were used to compare three-dimensional knee moments during weight acceptance and GRFs during the stance phase between anticipated and unanticipated conditions. Results Unanticipated side-stepping incurred lower knee flexion (18%-39% of stance, p<0.01) and abduction (11%-24% of stance, p<0.01) moments. Braking and propulsive GRFs were lower and higher, respectively, across the majority of stance phase (6%-90% of stance, p<0.01) in unanticipated side-stepping. Vertical GRFs were lower in unanticipated side-stepping in the early stance phase (14%-29% of stance, p<0.01). Conclusion Contrary to existing literature, AFLW players exhibited knee joint moments associated with reduced ACL loading when performing unanticipated side-stepping. Players appeared to adopt a 'cautious' approach to the unanticipated side-step (ie, decelerating at the change of direction), by reducing braking and vertical GRFs in the early stance phase of cutting. This approach may be implausible to employ or detrimental to performance during matches. AFLW ACL injury prevention programmes may be enhanced with greater exposure to scenarios that replicate reactive match-play demands when aiming to improve side-stepping biomechanics.
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Affiliation(s)
- Tess Rolley
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Stephen D Gill
- Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Meghan Keast
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Tom Reade
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Richard Page
- Barwon Centre for Orthopaedic Research and Education (B-CORE), Barwon Health, Geelong, Victoria, Australia
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Jason Bonacci
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Julian Stella
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Emergency Department, University Hospital Geelong, Geelong, Victoria, Australia
| | - Brett Johnson
- Geelong Cats Football Club, Geelong, Victoria, Australia
| | - Aaron Fox
- Centre for Sport Research, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
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