TYPICAL RISK PATTERN FOR ANTERIOR CRUCIATE LIGAMENT INJURY IS LARGELY PRESENT IN COMPETITIVE ATHLETES: BIOMECHANICAL SCREENING THROUGH WEARABLE SENSORS

The purpose of this study was to investigate the presence of biomechanical risk patterns for Anterior Cruciate Ligament (ACL) injury in a healthy population during the execution of high-dynamics movements. Competitive athletes (n=34) performed a test battery, including single-leg landings, sprints, and cuts. Kinematics was assessed through wearable sensors, and movements exhibiting risk patterns were searched through multiple joint thresholds based on the current literature on ACL injury mechanism. A large portion of the athletes exhibited dangerous patterns in one (94%) or more movements (up to 11). The incidence was higher at initial foot contact and for the movement performed with the non-dominant limb. The early identification of at-risk athletes might support ACL professionals and promote preventative training strategies focused on the increase of movement quality

BIOMECHANICS AND JOINT COORDINATION IN ANTERIOR CRUCIATE LIGAMENT-INJURED FEMALE FOOTBALLERS DURING A 90° CHANGE OF DIRECTION

The purpose of this study was to investigate the biomechanical predictors of Anterior Cruciate Ligament (ACL) injury in female football players by means of 3D motion capture with vector coding. Women\u27s first-division healthy football players (n=16) performed a series of 90° change of directions. Biomechanics was collected through a marker-based optoelectronic system. In the next 2 consecutive football seasons, 4 ACL injuries were registered. Vector cording technique was used to compare angle-angle coordination between ACL-injured and non-injured players. ACL-injured players showed greater knee valgus (p=0.029) and internal rotation (p=0.017), external hip rotation (p=0.003), ankle eversion (

Two-Dimensional and Three-Dimensional Biomechanical Factors During 90° Change of Direction are Associated to Non-Contact ACL injury in Female Soccer Players

# Background The two-dimensional (2D) video-analysis of the change of direction (COD) technique has never been used to attempt to predict the risk of ACL injury in female football players. # Hypothesis/Purpose The purpose of the present pilot study was to prospectively investigate the biomechanical predictors of ACL injury during a COD task in female football players using both gold standard 3D motion capture and a qualitative scoring system based on 2D video-analysis. # Study Design Prospective cohort study # Methods Sixteen competitive female football (soccer) players (age 21.4 ± 4.3) performed a series of pre-planned 90° COD tasks. 3D motion data was recorded through 10 stereophotogrammetric cameras and a force platform. 2D frontal and transverse plane joint kinematics were computed through video-analysis from three high-speed cameras. A scoring system based on five criteria was adopted: limb stability, pelvis stability, trunk stability, shock absorption, and movement strategy. The players were prospectively followed for the next two consecutive football seasons and the occurrence of severe knee injuries was registered. # Results Four players (25%) experienced an ACL injury. In 3D analysis, ACL-injured players showed greater knee valgus, knee internal rotation, and lower knee flexion (p= 0.017 -- 0.029). Lower hip flexion coupled with greater external rotation (p= 0.003 -- 0.042), ankle eversion, and contralateral pelvic drop (p\<0.001) were also noted. In 2D analysis, ACL-injured players showed greater internal foot rotation, contralateral pelvic drop, lower knee flexion, and contralateral trunk tilt (moderate-to-large effect size). Pelvis stability and trunk stability showed the highest predictive value towards ACL injury. Total score was significantly lower in ACL-injured players with a moderate effect size (d=0.45). # Conclusions Both 3D and 2D methodologies depicted biomechanical risk factors and offered predictive insights towards the ACL injury risk. Awareness should rise in women's football regarding the high risk of ACL injury and the strategies to assess and mitigate it. # Level of Evidence 3 ©The Author(s

Video analysis of Achilles tendon rupture in male professional football (soccer) players: injury mechanisms, patterns and biomechanics.

Background Achilles tendon rupture (ATR), while rare in football, is a severe career-threatening injury associated with long-layoff times. To date, no study has documented ATR's mechanism in professional football players. Aim To describe the mechanisms, situational patterns and gross biomechanics (kinematics) of ATR injuries in professional male football players. Methods Eighty-six (n=86) consecutive ATR injuries in professional football players during official matches were identified. Sixty (70%) injury videos were identified for mechanism and situational pattern, with biomechanical analysis feasible in 42 cases. Three independent reviewers evaluated the injury videos. Distribution of ATR during the season, the match play and on the field were also reported. Results Fifty (n=50, 83%) injuries were classified as non-contact and 10 (17%) as indirect contact. ATRs are injuries occurring during accelerations; three main situational patterns were identified: (1) forward acceleration from standing (n=25, 42%); (2) cross-over cutting (n=15, 25%) and (3) vertical jumping (n=11, 18%). Biomechanically, ATR injuries were consistent with a multiplanar loading at the injury frame consisting of a slightly flexed trunk (15.5°), extended hip (-19.5°), early flexed knee (22.5°) and end-range dorsiflexed (40°) ankle in the sagittal plane and foot pronation; 27 (45%) ATRs occurred in the first 30 min of effective match time. Conclusions All ATRs in professional football were either non-contact (83%) or indirect contact (17%) injuries. The most common situational patterns were forward acceleration from standing, cross-over cutting and vertical jumping. Biomechanics was consistent and probably triggered by a multiplanar, although predominantly sagittal, loading of the injured Achilles tendon

Systematic Video Analysis of ACL injuries in Male Basketball Players: Injury Mechanisms, Situational patterns, and Biomechanics Study on 36 Consecutive Cases

Background: ACL injuries represent a significant burden to basketball players. Improving our understanding of the situations and biomechanics which result in ACL injury may support the design of more effective injury risk mitigation programs. Purpose: To describe with video analysis the mechanisms, situational patterns, and gross biomechanics (kinematics) of ACL injuries in professional basketball matches. Study design: Case series. Methods: Thirty-eight ACL injuries across six consecutive seasons of professional male European basketball were identified. Thirty-six (95%) injury videos were analyzed for injury mechanism and situational pattern, whilst biomechanical analysis was possible on 32 cases. Three independent reviewers evaluated each video. ACL injury timing during the match and location on the court was also reported. Results: More injuries occurred whilst attacking (n=25, 69%), than defending (n=11, 31%). One (3%) injury was direct contact, 21 (58%) indirect contact and 14 (39%) non-contact. Most injuries (83%) occurred during three main situational patterns: 1) offensive cut (n=17, 47%); 2) landing from jump (n=8, 22%) and 3) defensive cut (n=5, 14%). Injuries generally involved a knee flexion strategy (with minimal hip/trunk flexion and reduced plantar flexion) in the sagittal plane and knee valgus loading in most cases (75%). A similar number of injuries occurred across first (53%) and second (47%) halves, with a higher prevalence in the second (37%) and fourth (34%) quarters. A third and half of injuries occurred during the first 5 and 10 minutes of effective match-time (the number of minutes the player actually played prior to the injury as opposed to the match minute), respectively. More injuries occurred in Guards (58%) and 73% of all injuries occurred in the scoring zone. Conclusion: Indirect contact as opposed to non-contact, is the main ACL injury mechanism in male professional basketball players. Three main situational patterns were described, with offensive cut being the most prevalent. Biomechanical analysis confirms a multiplanar mechanism, with knee loading patterning in the sagittal plane accompanied with dynamic valgus. More injuries occurred in the first 10 minutes of a player’s effective playing time, within the attacking zone and amongst Guards. Clinical relevance: A complete comprehension of injury causation may aid to better exercise programs design for both primary and secondary reduction of ACL injuries in male basketball

Systematic Video Analysis of Anterior Cruciate Ligament Injuries in Professional Male Rugby Players: Pattern, Injury Mechanism, and Biomechanics in 57 Consecutive Cases.

BACKGROUND Anterior cruciate ligament (ACL) injuries represent a significant burden to rugby players. Improving our understanding of the patterns and biomechanics that result in ACL injury may aid in the design of effective prevention programs. PURPOSE To describe, using video analysis, the mechanisms, situational patterns, and biomechanics of ACL injuries in professional rugby matches. Further aims were to document injuries according to pitch location and timing within the match. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 62 ACL injuries were identified in players of the 4 most important rugby leagues across 4 consecutive seasons. We analyzed 57 (92%) injury videos for injury mechanism and situational patterns; biomechanical analysis was performed on indirect and noncontact ACL injuries only (38 cases available). Three reviewers independently evaluated each video. RESULTS More injuries occurred while attacking than defending (41 [72%] vs 16 [28%]; < .01). Regarding mechanism, 18 (32%) injuries were direct contact; 15 (26%), indirect contact; and 24 (42%), noncontact. Most direct contact injuries involved being tackled directly to the knee (n = 10). Three situational patterns were identified for players who had a noncontact or indirect contact injury: offensive change of direction (COD) (n = 18), being tackled (n = 10), and pressing/tackling (n = 8). Injuries generally involved a knee-loading strategy in the sagittal plane, which was accompanied by knee valgus loading in most cases (94%). Overall, 73% of injuries occurred during the first 40 minutes of effective playing time. CONCLUSION Most ACL injuries in professional male rugby players happened through a noncontact or indirect contact mechanism (68%). Three situational patterns were described, including offensive change of direction, being tackled, and pressing/tackling. Biomechanical analysis confirmed a multiplanar mechanism, with a knee-loading pattern in the sagittal plane accompanied by dynamic valgus. As most injuries occurred in the first 40 minutes, accumulated fatigue appears not to be a major risk factor for ACL injury

Return to sports after ACL injury 5 years from now:10 things we must do

Background The outcome after ACL reconstruction (ACLR) is in general disappointing with unacceptable number of athletes that do not return to pre-injury level of sports, high re-injury rates, early development of osteoarthritis and shorter careers. Athletes after ACLR have high expectation to return to sports which is in contrast with the current outcomes. The aim of this manuscript is to present an overview of factors that are needed to be incorporated and to personalize the rehabilitation process for an athlete who has undergone an ACLR

Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group

© 2020, The Author(s). Purpose: A stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed. Methods: To establish a standardized approach to assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA; USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method. Results: In general, outcomes after ACL treatment can be divided into four robust categories—early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific PROs and Health-Related Quality of Life questionnaires. In the mid- to long-term follow-up, the presence of osteoarthritis should be evaluated. Conclusion: This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment. Level of evidence: V

Return to sports after ACL injury 5 years from now: 10 things we must do.

BACKGROUND The outcome after ACL reconstruction (ACLR) is in general disappointing with unacceptable number of athletes that do not return to pre-injury level of sports, high re-injury rates, early development of osteoarthritis and shorter careers. Athletes after ACLR have high expectation to return to sports which is in contrast with the current outcomes. The aim of this manuscript is to present an overview of factors that are needed to be incorporated and to personalize the rehabilitation process for an athlete who has undergone an ACLR. LEVEL OF EVIDENCE: