Injury Risk Estimation Expertise: Interdisciplinary Differences in Performance on the ACL Injury Risk Estimation Quiz

Background: Simple observational assessment of movement is a potentially low-cost method for anterior cruciate ligament (ACL) injury screening and prevention. Although many individuals utilize some form of observational assessment of movement, there are currently no substantial data on group skill differences in observational screening of ACL injury risk. Purpose/Hypothesis: The purpose of this study was to compare various groups’ abilities to visually assess ACL injury risk as well as the associated strategies and ACL knowledge levels. The hypothesis was that sports medicine professionals would perform better than coaches and exercise science academics/students and that these subgroups would all perform better than parents and other general population members. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 428 individuals, including physicians, physical therapists, athletic trainers, strength and conditioning coaches, exercise science researchers/students, athletes, parents, and members of the general public participated in the study. Participants completed the ACL Injury Risk Estimation Quiz (ACL-IQ) and answered questions related to assessment strategy and ACL knowledge. Results: Strength and conditioning coaches, athletic trainers, physical therapists, and exercise science students exhibited consistently superior ACL injury risk estimation ability (þ2 SD) as compared with sport coaches, parents of athletes, and members of the general public. The performance of a substantial number of individuals in the exercise sciences/sports medicines (approximately 40%) was similar to or exceeded clinical instrument-based biomechanical assessment methods (eg, ACL nomogram). Parents, sport coaches, and the general public had lower ACL-IQ, likely due to their lower ACL knowledge and to rating the importance of knee/thigh motion lower and weight and jump height higher. Conclusion: Substantial cross-professional/group differences in visual ACL injury risk estimation exist. The relatively profound differences in injury risk estimation accuracy and their potential implications for risk screening suggest the need for additional training and outreach

Visual estimation of ACL injury risk: Efficient assessment method, group differences, and expertise mechanisms

Simple observational assessment of movement quality (e.g., drop vertical jump biomechanics) is an efficient and low cost method for anterior cruciate ligament (ACL) injury screening and prevention. A recently developed test (see www.ACL-IQ.org) has revealed substantial cross-professional/group differences in visual ACL injury risk estimation skill. Specifically, parents, sport coaches, and to some degree sports medicine physicians, would likely benefit from training or the use of decision support tools. In addition, expertise mechanisms (perceptual-cognitive characteristics of skilled performers) were investigated in order to design training systems to improve risk estimation performance

CROSS-PROFESSIONAL DIFFERENCES IN REAL-TIME ASSESSMENT OF ACL INJURY RISK

Simple visual inspection of movement is a potentially low cost method for anterior cruciate ligament (ACL) injury screening and prevention. Although many professionals, athletes, and coaches utilize some form of visual inspection of movement/injury risk, there is currently no substantial data on group skill differences. Sports medicine professionals, exercise science students/academics, and strength and conditioning coaches exhibited consistently superior ACL injury risk estimation skill compared to sport coaches, parents of athletes and the general public (about 2 standard deviations). In addition, many individuals’ visual risk assessment accuracy was similar to or exceeded clinical instrument-based biomechanical assessment methods (i.e., ACL nomogram). Perceptual-cognitive mechanisms are discussed

Evaluation of Head Impact Exposure Between One Season of Youth Versus High School Football

In Volume 4, Issue 1 of the JSMAHS you will find Professional research abstracts, as well as Under Graduate student research abstracts, case reports, and critically appraised topics. Thank you for viewing this 4th Annual OATA Special Edition

An audit of injuries in six English professional soccer academies

Regulations now state that professional academies in the United Kingdom are required to substantially increase the volume of soccer training. This study assessed the current injury occurrence, providing an update to reports published prior to the introduction of the Elite Player Performance Plan (EPPP). 608 soccer players aged 11–18 years from six professional soccer clubs were prospectively monitored, recording injuries during the 2014–2015 season. An injury rate of 1.32 injuries per player/season was indicated with a mean time loss of 21.9 days per injury. The greatest time loss per injury was in the U14s-U15s, and the highest rate of severe injuries in the U15s. Strains and sprains were the most common injury type, with the knee and ankle the most frequently injured anatomical sites. Seasonal variation indicated two peaks in injury incidence, occurring in September and January. In comparison to a published audit prior to the inception of the EPPP, this study indicates that academy soccer players are three-times more likely to experience an injury. Given that time loss and injury severity also increased during periods that typically follow rapid growth, these players should be considered an important group for training load monitoring and injury prevention strategies

Preferential Quadriceps Activation in Female Athletes with Incremental Increases in Landing Intensity

The purpose of this study was to identify alterations in preparatory muscle activation patterns across different drop heights in female athletes. Sixteen female high school volleyball players performed the drop vertical jump from three different drop heights. Surface electromyography of the quadriceps and hamstrings were collected during the movement trials. As the drop height increased, muscle activation of the quadriceps during preparatory phase also increased (p \u3c .05). However, the hamstrings activation showed no similar increases relative to drop height. Female athletes appear to preferentially rely on increased quadriceps activation, without an increase in hamstrings activation, with increased plyometric intensity. The resultant decreased activation ratio of the hamstrings relative to quadriceps before landing may represent altered dynamic knee stability and may contribute to the increased risk of ACL injury in female athletes

The influence of biological maturity on dynamic force–time variables and vaulting performance in young female gymnasts

Purpose: This cross-sectional study investigated dynamic force–time variables and vaulting performance in young female gymnasts of different maturity status. Methods: 120 gymnasts aged 5–14 years were sub-divided into maturity groupings using percent of predicted adult height (%PAH) attained. Participants performed three jumping protocols, the squat jump (SJ), countermovement jump (CMJ) and drop jump (DJ), before completing straight jump vaults that were recorded using two-dimensional video. Results: Jumping performance improved with biological maturity evidenced by the most mature gymnasts’ producing significantly more absolute force (P \u3c 0.05; all d \u3e 0.78), impulse (P \u3c 0.05; all d \u3e 0.75) and power (P \u3c 0.05; all d \u3e 0.91) than the least mature group, resulting in the greater jump heights (P \u3c 0.05; all d \u3e 0.70). While, no significant differences were observed in relative peak force across multiple tests, measures of relative peak power did significantly increase with maturity. Based upon regression analyses, maturation was found to influence vertical take-off velocity during vaulting, explaining 41% of the variance in each jumping protocol. Across all tests, the DJ was found to have the highest predictive ability of vaulting vertical take-off velocity, explaining 55% of the total variance. Conclusion: Biological maturation impacts jump height and underpinning mechanical variables in young female gymnasts. Vaulting vertical take-off velocity appears to be influenced by maturation and various dynamic force–time variables, particularly those during DJ, which had the highest explained total variance

Factors Influencing Return to Play and Second Anterior Cruciate Ligament Injury Rates in Level 1 Athletes After Primary Anterior Cruciate Ligament Reconstruction:2-Year Follow-up on 1432 Reconstructions at a Single Center

BACKGROUND: Despite the importance of return-to-play (RTP) rates, second anterior cruciate ligament (ACL) injury rates, and patient-reported outcomes of athletes returning to sports after ACL reconstruction (ACLR), these outcomes have not been evaluated together across a single cohort nor the pre- and intraoperative factors influencing outcomes explored. PURPOSE: To prospectively report outcomes after ACLR relating to RTP, second ACL injury, and International Knee Document Committee (IKDC) scores in a large cohort of athletes at a single center to examine the influence of pre- and intraoperative variables on these outcomes. DESIGN: Cohort study; Level of evidence, 3. METHODS: A consecutive cohort of 1432 athletes undergoing primary ACLR by 2 orthopaedic surgeons was followed up prospectively more than 2 years after surgery. Pre- and intraoperative findings were reported with outcomes at follow-up relating to RTP, second ACL injury, and IKDC. Between-group differences for each outcome were reported and the predictive ability of pre- and intraoperative variables relating to each outcome assessed with logistic regression. RESULTS: There was >95% follow-up 2 years after surgery. The RTP rate was 81%, and of those who returned, 1.3% of those with patellar tendon grafts and 8.3% of those with hamstring grafts experienced ipsilateral rerupture (hazard ratio, 0.17). The contralateral ACL injury rate was 6.6%, and the IKDC score at follow-up was 86.8, with a greater proportion of patients with patellar tendon grafts scoring <80 on the IKDC (odds ratio, 1.56; 95% CI, 1.15–3.12). There was no relationship between time to RTP and second ACL injury, and there was a moderate correlation between ACL–Return to Sport After Injury score and RTP at follow-up (P < .001, rho = 0.46). There were a number of differences in pre- and intraoperative variables between groups for each outcome, but they demonstrated a poor ability to predict outcomes in level 1 athletes at 2-year follow-up. CONCLUSION: Findings demonstrated high overall RTP rates, lower reinjury rates with patellar tendon graft after 2-year follow-up in level 1 athletes, and no influence of time to RTP on second ACL injury. Despite differences between groups, there was poor predictive ability of pre- and intraoperative variables. Results suggest pre- and intraoperative variables for consideration to optimize outcomes in level 1 athletes after ACLR, but future research exploring other factors, such as physical and psychological recovery, may be needed to improve outcome prediction after ACLR

Individual hop analysis and reactive strength ratios provide better discrimination of ACL reconstructed limb deficits than triple hop for distance scores in athletes returning to sport

Surgical treatment and rehabilitation programs for anterior cruciate ligament reconstruction (ACLR) remain a costly burden to health care services (23). Approximately two thirds of patients successfully return to sport (48); however, re-injury rates are high (~ 35%), occurring to either the reconstructed graft or the contralateral ACL (49). To minimise the risk of re-injury, return-to-sport (RTS) test batteries are used as part of the rehabilitation process to ensure neuromuscular function recovers as close to their pre-injury levels as possible