Monitoring Internal Load in Women's Basketball via Subjective and Device-Based Methods: A Systematic Review.

The monitoring of internal load in basketball can be used to understand the effects and potential physiological adaptations caused by external load. The main aim of this systematic review was to identify the methods and variables used to quantify internal load in female basketball. The studies included different populations and events: youth athletes, elite, and amateur players. Subjective methods included using the rating of perceived exertion (RPE) method, and sensor-based methods included monitoring the cardiac response to exercise, using heart rate (HR) as the primary metric. The results showed that the HRAvg exhibited a wider range of values during training than during competition, and different metrics were used to evaluate internal load, such as HRMax, HRmin, %HRMax, total time and % of time spent in different HR zones (2-8 zones), Banister's TRIMP, and summated HR zones. RPE and HR metrics were the most commonly used methods. However, the use of multiple metrics with little standardization resulted in significant heterogeneity among studies, limiting meaningful comparisons. The review provides a reference for current research on female basketball. Future research could address this limitation by adopting more consistent measurement protocols standardizing the use of metrics.

A Pedagogical Approach to Integrative Neuromuscular Training to Improve Motor Competence in Children: A Randomized Controlled Trail.

Font-Lladó, R, López-Ros, V, Montalvo, AM, Sinclair, G, Prats Puig, A, and Fort-Vanmeerhaeghe, A. A pedagogical approach to integrative neuromuscular training to improve motor competence in children: a RCT. J Strength Cond Res 34(11): 3078-3085, 2020-To assess the effectiveness of a pedagogical approach to an integrative neuromuscular training (INT) program as a warm-up in physical education (PE) lessons in healthy children: (a) to improve the level of motor competence (MC) and (b) to master fundamental motor skills (FMS) patterns, considering the baseline MC level and the time spent when performing different motor tasks. One hundred ninety students (7.43 ± 0.32 years; 52% girls) were included in this randomized controlled trail and grouped up according to MC basal levels (L1-L4). Motor competence and FMS patterns (CAMSA protocol) were assessed before and after the intervention in a group-based INT warm-up (n = 97) and a group-based conventional warm-up (n = 93). The INT program improved MC (p < 0.001; d = 0.71) and FMS (p < 0.001, d = 0.52). The independent predictors of MC change were: baseline MC level (ß = -196; p < 0.012), time spent to perform the task (ß = -0.235 p < 0.003), and participation in the INT program (ß = 0.201; p < 0.005), explaining 71% of its variability. The INT warm-up shows correlations between improvements in MC in relation to time reduction (L1 p = 0.016, d, L2 p = 0.001, and L4 = 0.001) and FMS patterns (L1 p < 0.001, L2 p < 0.003, L3 p < 0.005, and L4 < 0.001) Moreover, only L3, it showed correlation between changes in time and FMS mastery (p = 0.001). Our results showed that a pedagogical approach to an INT program developed as a warm-up in primary school PE lessons can improve MC and FMS patterns in all subjects, independent of the initial MC level. More interestingly, only in L3, the improvement in MC can be explained by the balance in time required to perform the task and the level of improvement in FMS patterns.

"What's my risk of sustaining an ACL injury while playing sports?" A systematic review with meta-analysis.

OBJECTIVE: To estimate the incidence proportion (IP) and incidence rate (IR) for ACL injury in athletes. DESIGN: Systematic review with meta-analysis DATA SOURCES: The PubMed, CINAHL and SPORTDiscus electronic databases were searched from inception to 20 January 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies were included if they reported total number of participants/population by sex, total number of ACL injuries by sex and total person-time by sex. RESULTS: Fifty-eight studies were included. The IP and IR of ACL injury in female athletes were 3.5% (1 out of every 29 athletes) and 1.5/10 000 athlete-exposures over a period of 1 season-25 years. The IP and IR of ACL injury in male athletes were 2.0% (1 out of every 50 athletes) and 0.9/10 000 athlete-exposures over a period of 1-25 years. Female athletes had a higher relative risk (RR) for ACL injury compared with males (RR=1.5; 95% CI 1.2 to 1.9; P<0.01) and a higher incidence rate ratio (IRR) of ACL injury compared with males over 1 season-25 years (IRR=1.7; 95% CI 1.4 to 2.2; P<0.010). When accounting for participation level, the disparity in the IR between female and male athletes was highest for amateur athletes compared with intermediate and elite athletes (IRR=2.1; 95% CI 1.3 to 3.4; P<0.01; I²=82%). Amateur female athletes remained at higher risk of ACL injury than did with amateur male athletes. In studies where follow-up length was <1 year, female athletes had a higher IR of ACL injury than did to males (IRR=1.7; 95% CI 1.3 to 2.2; P<0.01). Where follow-up was 1 year and beyond, there was no sex difference in the IR of ACL injury (IRR=2.1; 95% CI 0.9 to 4.8; P=0.06; I²=65%). SUMMARY/CONCLUSIONS: One in 29 female athletes and 1 in 50 male athletes ruptured their ACL in a window that spanned from 1season to 25 years. The IR of ACL injury among female athletes in a season was 1.7 times higher than the IR of ACL injury among male athletes and the IP of ACL injury among female athletes was 1.5 times higher than the IP of ACL injury among male athletes. The reported sex disparity in ACL injury rates is independent of participation level and length of follow-up.

'What's my risk of sustaining an ACL injury while playing football (soccer)?' A systematic review with meta-analysis.

OBJECTIVE: To estimate the incidence proportion (IP) and incidence rate (IR) of ACL injury in football players. DESIGN: Systematic review with meta-analysis. DATA SOURCES: PubMed, CINAHL and SPORTDiscus electronic databases were searched from inception to 20 January 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDY: Studies that reported the total number of participants/population by sex, total number of ACL injuries by sex and total person-time by sex were included. RESULTS: Twenty-eight studies were included. The IP and IR of ACL injury in female football players were 2.0% (95% CI 1.2% to 3.1%) and 2.0/10 000 athlete exposures (AEs) (95% CI 1.6 to 2.6; I2=91%) over a period of one season to 4 years. The IP and IR of ACL injury in male players were 3.5% (95% CI 0.7% to 8.2%) and 0.9/10 000 AEs (95% CI 0.7 to 1.1; I2=94%). Studies that evaluated matched cohorts of female and male players showed no difference in IP (relative risk=1.2; 95% CI 0.9 to 1.6; P=0.47) over a period of one season to 4 years. Women were at greater risk than men (incidence rate ratio (IRR)=2.2; 95% CI 1.6 to 3.1; I2=83%; P<0.001). When accounting for participation level, the difference in IR between women and men was greatest for intermediate players (IRR=2.9; 95% CI 2.4 to 3.6) compared with amateur (IRR=2.6; 95% CI 1.4 to 4.8) and elite (IRR=2.0; 95% CI 1.1 to 3.4) players. SUMMARY/CONCLUSION: Overall, more men sustained ACL injury in football. There was no difference in the relative risk of ACL injury between female and male football players in a window that spanned one season to 4 years. The IR of ACL injury among women was 2.2 times higher than the IR of ACL injury among men. The reported sex disparity in ACL injury was independent of participation level.

Sex and Maturation Differences in Performance of Functional Jumping and Landing Deficits in Youth Athletes.

CONTEXT: Understanding how neuromuscular and biomechanical deficits that are associated with knee injuries change as youth mature may improve injury prevention strategies in this population. OBJECTIVE: To investigate sex and maturation differences in jump-landing technique performance in youths using a practical clinical tool. DESIGN: Cross-sectional study. SETTING: High Performance Center Laboratory. PARTICIPANTS: A total of 165 youth athletes were included in this study. MAIN OUTCOME MEASURES: The main outcome measures were each of the 10 items of the modified tuck jump assessment and the total score. These measures include (1) knee valgus at landing, (2) thighs do not reach parallel, (3) thighs not equal side to side, (4) foot placement not shoulder width apart, (5) foot placement not parallel, (6) foot contact timing not equal, (7) excessive landing contact noise, (8) pause between jumps, (9) technique declines prior to 10 seconds, and (10) does not land in same footprint. RESULTS: Only knee valgus at landing had a significant sex × maturation interaction. The main effect of maturation was significant for items 2, 3, 6, 7, 9, and total score. Plyometric technique performance improved with increasing maturation. The main effect of sex was significant for items 1 and 9, with males performing better than females. CONCLUSIONS: Female athletes demonstrate increased knee valgus at landing and fatigue relative to males during jump-landing performance. Overall, there was a trend of improved jump-landing performance with maturation.

Retrospective Injury Epidemiology and Risk Factors for Injury in CrossFit.

The objective of the study is to examine injury epidemiology and risk factors for injury in CrossFit athletes. A survey was administered to athletes at four owner-operated facilities in South Florida. Respondents reported number, location of injury, and training exposure from the preceding six months and answered questions regarding potential risk factors for injury. Fifty out of 191 athletes sustained 62 injuries during CrossFit participation in the preceding six months. The most frequently injured locations were the shoulder, knee, and lower back. Injury incidence was 2.3/1000 athlete training hours. Competitors were more likely to be injured (40% v 19%, p = 0.002) and had greater weekly athlete training hours (7.3 ± 7.0 v 4.9 ± 2.9, p < 0.001) than non-competitors. Athletes who reported injury also reported significantly higher values for the following risk factors: years of participation (2.7 ± 1.8 v 1.8 ± 1.5, p = 0.001), weekly athlete training hours (7.3 ± 3.8 v 4.9 ± 2.1, p = 0.020), weekly athlete-exposures (6.4 ± 3.8 v 4.7 ± 2.1, p = 0.003), height (1.72 ± 0.09 m v 1.68 ± 0.01 m, p = 0.011), and body mass (78.24 ± 16.86 kg v 72.91 ± 14.77 kg, p = 0.037). Injury rates during CrossFit and location of injuries were similar to those previously reported. Injury incidence was similar to related sports, including gymnastics and powerlifting. While being a competitor was related to injury, increased exposure and length of participation in CrossFit likely underlied this association. Specifically, increased exposure to training in the form of greater weekly athlete training hours and weekly participations may contribute to injury. Increased height and body mass were also related to injury which is likely reflective of increased load utilized during training. Further research is warranted to determine if biomechanical factors associated with greater height and ability to lift greater loads are modifiable factors that can be adapted to reduce the increase risk of injury during CrossFit.

Intra- and Inter-Rater Reliability of the Modified Tuck Jump Assessment.

The Tuck Jump Assessment (TJA) is a clinician-friendly screening tool that was designed to support practitioners with identification of neuromuscular deficits associated with anterior cruciate ligament injury. This study aimed to evaluate the inter- and intra-rater reliability of the modified scoring (0 to 2) TJA to add an additional range of objectivity for each criterion. A total of 24 elite youth volleyball athletes (12 males and 12 females) were included in this study. Each participant's recorded performance of the TJA was scored independently by two raters across ten criteria using the modified scale. The two raters then scored the same videos one week later. Another investigator who was blind to the identity of the raters analyzed the scores from both raters for each participant. Kappa coefficient (k) and percentage of exact agreement (PEA) for both intra- and inter-rater reliability were analyzed for each item. Intraclass correlation coefficients (ICC) were calculated to determine intra- and inter-rater reliability of the modified TJA total score. Intra- and inter-rater k was good to excellent for most items (0.65-0.91). Average PEA between the two raters and two sessions ranged from 83.3 to 100% in all scored items. The ICC for the total score was excellent in both inter- and inter-rater correlations (0.94-0.96). This research demonstrated that the modified version of the TJA predominantly shows good to excellent intra- and inter-rater reliability in all analyzed criteria.

Effect of kinesiology taping on pain in individuals with musculoskeletal injuries: systematic review and meta-analysis.

Kinesiology tape, an elastic tape used by sports medicine clinicians to enhance sports performance in athletes, is purported to facilitate a reduction in pain during physical activity in individuals with orthopedic injuries, but high-quality literature on this topic remains scarce. The purpose of this meta-analysis is to critically examine and review the existing literature to evaluate the effect of kinesiology tape application on pain in individuals with musculoskeletal injury. English-language publications from 2003 to 2013 were surveyed by searching SPORTDiscus, Scopus, ScienceDirect, CINAHL, Cochrane Library, PubMed, and PEDro databases using the terms kinesio tap*, kinesiology tap*, kinesiotap*, and pain. Thirteen articles investigating the effects of kinesiology tape application on pain with at least level II evidence were selected. The combined results of this meta-analysis indicate that kinesiology tape may have limited potential to reduce pain in individuals with musculoskeletal injury; however, depending on the conditions, the reduction in pain may not be clinically meaningful. Kinesiology tape application did not reduce specific pain measures related to musculoskeletal injury above and beyond other modalities compared in the context of included articles. We suggest that kinesiology tape may be used in conjunction with or in place of more traditional therapies, and further research that employs controlled measures compared with kinesiology tape is needed to evaluate efficacy.

Post-Pandemic Changes to Employment and Employment Satisfaction in Early Career and Career Advancing Athletic Trainers.

CONTEXT: The labor market suffered a mass exodus of employees, including healthcare workers, due to the COVID-19 pandemic. Previous research highlights the vulnerability of young professional athletic trainers (YPATs) to attrition. Investigating pandemic-related employment changes and their impact is essential for developing strategies to improve the retention of YPATs. OBJECTIVE: to determine impact of COVID-19 on YPATs' employment and effect of COVID-19 and employment setting migration on outcome measures of personal and financial well-being, job and career satisfaction, and optimism about staying in the profession. DESIGN: Cross-sectional, descriptive study. SETTING: Web-based survey. PARTICIPANTS: 1,111 participants responded to survey for an 11.5% response rate (n=1,111/12,810). Partial responses were included; thus, number of respondents varied by question. DATA COLLECTION AND ANALYSIS: A web-based survey comprised of 34 closed-ended questions was disseminated to NATA members in November 2022. Descriptive statistics including counts and frequencies for each surveyed item in addition to chi-square tests were used to analyze responses. RESULTS: 30.2% (n=335/1,111) of YPATs changed employers and 25.7% (n=286/1,111) reported a change in employment setting. Notably, YPATs migrated from high school, collegiate, and professional athletics to clinic, industrial, or sales settings. Overall, the pandemic decreased job satisfaction, career satisfaction, and optimism about professional longevity. Changes in employment had a positive impact on personal well-being in addition to job and career satisfaction, but not optimism regarding staying in profession. Salary and work-life balance were reported as important predictors of short and long-term retention for YPATs. CONCLUSIONS: The pandemic brought changes to employers and employment settings for many YPATs. To reduce turnover and attrition, administrators must begin to prioritize employee well-being and satisfaction. In addition to increasing salary and reducing workload, employers should recognize the importance of administrative support in promoting well-being together with satisfaction and professional optimism in early professional and career-advancing athletic trainers.

Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction Using an All-Soft Tissue Quadriceps Tendon Autograft in a Young Active Population.

BACKGROUND: The ideal graft for anterior cruciate ligament (ACL) reconstruction (ACLR) in young athletes has a high return-to-sport (RTS) rate and a low reinjury rate. Quadriceps tendon autografts are being used with increasing frequency for ACLR in this population, despite a paucity of evidence to support their use. PURPOSE: To report the RTS rate, ipsilateral reinjury rate, and contralateral ACL injury rate in a young athletic population undergoing primary ACLR using an all-soft tissue quadriceps tendon (ASTQT) autograft. STUDY DESIGN: Cases series; Level of evidence, 4. METHODS: Patients aged 14 to 22 years who underwent primary ACLR using an ASTQT autograft by a single surgeon between January 1, 2005, and April 30, 2020, were identified via electronic medical records and contacted ≥24 months after ACLR to complete a survey regarding subsequent ipsilateral or contralateral ACL injuries and RTS. Patients who had undergone previous ACLR (ipsilateral or contralateral) were excluded. RESULTS: A total of 656 patients (330 male, 326 female; mean age, 17.9 years) were identified, and 395 patients completed the survey (60.2%; 174 male, 221 female; mean age, 17.8 years) with a mean follow-up of 73 ± 29 months (range, 24-139 months). The RTS rate was high (male: 87.7%; female: 82.8%; P = .19). Male and female patients had similar rates of revision ACLR (male: 12.6%; female: 10.0%; P = .40) and contralateral ACL injuries (male: 13.8%; female: 11.3%; P = .46). CONCLUSION: A high RTS rate and similar rates of ipsilateral and contralateral ACL injuries were found for male and female patients in a young athletic population undergoing primary ACLR using an ASTQT autograft. These results help one to better understand the utility of ASTQT grafts to support successful ACLR in young athletic populations, for which ASTQT grafts appear to yield favorable outcomes.

External Load Monitoring in Female Basketball: A Systematic Review.

The primary aim of this systematic review was to summarize the current state of research in relation to external load monitoring in female basketball. The review was conducted according to the PRISMA-P® statement. Publications included in the review: 1) were original research, 2) evaluated healthy female basketball players, and 3) monitored basketball practice and competition. The STROBE scale was used to assess quality. A total of 40 publications were included. The external load was assessed during practice (n = 9), competition (n = 11) or both events (n = 8). Also, time-motion analysis was implemented in practice (n = 2), competition (n = 9), or both events (n = 1). Accelerometry (n = 28) and time-motion (n = 12) analysis were the most frequently used methods. However, a wide range in methods and variables were used to quantify the external load. Placement of devices on the upper back and measuring with a sampling frequency of 100 Hz were most common. Player Load (PL) values increased with the competitive level of players and were higher in competition compared to training. Small-sided games can be used to gradually increase loads in female basketball (PL 5v5: 34.8 ± 8, PL 3v3: 47.6 ± 7.4, TD 5v5: 209.2 ± 35.8 m, and TD 3v3: 249.3 ± 2.8 m). Tasks without defense seemed to be less demanding. More research is needed to reach a consensus on load control in women's basketball, on what data are important to collect, and how to use and transfer knowledge to stakeholders.

Effects of Exercise-Induced Neuromuscular Fatigue on Jump Performance and Lower-Limb Asymmetries in Youth Female Team Sport Athletes.

The objective of the present study was to examine the effect of acute neuromuscular fatigue on unilateral jump performance and inter-limb asymmetries. Thirty elite youth female team sport athletes (age: U-14 to U-18) performed the Unilateral Countermovement Jump (UCJ) and the Unilateral Drop Jump (UDJ) (18-cm box) tests before and approximately 10 minutes after the 30-15 intermittent fitness test (30-15 IFT). A paired samples t-test showed significant reductions in UCJ jump height in the right leg after the 30-15 IFT (p = 0.018; d = 0.33), but not in the left leg (p = 0.459; d = 0.48). For the UDJ, significant reductions in jump height were shown in both the right (p < 0.001; d = 0.33) and left (p < 0.001; d = 0.33) legs. In addition, for the reactive strength index (UDJ), significant reductions were seen in the left leg after the 30-15 IFT (p < 0.001; d = 0.31), but not in the right leg (p = 0.948; d < 0.001). Only UCJ inter-limb jump height asymmetries increased significantly post 30-15 IFT (p = 0.033; d = 0.46). In conclusion, the current study indicates that the 30-15 IFT provides a sufficient dose of activity for inducing acute fatigue in elite youth female team sport athletes. Therefore, monitoring jump height in unilateral jump testing is recommended given the tests' sensitivity to detect significant differences in physical performance and inter-limb asymmetries under acutely fatigued conditions in healthy youth female athletes.

Current Sport Organization Guidelines From the AMSSM 2019 Youth Early Sport Specialization Research Summit.

CONTEXT: Youth athletes may be at elevated risk for adverse health due to sport specialization. Sport organizations have developed guidelines for participation during growth and development. OBJECTIVE: To assess youth sport development guidelines using a 15-item framework across sport organizations and governing bodies in soccer, basketball, ice hockey, and swimming. DATA SOURCES: English-language results from January 1, 2000, to December 31, 2018, from published sport organization guidelines and athlete development plans. STUDY SELECTION: Two investigators independently reviewed publications identified from sport organizations. A total of 23 guidelines were incorporated, including 5 general sport organizations and 18 sport-specific guidelines. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Two investigators independently identified all recommendations that fit within a predetermined rubric of recommendations encompassing 4 domains: Psychological Development/Approach, Physical Development/Load, Facilities and Resources, and Timing and Monitoring of Specialization. Sport-specific guidelines on volume were summarized. RESULTS: Sport organizations and sport-specific guidelines had consensus on 2 items out of the 15-item: emphasis on early skill development and access to well-trained coaches. While recommended by all sports organization, multisport participation was emphasized by 3 of 4 sports, excluding soccer. Volume recommendations were inconsistent between and within sports. No group proposed methods to monitor athlete well-being. CONCLUSION: This review highlights areas of agreement within sport organizations and governing bodies. Creating a framework to guide youth sport specialization may lead to specific and consistent guidelines.

Systematic Review of Health Organization Guidelines Following the AMSSM 2019 Youth Early Sport Specialization Summit.

CONTEXT: Youth sport specialization may place young athletes at increased risk for negative impacts to their physical and/or psychological health. In response to these health concerns, several health organizations have created guidelines and position statements to guide parents and practitioners toward best practices for management of the young athlete. OBJECTIVE: To systematically review and synthesize current organizations' recommendations and guidelines regarding youth sport specialization. DATA SOURCES: English-language articles from January 1, 2000, to December 31, 2018, in the NCBI Pubmed, Embase, Cochrane, CINAHL, and SPORTDiscus databases. STUDY SELECTION: Articles that reported on recommendations or interventions by health organizations or health representatives of sports organizations. A total of 56 articles were assessed, with 11 meeting inclusion eligibility criteria. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 4. DATA EXTRACTION: Two investigators independently identified all recommendations within the results that fit within a 15-item framework encompassing 4 domains: Psychological Development/Approach, Physical Development/Load, Facilities and Resources, and Timing and Monitoring of Specialization. RESULTS: Recommendations across organizations were primarily clustered in the Physical Development/Load (43%), Facilities and Resources (48%), and Sport Specialization (55%) domains. In contrast, the Psychological Development/Approach domain had fewer recommendations (20%). The most common recommendations endorsed concepts: "Monitor athlete well-being," "Youth athletes need access to well-trained, quality coaches," "Multi-sport participation," "Limit early organized participation and/or training," and "Parents require awareness of training, coaching, and best practices." The level of evidence provided to support a given recommendation varied significantly. The level of detail and the consistency of terms used throughout the results were typically low. Recommendations were frequently made without reference to potential outcome measures or specific strategies that could be used for practical implementation in the community. CONCLUSION: There was broad representation of different aspects of specialization but limited consistency between health organization guidelines. Adopting a framework for recommendations as used in this review could assist organizations in structuring future recommendations that are specific, measurable, and framed in a manner that will promote action in the youth sport community.

Muscle activation in suspension training: a systematic review.

Suspension training is an adjunct to traditional strength and conditioning. The effect of added instability on muscle activation during traditional exercises is unclear and depends on the exercise and type of instability. The purpose of this review was to compare the activations of different muscles in suspension training exercises and their traditional counterparts. A search of the current literature was performed without language restrictions using the electronic databases PubMed (1969-12 January 2017), SPORTDiscus (1969-12 January 2017) and Scopus (1969-12 January 2017). The inclusion criteria were: (1) descriptive studies; (2) physically active participants; and (3) studies that analysed muscle activation using normalised electromyographic signals during different suspension training exercises. Eighteen studies met the inclusion criteria. For the push-up, inverted row, prone bridge and hamstring curl in suspension, the activation of upper-body and core muscles ranged between moderate (21-40% maximum voluntary isometric contraction (MVIC)) and very high (>60% MVIC). Muscle activation in these same muscle groups was greater with suspension exercises relative to comparable traditional exercises, except for the inverted row. Muscle activation in the upper extremity and core muscles varied greatly amongst studies.

Biomechanical and Functional Outcomes After Medial Patellofemoral Ligament Reconstruction: A Pilot Study.

BACKGROUND: Previous studies have acknowledged the medial patellofemoral ligament (MPFL) as the primary stabilizer of the patella, preventing lateral displacement. MPFL reconstruction (MPFL-R) restores stability and functionality to the patellofemoral joint and has emerged as a preferred treatment option for recurrent lateral patellar instability. PURPOSE: To objectively measure biomechanical characteristics of athletes cleared for return to sport after MPFL-R compared with healthy controls. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A prospective case-control study design was employed on 31 total athletes. Sixteen athletes (6 male, 10 female; mean age, 16.1 ± 2.74 years; 385 ± 189 days after surgery and 235 ± 157 days after return to sport) underwent MPFL-R and were medically cleared to return to sport. This group was matched by age, sex, and activity level to 15 healthy athletes with no history of lower extremity injuries. Athletes and controls completed validated questionnaires as well as hopping, jumping, and cutting tests with 3-dimensional motion analysis and underwent strength, flexibility, laxity, and balance assessments. RESULTS: Participants in the MPFL-R group scored significantly lower (worse) on the International Knee Documentation Committee (IKDC) (89.2 ± 7.6 vs 98.1 ± 2.0, respectively; P = .0005) and significantly higher (worse) on the Tampa Scale for Kinesiophobia (TSK) (32.4 ± 5.0 vs 25.4 ± 6.5, respectively; P = .006) than those in the control group, but there was no difference in the Kujala score (95.6 ± 5.3 vs 98.8 ± 3.0, respectively; P = .06). Participants in the MPFL-R group demonstrated reduced hip and ankle flexion relative to those in the control group (P < .05). Participants in the MPFL-R group also took significantly longer to complete the 6-m timed hop test relative to those in the control group (P < .05). No statistically significant differences were found in anthropometrics, knee extension or flexion strength, hamstring flexibility, hip abduction strength, or joint laxity between the MPFL-R and control groups. CONCLUSION: The current data indicate that MPFL-R generally restores functional symmetry, while subtle deficits in global power may remain after being released to full activity. Clinicians should ensure that athletes are fully rehabilitated before returning to sport after MPFL-R by emphasizing functional multijoint exercises.

Anterior Cruciate Ligament Injury Risk in Sport: A Systematic Review and Meta-Analysis of Injury Incidence by Sex and Sport Classification.

OBJECTIVE: To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact). DATA SOURCES: A systematic review was performed using the electronic databases PubMed (1969-January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969-January 20, 2017) and the search terms anterior cruciate ligament AND injury AND (incidence OR prevalence OR epidemiology). STUDY SELECTION: Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English. DATA EXTRACTION: Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis. DATA SYNTHESIS: We conducted IR and IR ratio (IRR) meta-analyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10 000 versus 1.12/10 000 AEs, IRR = 1.14, P = .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21, P = .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49, P = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10 000 versus 0.87/10 000 AEs, IRR = 3.00, P < .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10 000 versus 1.75/10 000 AEs, IRR = 5.51, P < .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories. CONCLUSIONS: Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports.

Age-Dependent Patellofemoral Pain: Hip and Knee Risk Landing Profiles in Prepubescent and Postpubescent Female Athletes.

BACKGROUND: Female athletes are at an increased risk of developing patellofemoral pain (PFP) relative to male athletes. The unique effects of maturation may compound that risk. Hypothesis/Purpose: The purpose was to evaluate the neuromuscular control mechanisms that are adaptive to pubertal maturation and determine their relative contribution to PFP development. It was hypothesized that aberrant landing mechanics (reduced sagittal-plane and increased frontal- and transverse-plane kinematics and kinetics) would be associated with an increased risk for PFP. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: There were 506 high school female athletes who completed a detailed medical history, the Anterior Knee Pain Scale, and a knee examination for the diagnosis of PFP and attended follow-up appointments. Athletes performed a drop vertical jump task instrumented with force plates, and biomechanical measures generated from standard 3-dimensional biomechanical analyses were used to classify participants into high- or low-risk knee and hip landing profiles for the development of PFP. The biomechanical measures used in the knee landing profile included sagittal-plane knee range of motion, peak knee abduction angle, peak knee abduction moment, and peak-to-peak transverse-plane knee moment. The biomechanical measures used in the hip landing profile included sagittal-plane hip range of motion, peak hip extensor moment, peak abductor moment, and peak hip rotator moment. Testing was conducted at sport-specific preseason appointments over the course of 2 years, and changes in pubertal status, landing profile, and PFP development were documented. RESULTS: Female athletes with high-risk hip landing profiles experienced increased hip flexion and decreased abductor, rotator, and extensor moments. Participants with high-risk hip landing profiles who transitioned to postpubertal status at follow-up had higher odds (odds ratio, 2.1 [95% CI, 1.1-4.0]; P = .02) of moving to a low-risk hip landing profile compared with those who had not reached postpubertal status at follow-up. Participants with high-risk knee landing profiles experienced decreased knee flexion and increased knee abduction, external abductor, and external rotator moments. Pubertal maturation was not associated with a change in the high-risk knee landing profile at follow-up. CONCLUSION: The progression from prepubertal to postpubertal status may have a protective effect on high-risk hip mechanics but no similar adaptations in high-risk knee mechanics during maturation. These data indicate that before puberty, maladaptive hip mechanics may contribute to PFP, while aberrant knee mechanics associated with PFP are sustained throughout the maturational process in young female athletes.

Return-to-sport following anterior cruciate ligament reconstruction in team sport athletes. Part II: Progressive framework

In the second part of this evidence- and experience-based guide, we present a progressive framework for return-to-sport following anterior cruciate ligament reconstruction in team sport athletes. This framework guides programs that return athletes to competition at maximum performance while minimizing risk of reinjury. We have built onto a framework typically used in team sports that proposes progress move from general to specific. The progression is accomplished through the use of motor learning principles and attention to hypercomplexity, which characterizes situation sports. The framework focuses on preparing players to withstand repeated high-intensity actions, combining jumps, accelerations, decelerations and changes of direction with dribbling, passing, receiving, shooting and/or reacting to their teammates and opponents while minimizing risk of reinjury.

Does Simulation-Based Training Increase Athletic Training Students' Clinical Confidence and Competence in Performing a Cardiovascular Screening?

CONTEXT: The incidence of sudden cardiac death (SCD) in athletes is higher than previously estimated. The need for increased screening to detect cardiac diseases in preparticipation physical examinations (PPE) has become a focus in athletic training. The use of simulation-based training in healthcare professionals' education has increased clinical confidence and competence, but research is limited. OBJECTIVE: To examine if a simulation-based educational intervention can increase athletic training students' self-reported confidence and clinical competence in conducting a cardiovascular screening. DESIGN: Pretest-posttest design. METHODS: 25 first-year athletic training students in a professional master's program participated. The intervention consisted of a standardized cardiovascular curriculum consisting of a 45-minute, interactive instructor-led session and a 45-minute audio session which included repetitions of heart murmurs. Learner self-reported confidence scale, multiple-choice knowledge exam, and objective structured clinical examination (OSCE) of cardiovascular assessment skills and auditory recognition of heart murmurs were recorded. RESULTS: Self-reported confidence increased significantly from 4.4±2.1 to 9.2±3.0 post-intervention (F=78.7, p<0.001) with a moderately high effect size (n2=0.789). Knowledge exam scores increased significantly from 11.0±2.5 to 13.6±4.0 post-intervention (F=5.3, p=0.031) with a low effect size (n2=0.191). The history-taking assessment of the OSCE increased significantly from 2.6±1.6 to 5.7±1.7 post-intervention (F=70.1, p<0.001) with a moderately high effect size (n2=0.751). The clinical skills assessment of the OSCE increased significantly from 4.1±2.8 to 15.6±1.6 post-intervention (F=415.4, p<0.001) with a high effect size (n2=0.952). CONCLUSIONS: Simulation-based training is an effective tool for increasing athletic training students' self-reported confidence and competence in conducting a cardiovascular screening.