A comparative video analysis of hamstring injuries mechanism and situational pattern in men's and women's football (soccer).

PURPOSE: To describe the injury mechanism and situational patterns of severe (absence >28 days) hamstring muscle injuries in professional male and female football (soccer) players. METHODS: The data for males were sourced from Serie A clubs participating in both national and international competitions from 2018 to 2021. For the female cohort, hamstring injuries were identified during matches of the top national/international competitions from 2017 to 2023. Video footage was obtained, and three raters categorised injury mechanisms and situational patterns. Injuries were also examined according to the month, minute and location. RESULTS: A total of 129 severe hamstring injuries were identified, with 64 occurring in females and 65 in males. Video analysis was possible for 29 (45%) female cases and 61 (94%) male cases. Female injuries had longer lay-off times (97.8 ± 77.1 days) than males (39.6 ± 20.9 days). Females had a higher proportion of indirect contact injuries (34%) than males (13%) and a lower proportion of non-contact injuries (66% vs. 87%). Four situational patterns were identified: running was the most common for both sexes, representing 59% of female injuries and 41% of male injuries. Over-stretching injuries were split across open and CKC scenarios but collectively explained nearly half (48%) of male injuries but only one in five (21%) female injuries. Kicking injuries had a higher proportion in females (17%) than males (10%). Injuries were more common in the second half for females and the first half for males. CONCLUSION: Females had a higher proportion of indirect contact, running and kicking injuries and a lower proportion of non-contact and stretch-type injuries than males. Understanding injury patterns can inform tailored prevention programs, considering sex-specific differences. LEVEL OF EVIDENCE: Level IV.

Validation of Step Detection and Distance Calculation Algorithms for Soccer Performance Monitoring.

This study focused on developing and evaluating a gyroscope-based step counter algorithm using inertial measurement unit (IMU) readings for precise athletic performance monitoring in soccer. The research aimed to provide reliable step detection and distance estimation tailored to soccer-specific movements, including various running speeds and directional changes. Real-time algorithms utilizing shank angular data from gyroscopes were created. Experiments were conducted on a specially designed soccer-specific testing circuit performed by 15 athletes, simulating a range of locomotion activities such as walking, jogging, and high-intensity actions. The algorithm outcome was compared with manually tagged data from a high-quality video camera-based system for validation, by assessing the agreement between the paired values using limits of agreement, concordance correlation coefficient, and further metrics. Results returned a step detection accuracy of 95.8% and a distance estimation Root Mean Square Error (RMSE) of 17.6 m over about 202 m of track. A sub-sample (N = 6) also wore two pairs of devices concurrently to evaluate inter-unit reliability. The performance analysis suggested that the algorithm was effective and reliable in tracking diverse soccer-specific movements. The proposed algorithm offered a robust and efficient solution for tracking step count and distance covered in soccer, particularly beneficial in indoor environments where global navigation satellite systems are not feasible. This advancement in sports technology widens the spectrum of tools for coaches and athletes in monitoring soccer performance.

Injury Burden in Professional European Football (Soccer): Systematic Review, Meta-Analysis, and Economic Considerations.

OBJECTIVE: We performed a systematic review and meta-analysis to evaluate the injury burden and the related economic cost in European professional male football players. DATA SOURCES: Multiple database research was performed up to August 5, 2022 (PubMed, EMbase, Scopus, Cochrane Library), including only studies that reported severity in the number of days of absence for each injury, incidence reported in the number of injuries/1000 hours, or reported number of injuries and exposure time and adult male football players, professionals from European clubs. Two reviewers extracted data and assessed paper quality with the Strengthening the Reporting of Observational Studies in Epidemiology statement and the Newcastle-Ottawa Scale. MAIN RESULTS: Twenty-two studies have reported incidence, severity, and burden of injuries in professional football. The highest injury burden was found for ligament-joint injuries (37.9 days/1000 hours; 222 397 €/1000 hours) and for muscle injuries (34.7 days/1000 hours; 203 620 €/1000 hours). Injury locations with high burden were knee injuries (34.8 days/1000 hours; 20 4206 €/1000 hours)-mainly anterior cruciate ligament injuries (14.4 days/1000 hours; 84 499 €/1000 h)-followed by thigh injuries (25.0 days/1000 hours; 146 700 €/1000 hours), hamstrings injuries (15.4 days/1000 hours; 90 367 €/1000 hours), hip-and-groin injuries (16.1 days/1000 hours; 94 475 €/1000 hours), primarily adductor muscles injuries (9.4 days/1000 hours; 55 159€/1000 hours), and ankle injuries (13.1 days/1000 h; 76 871 €/1000 hours) with ankle sprains (7.4 days/1000 hours; 43 423 €/1000 hours). CONCLUSIONS: Being exposed to injury risk has serious consequences for individual and club performance and economy. This review identified the most relevant targets in injury management, compared their injury data with reference values, and provided economic evidence when trying to gain buy-in from the key decision makers.

The three-dimensional reconstruction of an Achilles tendon rupture in a professional football player reveals a multiplanar injury mechanism.

Achilles tendon rupture (ATR) is a rare although very serious injury for football players; currently, studies on ATR in football are scant. This case report intends to firstly describe the situational pattern and three-dimensional mechanism of the ATR injury occurred to a professional football player during the last UEFA 2020 Championship. To reconstruct the full 3D joint kinematics throughout the injury action, the model-based image-matching technique was used. The key findings were: (i) ATR injury combined a sudden ankle dorsiflexion action with an internal plantarflexion moment while performing a crossover cut at high speed; (ii) a multi-planar loading occurred during the push-off phase.Level of evidence V.

Machine Learning-Based Estimation of Ground Reaction Forces and Knee Joint Kinetics from Inertial Sensors While Performing a Vertical Drop Jump.

Nowadays, the use of wearable inertial-based systems together with machine learning methods opens new pathways to assess athletes' performance. In this paper, we developed a neural network-based approach for the estimation of the Ground Reaction Forces (GRFs) and the three-dimensional knee joint moments during the first landing phase of the Vertical Drop Jump. Data were simultaneously recorded from three commercial inertial units and an optoelectronic system during the execution of 112 jumps performed by 11 healthy participants. Data were processed and sorted to obtain a time-matched dataset, and a non-linear autoregressive with external input neural network was implemented in Matlab. The network was trained through a train-test split technique, and performance was evaluated in terms of Root Mean Square Error (RMSE). The network was able to estimate the time course of GRFs and joint moments with a mean RMSE of 0.02 N/kg and 0.04 N·m/kg, respectively. Despite the comparatively restricted data set and slight boundary errors, the results supported the use of the developed method to estimate joint kinetics, opening a new perspective for the development of an in-field analysis method.

Machine-Learning Based Determination of Gait Events from Foot-Mounted Inertial Units.

A promising but still scarcely explored strategy for the estimation of gait parameters based on inertial sensors involves the adoption of machine learning techniques. However, existing approaches are reliable only for specific conditions, inertial measurements unit (IMU) placement on the body, protocols, or when combined with additional devices. In this paper, we tested an alternative gait-events estimation approach which is fully data-driven and does not rely on a priori models or assumptions. High-frequency (512 Hz) data from a commercial inertial unit were recorded during 500 steps performed by 40 healthy participants. Sensors' readings were synchronized with a reference ground reaction force system to determine initial/terminal contacts. Then, we extracted a set of features from windowed data labeled according to the reference. Two gray-box approaches were evaluated: (1) classifiers (decision trees) returning the presence of a gait event in each time window and (2) a classifier discriminating between stance and swing phases. Both outputs were submitted to a deterministic algorithm correcting spurious clusters of predictions. The stance vs. swing approach estimated the stride time duration with an average error lower than 20 ms and confidence bounds between ±50 ms. These figures are suitable to detect clinically meaningful differences across different populations.

BMI and inverted BMI as predictors of fat mass in young people: a comparison across the ages.

Background: The use of body mass index (BMI) could lead to over/under estimation of fat mass percentage (FM%). An alternative index (inverted BMI, iBMI) has been proposed as a better estimator of FM% in adults, while its practical feasibility in children and adolescents has not been fully investigated.Aim: To examine if iBMI can better estimate FM% than BMI in children/adolescents.Subjects and methods: Height, weight, and triceps and subscapularis skinfolds were measured in 6686 schoolchildren aged 11-14-years-old. BMI and iBMI (squared height/weight) were calculated; FM% was estimated by skinfold thicknesses. The Pearson correlation coefficient and the coefficient of determination were obtained to test the best regression model between the indexes and FM%.Results: FM% was linearly related to both indexes with R2 values that were overall > 0.7. No significant differences among the R2 values were found (p value = .2, ANOVA).Conclusion: BMI persists as a robust index for health surveillance screening in children/adolescents, being very intuitive and ready-to-use. Inverted BMI may be more accurate within a cohort of adults who experience only ponderal modifications, directly implicated in the variation of FM. In conclusion, the BMI remains a quick, handy and intuitive predictor of FM%.

Ultrasonographic and Myotonometric Evaluation of the Shoulder Girdle After an Isokinetic Muscle Fatigue Protocol.

OBJECTIVES: The aim of the study was to investigate supraspinatus tendon thickness, acromiohumeral distance (AHD), and stiffness/creep measures of the shoulder girdle in overhead asymptomatic athletes in muscle fatigue conditions. DESIGN: Observational, case series study. SETTING: Biomechanics and motion analysis lab. PARTICIPANTS: Twenty-four male overhead volleyball (n = 8), handball (n = 8), and tennis (n = 8) athletes. All subjects were without shoulder injury history. MAIN OUTCOME MEASURE: The subjects were tested for supraspinatus tendon thickness (in short and long axis), AHD using ultrasound scans and stiffness/creep of upper trapezius, infraspinatus, anterior and posterior deltoid, and pectoralis major using the myotonometer device before and immediately after a fatigue protocol. INTERVENTION: The fatigue protocol consisted of 3 sets of 32 maximum isokinetic concentric contractions performing shoulder internal and external rotation at isokinetic speed of 120°/s. RESULTS: A significant increase in supraspinatus tendon thickness (both in short and long axis) (P = .045 and P = .01, respectively) and a reduction in AHD (P = .01) were found after an isokinetic protocol. The stiffness increased significantly in upper trapezius (P ≤ .01), infraspinatus (P = .003), posterior deltoid (P = .047), and pectoralis major (P = .01), whereas the creep showed a significant decrement for upper trapezius (P = .001) and infraspinatus (P = .003). CONCLUSION: The present study has demonstrated the postexercise fatigue in overhead athletes. The increase of stiffness (reduction of muscle creep) and tendon thickness (simultaneous to the reduction of AHD) may indicate rotator cuff overloading as a primary intrinsic tendon pathology process.

Gait and postural control patterns and rehabilitation in Down syndrome: a systematic review.

[Purpose] To describe (1) the current knowledge on gait and postural control in individuals with Down syndrome in terms of spatiotemporal, kinematics and kinetics, and (2) relevant rehabilitation strategies. [Methods] Randomized and non-randomized clinical trials published between January 1997 and October 2019 were selected by searching four scientific databases. We included studies on patients with Down syndrome involving gait analysis or postural control. A custom data-extraction and appraisal form was developed to collect the key features of each article. The PEDro Scale was used to evaluate the methodological quality of the studies. [Results] A total of 37 out of 146 cross-sectional and longitudinal studies were included in the review. The main abnormalities included: reduction of gait velocity and step length, poor static balance with increased anteroposterior and mediolateral oscillations and a larger step width. [Conclusion] A number of compensatory patterns during movement was observed, with a direct influence on improvements in stability and postural control throughout daily life. Intensive gait training at an early age appears to produce long-term improvements in this population. Future research should focus on the interaction between the motor and cognitive function, and on the functional effects due to the exposure to an enriched environment.

Donor-Site Morbidity After Osteocutaneous Free Fibula Transfer: Longitudinal Analysis of Gait Performance.

PURPOSE: The purpose was to evaluate donor-site clinical morbidity and changes in kinematic gait parameters after the harvest of a vascularized free fibula flap for facial reconstruction. MATERIALS AND METHODS: We enrolled 14 patients (aged 50 ± 15 years) in a longitudinal study. Every patient underwent a double evaluation in which a presurgical assessment and 6-month postsurgical assessment were performed. Subjective donor-site evaluation was carried out through unstructured clinical questioning about pain, paresthesia, walking ability, and restrictions in activity. Further subjective evaluations were assessed through the Western Ontario and McMaster Universities Osteoarthritis Index and the Point Evaluation System for Lower Extremity Fibulectomy. A clinical evaluation of the donor site assessed muscular deficits, sensibility disturbance, and wound healing. Temporal and spatial kinematic parameters were measured through gait analysis during overground walking at a comfortable speed. RESULTS: Postsurgical clinical examinations detected 1 patient affected by a neurologic disorder and 3 patients with donor-site pain, whereas 10 patients (71%) declared no residual alterations in the operated leg. On average, the Western Ontario and McMaster Universities Osteoarthritis Index score was 367 of 2,400, and the Point Evaluation System for Lower Extremity Fibulectomy score was 19 of 24. Presurgical versus postsurgical gait analysis comparison showed no significant differences in gait parameters except for a 6% reduction in the double-support phase. Stance values were higher for the operated limb in both evaluations (+1.3% before surgery, +1.8% after surgery). No alterations were detected in the range of motion of the lower-limb joints. CONCLUSIONS: Considering the slight modification of the gait pattern, which is not usually perceived by patients, vascularized free fibula flap harvest was generally associated with successful functional and subjective outcomes of the donor site.

Identifying the optimal body shape and composition associated with strength outcomes in children and adolescent according to place of residence: An allometric approach.

The purpose of the study was to identify the optimal body shape and composition associated with physical fitness levels of children living in urban and rural areas of Italy. A total of 7102 children (11-14 years) were assessed for weight, height, percentage body fat (FM%), sit-and-reach flexibility (SAR), standing broad jump (SBJ) and sit-ups (SUP). A multiplicative allometric model, Y = a · massk1 · heightk2 ·Îµ, was used to predict the physical outcome variables Y = SBJ and SUP. The model was expanded to incorporate FM% and SAR as follows Y = a · massk1 · heightk2 · FM%k3 · exp(b· FM% + c· SAR) ·Îµ. Note that FM% was incorporated as a "gamma function" that allows an initial growth, and subsequent decline in Y as FM% increases in size. Although having an ectomorph body shape appears advantageous, being too thin appears detrimental to the strength outcomes. Being flexible would also benefit physical fitness levels. Finally, our results indicate that ursban children aged 11-14 have superior strength outcomes compared with rural children, having controlled for differences in body shape and composition, a finding that may be associated with rural environments having fewer exercise facilities compared with urban conurbations.

Use of Machine Learning and Wearable Sensors to Predict Energetics and Kinematics of Cutting Maneuvers.

Changes of directions and cutting maneuvers, including 180-degree turns, are common locomotor actions in team sports, implying high mechanical load. While the mechanics and neurophysiology of turns have been extensively studied in laboratory conditions, modern inertial measurement units allow us to monitor athletes directly on the field. In this study, we applied four supervised machine learning techniques (linear regression, support vector regression/machine, boosted decision trees and artificial neural networks) to predict turn direction, speed (before/after turn) and the related positive/negative mechanical work. Reference values were computed using an optical motion capture system. We collected data from 13 elite female soccer players performing a shuttle run test, wearing a six-axes inertial sensor at the pelvis level. A set of 18 features (predictors) were obtained from accelerometers, gyroscopes and barometer readings. Turn direction classification returned good results (accuracy > 98.4%) with all methods. Support vector regression and neural networks obtained the best performance in the estimation of positive/negative mechanical work (coefficient of determination R2 = 0.42-0.43, mean absolute error = 1.14-1.41 J) and running speed before/after the turns (R2 = 0.66-0.69, mean absolute error = 0.15-018 m/s). Although models can be extended to different angles, we showed that meaningful information on turn kinematics and energetics can be obtained from inertial units with a data-driven approach.

Energy Cost of Continuous Shuttle Running: Comparison of 4 Measurement Methods.

Ciprandi, D, Lovecchio, N, Piacenza, M, Limonta, E, Esposito, F, Sforza, C, Zago, M. Energy cost of continuous shuttle running: Comparison of 4 measurement methods. J Strength Cond Res 32(8): 2265-2272, 2018-Assessing runs with frequent turns (shuttle run) is a viable option to evaluate the energy cost associated with sport-specific high-intensity intermittent activities. To date, no study investigated the extent to which the computation of energy cost of exercise is affected by the following factors: procedure and duration of oxygen uptake measurement during exercise, oxygen uptake measurement during recovery, estimation of the anaerobic alactic contribution, consideration of respiratory exchange ratio (RER) in the computation, and exercise intensity. Therefore, the aim of the current study was to determine whether these factors may lead to different estimations of the energy cost of locomotion. Twenty-six healthy young men participated in two 5-m shuttle-run trials at an average speed of 50 and 75% of their maximal aerobic velocity, respectively. Oxygen uptake and lactate concentration were measured before, during, and after the trials. Results revealed that different methods of computing the energy cost of 5-m shuttle run returned significantly different results, in particular at high intensity levels. The largest significant difference found between methods was lower than 10%. This suggests that for the most accurate computation of the workload, the contribution of the anaerobic alactic mechanisms and the influence of the RER cannot be neglected. These findings might help sport scientists and conditioning trainers in identifying the exercise conditions in which including all the metabolic components are required for an accurate computation of athletes' energy expenditure. In turn, exercise conditions would be defined where the computation could be conveniently simplified without worsening results reliability.

Multi-segmental movements as a function of experience in karate.

Karate is a martial art that partly depends on subjective scoring of complex movements. Principal component analysis (PCA)-based methods can identify the fundamental synergies (principal movements) of motor system, providing a quantitative global analysis of technique. In this study, we aimed at describing the fundamental multi-joint synergies of a karate performance, under the hypothesis that the latter are skilldependent; estimate karateka's experience level, expressed as years of practice. A motion capture system recorded traditional karate techniques of 10 professional and amateur karateka. At any time point, the 3D-coordinates of body markers produced posture vectors that were normalised, concatenated from all karateka and submitted to a first PCA. Five principal movements described both gross movement synergies and individual differences. A second PCA followed by linear regression estimated the years of practice using principal movements (eigenpostures and weighting curves) and centre of mass kinematics (error: 3.71 years; R2 = 0.91, P â‰ª 0.001). Principal movements and eigenpostures varied among different karateka and as functions of experience. This approach provides a framework to develop visual tools for the analysis of motor synergies in karate, allowing to detect the multi-joint motor patterns that should be restored after an injury, or to be specifically trained to increase performance.

Dribbling determinants in sub-elite youth soccer players.

Dribbling speed in soccer is considered critical to the outcome of the game and can assist in the talent identification process. However, little is known about the biomechanics of this skill. By means of a motion capture system, we aimed to quantitatively investigate the determinants of effective dribbling skill in a group of 10 Under-13 sub-elite players, divided by the median-split technique according to their dribbling test time (faster and slower groups). Foot-ball contacts cadence, centre of mass (CoM), ranges of motion (RoM), velocity and acceleration, as well as stride length, cadence and variability were computed. Hip and knee joint RoMs were also considered. Faster players, as compared to slower players, showed a 30% higher foot-ball cadence (3.0 ± 0.1 vs. 2.3 ± 0.2 contacts · s(-1), P < 0.01); reduced CoM mediolateral (0.91 ± 0.05 vs. 1.14 ± 0.16 m, P < 0.05) and vertical (0.19 ± 0.01 vs. 0.25 ± 0.03 m, P < 0.05) RoMs; higher right stride cadence (+20%, P < 0.05) with lower variability (P < 0.05); reduced hip and knee flexion RoMs (P < 0.05). In conclusion, faster players are able to run with the ball through a shorter path in a more economical way. To effectively develop dribbling skill, coaches are encouraged to design specific practices where high stride frequency and narrow run trajectories are required.

Three-dimensional motion analysis of facial movement during verbal and nonverbal expressions in healthy subjects.

Functional impairments of facial expressions alter the quality of life and their quantitative analysis is key to describing and grading facial function and dysfunction. The aim of this investigation was to quantify 3D lip movements in a group of healthy young subjects. Lip movements during five repetitions of common and random sequences of vowels and nonverbal expressions were recorded using an optoelectronic 3D motion analyzer. The mean maximum displacement of facial landmarks was used to compute 3D unilateral mobility and the symmetry indices (SI) separately for each sex. Facial mobility was significantly greater during open-mouth than closed-mouth smiles. Facial movement among the subjects was largest during articulation of the vowel /a/ and smallest for /i/. Lips were pursed with a SI very close to 95%, while smiles were slightly more asymmetric. The vowel /a/ was articulated with significantly greater symmetry than /e/, /i/ and /u/. The outcomes suggest that the proposed method characterized normal facial animations satisfactorily, so it could be a useful tool for assessing patients with facial lesions and dentofacial deformities. Patient assessment would profit from this quantitative approach, which would reduce discrepancies among several clinical examinations. Clin. Anat. 29:991-997, 2016. © 2016 Wiley Periodicals, Inc.

lower limbs kinematic assessment of the effect of a gym and hydrotherapy rehabilitation protocol after knee megaprosthesis: a case report.

[Purpose] To quantitatively assess the effect of a personalized rehabilitation protocol after knee megaprosthesis. [Subject and Methods] The gait patterns of a 33-year-old male patient with knee synovial sarcoma were assessed by a computerized analysis before and after 40 rehabilitation sessions. [Results] The rehabilitation protocol improved the gait pattern. After rehabilitation, hip flexion was nearly symmetric, with normalized affected limb hip flexion, and improved ankle flexion. Ankle in/eversion was asymmetric and did not improve after physiotherapy. Before physiotherapy, the hip flexion on the affected side anticipated the movement but nearly normalized in the follow-up assessment. Hip abduction range of motion increased, with wider movements and good balance. Knee range of motion nearly symmetrized, but maintained an anticipated behavior, without shock absorption at heel-strike. [Conclusion] Instrumental gait analysis allowed us to gain evidence about the training and how to expand rehabilitative interventions to improve efficacy. In particular, we recommend quadriceps and gastrocnemius eccentric contraction training (to improve the shock absorption phase, preventing early failures of the prosthesis); one-leg standing performance (to improve the support phase of the affected limb); adductor strength training (to aid in hip control during the swing phase); and peroneus strength training (to increase ankle joint stabilization).

Squat exercise to estimate knee megaprosthesis rehabilitation: a pilot study.

[Purpose] This study evaluated a specific rehabilitation protocol using a half squat after total knee reconstruction with distal femur megaprosthesis and tibial allograft-prosthesis composite. [Subject and Methods] Squat execution was recorded by a three-dimensional system before and after a specific rehabilitation program on a 28-year-old patient. Squat duration, body center of mass trajectory, and vertical range of motion were determined. Step width and joint angles and symmetry (hip flexion, extension, and rotation, knee flexion, and ankle dorsal and plantar flexion) were estimated. Knee and hip joint symmetry was computed using a bilateral cyclogram technique. [Results] After rehabilitation, the squat duration was longer (75%), step width was similar, and vertical displacement was higher. Hip flexion increased by over 20%, and ankle dorsiflexion diminished by 14%. The knee had the highest symmetry gain (4.1-3.4%). Angle-angle plot subtended areas decreased from 108° to 40°(2) (hip) and from 204° to 85°(2) (knee), showing improvement in movement symmetry. [Conclusion] We concluded that the squat is an effective multifactorial exercise to estimate rehabilitation outcomes after megaprosthesis, also considering that compressive and shear forces are minimal up to 60-70° of knee flexion.

Muscle activation while running on the ground compared to artificial turf in males with pronated and supinated feet.

BACKGROUND: Running on different surfaces, including natural and artificial surfaces, requires different gait mechanics, especially in individuals with foot deformity. RESEARCH QUESTION: How muscle activity change during running on the ground and artificial turf in males with pronated and supinated feet? METHODS: In this quasi-experimental study, we assessed a cohort of young male subjects, classified as healthy (n = 10), and with pronated (n = 10) or supinated (n = 10) feet. An electromyographic system was used to record lower limb muscle activity while running on the ground and artificial turf at constant speed (3.2 m/s). RESULTS: Results demonstrated significant main effects of the "surface" factor for vastus medialis activity during the loading phase (p = 0.040, η2 =0.147). Paired comparison revealed significantly greater vastus medialis activity while running on artificial grass with respect to the ground. A significant effect of the "group" factor was found for medial gastrocnemius during loading phase (p = 0.020, η2 =0.250). Paired-wise comparison revealed significantly lower medial gastrocnemius activity in the pronated and supinated feet groups than in the healthy group. SIGNIFICANCE: The healthy group may possess better neuromuscular control, allowing them to effectively coordinate the activation of the medial gastrocnemius with other muscles involved in running. Based on these findings, running on artificial turf is useful when the runner would like to strengthen vastus medialis muscle. The runner should carefully choose the running surface according to his/her state and training session goal.

3-Dimensional Biomechanics of Noncontact Anterior Cruciate Ligament Injuries in Male Professional Soccer Players.

BACKGROUND: The understanding of noncontact anterior cruciate ligament (ACL) injury causation in soccer has improved over the past decades. Bidimensional video analyses have significantly augmented our awareness, representing to date the only practical method to describe injury biomechanics. However, the extent of the problem continues to raise serious concerns. PURPOSE: To advance our understanding of the causal pathways leading to ACL injury with a large-scale reconstruction of 3-dimensional (3D) whole-body joint kinematics of injuries that occurred to male elite soccer players, as well as to compare the joint angle time course among situational patterns. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 33 consecutive noncontact and indirect contact ACL injuries that occurred in 6 national and 2 international professional leagues (seasons 2020-2021 to 2022-2023 until December 2022) were analyzed: (1) multiview noncoaxial television images were inspected; (2) multiple camera views were taken from 400 ms before the initial ground contact to 200 ms after the injury frame; (3) a size-matched pitch was modeled and used to calibrate cameras; (4) a 3D skeletal model was adjusted to fit the player's pose in each frame/view; and (5) poses were interpolated, and Euler joint angles were extracted. RESULTS: The authors reconstructed the 3D lower limb joint kinematic curves preceding and during ACL injuries in 33 cases; notably, a sudden external (up to 5°) and then internal knee rotation was observed after the initial contact and before the injury frame. The overall kinematics at injury were knee moderately flexed (45.9°± 21.7°), abducted (4.3°± 5.1°), and externally rotated (3.0°± 6.4°); trunk shallowly flexed (17.4°± 12.5°) and rotated and tilted toward the injured side; and hip flexed (32.0°± 18.7°), abducted (31.1°± 12.0°), and slightly internally rotated (6.6°± 12.2°). Variable behaviors were observed at the ankle level. CONCLUSION: Via reconstruction of the sequence of whole-body joint motion leading to injury, we confirmed the accepted gross biomechanics (dynamic valgus trend). This study significantly enriches the current knowledge on multiplanar kinematic features (transverse and coronal plane rotations). Furthermore, it was shown that ACL injuries in male professional soccer players manifest through distinct biomechanical footprints related to the concurrent game situation. CLINICAL RELEVANCE: Interventions aimed at reducing ACL injuries in soccer should consider that environmental features (ie, situational patterns) affect injury mechanics.