Predicting radiation-induced immune suppression in lung cancer patients treated with stereotactic body radiation therapy.

BACKGROUND: Stereotactic body radiation therapy (SBRT) is known to modulate the immune system and contribute to the generation of anti-tumor T cells and stimulate T cell infiltration into tumors. Radiation-induced immune suppression (RIIS) is a side effect of radiation therapy that can decrease immunological function by killing naive T cells as well as SBRT-induced newly created effector T cells, suppressing the immune response to tumors and increasing susceptibility to infections. PURPOSE: RIIS varies substantially among patients and it is currently unclear what drives this variability. Models that can accurately predict RIIS in near real time based on treatment plan characteristics would allow treatment planners to maintain current protocol specific dosimetric criteria while minimizing immune suppression. In this paper, we present an algorithm to predict RIIS based on a model of circulating blood using early stage lung cancer patients treated with SBRT. METHODS: This Python-based algorithm uses DICOM data for radiation therapy treatment plans, dose maps, patient CT data sets, and organ delineations to stochastically simulate blood flow and predict the doses absorbed by circulating lymphocytes. These absorbed doses are used to predict the fraction of lymphocytes killed by a given treatment plan. Finally, the time dependence of absolute lymphocyte count (ALC) following SBRT is modeled using longitudinal blood data up to a year after treatment. This model was developed and evaluated on a cohort of 64 patients with 10-fold cross validation. RESULTS: Our algorithm predicted post-treatment ALC with an average error of 0.24 ± 0.21 × 10 9 $0.24 \pm 0.21 \times {10}^9$ cells/L with 89% of the patients having a prediction error below 0.5 × 109 cells/L. The accuracy was consistent across a wide range of clinical and treatment variables. Our model is able to predict post-treatment ALC < 0.8 (grade 2 lymphopenia), with a sensitivity of 81% and a specificity of 98%. This model has a ∼38-s end-to-end prediction time of post treatment ALC. CONCLUSION: Our model performed well in predicting RIIS in patients treated using lung SBRT. With near-real time model prediction time, it has the capability to be interfaced with treatment planning systems to prospectively reduce immune cell toxicity while maintaining national SBRT conformity and plan quality criteria.

Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma.

Introduction Human papillomavirus-related (HPV + ) oropharyngeal squamous cell carcinoma (OPSCC) is increasing in incidence and presents diagnostic challenges given its unique clinical presentation. Objective The purpose of the present study is to characterize the impact of the unique clinical presentation of HPV-related OPSCC on delays in diagnosis. Methods Retrospective review of presenting symptoms and clinical characteristics of 284 patients with OPSCC treated from 2002-2014. Delay in diagnosis was defined as the presence of any of the following: multiple non-diagnostic fine needle aspirate (FNA) biopsies; two or more courses of antibiotic therapy; surgery with incorrect preoperative diagnosis; evaluation by an otolaryngologist without further workup; or surgery without definitive postoperative diagnosis. Results p16+ tumors demonstrated a distinct clinical presentation that more commonly involved a neck mass (85.1% versus 57.3% of p16-; p < 0.001) and less frequently included odynophagia (24.6% versus 51.7% of p16-; p < 0.001). Patients who experienced diagnostic delay were more likely to have p16+ tumors (77.7% delayed versus 62.8% not delayed; p = 0.006). p16+ primary tumors were more likely to be undetectable by physical examination of the head and neck including flexible laryngoscopy (19.0% versus 6.7% of p16-; p = 0.007) and more frequently associated with nondiagnostic FNA biopsies of a cervical nodal mass (11.8% versus 3.4% of p16-, p = 0.03). Conclusions Compared with non-HPV related OPSCC, the unique clinical presentation and characteristics of HPV+ OPSCC are associated with an increased incidence of diagnostic delay. Targeted education of appropriate care providers may improve time to diagnosis and treatment.

Total Score of Athleticism: Profiling Strength and Power Characteristics in Professional Soccer Players After Anterior Cruciate Ligament Reconstruction to Assess Readiness to Return to Sport.

BACKGROUND: There is no consensus on the optimal testing procedure to determine return-to-sport (RTS) readiness after anterior cruciate ligament (ACL) reconstruction. Current approaches use limb symmetry across a range of tests, but this does not consider a patient's level of athleticism or benchmarks relative to his or her noninjured counterparts. PURPOSE: To examine the utility of the Total Score of Athleticism (TSA), a composite scale including strength, power, and reactive strength assessments, to aid RTS decision-making. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 95 professional soccer players (60 who underwent ACL reconstruction [mean age, 25.1 ± 12.6 years] and 35 who were uninjured [mean age, 23.8 ± 2.8 years]) completed a battery of tests including isokinetic knee extension and flexion torque, bilateral and unilateral countermovement jump height, relative peak power, and reactive strength index-modified. The TSA score (derived from Z scores) was calculated, and we (1) examined differences between the ACL-reconstructed and uninjured groups at the time of RTS, (2) assessed the predictive ability of the TSA to identify the player's status (ACL reconstruction vs uninjured control), and (3) included a case series to discuss the characteristics of players who sustained a subsequent injury within 4 months after RTS. RESULTS: A large difference between the ACL-reconstructed and uninjured groups in the TSA score (d = 0.84; P < .0001) was evident. For every additional increase of 1 unit in the TSA score, the odds of belonging to the ACL-reconstructed group decreased by 74% (95% CI, 0.19-0.56). By visual inspection, the frequency of reinjured players was higher in the low (4/7) TSA tertile compared with the medium (2/7) and high (1/7) TSA tertiles. CONCLUSION: Preliminary evidence indicates that the TSA may be a useful RTS readiness tool, as the composite score derived from strength and power measures was different in soccer players at the time of RTS after ACL reconstruction compared with healthy matched controls. There was also a higher frequency of low TSA scores in players who sustained a second injury after RTS. Therefore, it is recommended to routinely administer RTS tests encompassing strength, power, and reactive strength qualities each season across the largest possible number of players (ideally teammates).

Residual Deficits in Reactive Strength After Anterior Cruciate Ligament Reconstruction in Soccer Players.

CONTEXT: Deficits in plyometric abilities are common after anterior cruciate ligament reconstruction (ACLR). Vertical rebound tasks may provide a targeted evaluation of knee function. OBJECTIVE: To examine the utility of a vertical hop test for assessing function after ACLR and establishing factors associated with performance. DESIGN: Cross-sectional study. SETTING: Rehabilitation program. PATIENTS OR OTHER PARTICIPANTS: Soccer players with a history of ACLR (n = 73) and matched control individuals (n = 195). MAIN OUTCOME MEASURE(S): The 10-second vertical hop test provided measures of jump height, the Reactive Strength Index (RSI), and asymmetry. We also examined possible predictors of hop performance, including single-legged vertical drop jump, isokinetic knee-extension strength, and the International Knee Documentation Committee questionnaire score. RESULTS: Between-limbs differences were identified only for the ACLR group, and asymmetry scores increased in those with a history of ACLR (P < .001) compared with the control group. The single-legged vertical drop jump, RSI, and knee-extension torque were significant predictors of 10-second hop height (R2 = 20.1%) and RSI (R2 = 47.1%). CONCLUSIONS: Vertical hop deficits were present after ACLR, even after participants completed a comprehensive rehabilitation program. This may have been due to reduced knee-extension and reactive strength. Vertical hop tests warrant inclusion as part of the return-to-sport test battery.

Single leg drop jump is affected by physical capacities in male soccer players following ACL reconstruction.

Single leg drop jump (SLDJ) assessment is commonly used during the later stages of rehabilitation to identify residual deficits in reactive strength but the effects of physical capacity on kinetic and kinematic variables in male soccer players following ACL reconstruction remain unknown. Isokinetic knee extension strength, kinematics from an inertial measurement unit 3D system and SLDJ performance variables and mechanics derived from a force plate were measured in 64 professional soccer players (24.7 ± 3.4 years) prior to return to sport (RTS). SLDJ between-limb differences was measured (part 1) and players were divided into tertiles based on isokinetic knee extension strength (weak, moderate and strong) and reactive strength index (RSI) (low, medium and high) (part 2). Moderate to large significant differences between the ACL reconstructed and uninjured limb in SLDJ performance (d = 0.92-1.05), kinetic (d = 0.62-0.71) and kinematic variables (d = 0.56) were evident. Stronger athletes jumped higher (p = 0.002; d = 0.85), produced greater concentric (p = 0.001; d = 0.85) and eccentric power (p = 0.002; d = 0.84). Similar findings were present for RSI, but the effects were larger (d = 1.52-3.84). Weaker players, and in particular those who had lower RSI, displayed landing mechanics indicative of a 'stiff' knee movement strategy. SLDJ performance, kinetic and kinematic differences were identified between-limbs in soccer players at the end of their rehabilitation following ACL reconstruction. Players with lower knee extension strength and RSI displayed reduced performance and kinetic strategies associated with increased injury risk.

Comparison of Strength and Power Characteristics Before ACL Rupture and at the End of Rehabilitation Before Return to Sport in Professional Soccer Players.

BACKGROUND: Strength and power is often reduced on the involved versus contralateral limb and healthy controls after anterior cruciate ligament (ACL) reconstruction, but no study has compared with preinjury values at the time of return to sport (RTS). HYPOTHESIS: Divergent recovery patterns in strength and power characteristics will be present at RTS relative to preinjury baseline data and healthy matched controls. STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Isokinetic strength tests, bilateral and single-leg countermovement jumps (CMJ; SLCMJ) were measured before ACL rupture in 20 professional soccer players. These then had surgical reconstruction (ACL group) and completed follow-up testing before RTS. Healthy controls (uninjured group) were tested at the same time as the ACL group preinjury. Values recorded at RTS of the ACL group were compared with preinjury. We also compared the uninjured and ACL groups at baseline and RTS. RESULTS: Compared with preinjury, ACL normalized quadriceps peak torque of the involved limb (difference = -7%), SLCMJ height (difference = -12.08%), and Reactive Strength Index modified (RSImod) (difference = -5.04%) were reduced after ACL reconstruction. No significant reductions in CMJ height, RSImod, and relative peak power were indicated at RTS in the ACL group when compared with preinjury values, but deficits were present relative to controls. The uninvolved limb improved quadriceps (difference = 9.34%) and hamstring strength (difference = 7.36%) from preinjury to RTS. No significant differences from baseline were shown in SLCMJ height, power, and reactive strength of the uninvolved limb after ACL reconstruction. CONCLUSION: Strength and power in professional soccer players at RTS after ACL reconstruction were often reduced compared with preinjury values and matched healthy controls. CLINICAL RELEVANCE: Deficits were more apparent in the SLCMJ, suggesting that dynamic and multijoint unilateral force production is an important component of rehabilitation. Use of the uninvolved limb and normative data to determine recovery may not always be appropriate.

Mechanisms of ACL injuries in men's football: A systematic video analysis over six seasons in the Qatari professional league.

To assess the mechanisms of ACL injury in male professional football players in Qatar across multiple seasons using systematic video analysis. 15 ACL injuries occurred in competition among the professional football teams that participated in an injury Surveillance Programme during 6 seasons (2013/2014 to 2018/2019). High-definition broadcast videos of these injuries were analyzed (49 views; 34 slow motion) by five analysts who independently described the injury mechanisms (situation, behavior, biomechanical characteristics) using validated observational tools. A knee valgus mechanism was observed in two-thirds of the cases (1 with direct contact to the knee, 3 with indirect contact (other body parts) and 6 with no contact). No visible valgus was reported in 2 of the direct knee contact injuries, while 3 cases of non-contact and indirect contact injuries were unclear. We observed 4 main categories of injury situation among those (n = 12) classified as non-contact/ indirect contact (multiple combinations were possible): pressing (n = 6), tackling or being tackled (n = 4), blocking (n = 3) and screening (n = 2). Direct contact injuries (n = 3) were suffered by 2 players during tackling and 1 whilst being tackled. Contact injuries represented only 20% of ACL injuries occurring during competition in Qatari professional soccer players. Independent of the playing situation, knee valgus was frequently observed (10/15 cases). Pressing was the most common situation (6/15 cases) leading to injury. Landing after heading was not reported in any of these ACL injuries.

Novel HPV Associated Oropharyngeal Squamous Cell Carcinoma Surveillance DNA Assay Cost Analysis.

OBJECTIVES: We aim to propose a modified surveillance strategy using a novel blood assay that detects plasma circulating tumor-specific HPV DNA with reported 100% NPV and 94% PPV as the main method of detection to understand the cost implications of potentially avoiding routine imaging and surveillance visits at our institution. METHODS: We performed a retrospective chart review focusing on recurrences in p16+ patients with OPSCC and defined two surveillance strategies: "Strategy A", follow-up visits with flexible laryngoscopy (FL) plus regular imaging studies; "Strategy B", follow-up visits with FL plus regular NavDx assays and imaging used at the discretion of the physician(s) in cases of high clinical suspicion. RESULTS: Of the p16+ OPSCC patients (n = 214), 23 had confirmed recurrence (11%). Standard work-flow model determined 72 imaging studies and 2198 physical examinations with FL were needed to detect one recurrence. Potential individual patient cost reduction during surveillance was 42%. CONCLUSION: Implementing NavDx for HPV + OPSCC surveillance would benefit patients by reducing costs and unnecessary diagnostic testing. LEVEL OF EVIDENCE: Step/Level 3 Laryngoscope, 133:3006-3012, 2023.

London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport.

Hamstring injuries (HSIs) are the most common athletic injury in running and pivoting sports, but despite large amounts of research, injury rates have not declined in the last 2 decades. HSI often recur and many areas are lacking evidence and guidance for optimal rehabilitation. This study aimed to develop an international expert consensus for the management of HSI. A modified Delphi methodology and consensus process was used with an international expert panel, involving two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering round questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15), comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion around each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. Consensus threshold was set a priori at 70%. Expert response rates were 35/46 (76%) (first round), 15/35 (attendees/invitees to meeting day) and 99/112 (88.2%) for final survey round. Statements on rehabilitation reaching consensus centred around: exercise selection and dosage (78.8%-96.3% agreement), impact of the kinetic chain (95%), criteria to progress exercise (73%-92.7%), running and sprinting (83%-100%) in rehabilitation and criteria for return to sport (RTS) (78.3%-98.3%). Benchmarks for flexibility (40%) and strength (66.1%) and adjuncts to rehabilitation (68.9%) did not reach agreement. This consensus panel recommends individualised rehabilitation based on the athlete, sporting demands, involved muscle(s) and injury type and severity (89.8%). Early-stage rehab should avoid high strain loads and rates. Loading is important but with less consensus on optimum progression and dosage. This panel recommends rehabilitation progress based on capacity and symptoms, with pain thresholds dependent on activity, except pain-free criteria supported for sprinting (85.5%). Experts focus on the demands and capacity required for match play when deciding the rehabilitation end goal and timing of RTS (89.8%). The expert panellists in this study followed evidence on aspects of rehabilitation after HSI, suggesting rehabilitation prescription should be individualised, but clarified areas where evidence was lacking. Additional research is required to determine the optimal load dose, timing and criteria for HSI rehabilitation and the monitoring and testing metrics to determine safe rapid progression in rehabilitation and safe RTS. Further research would benefit optimising: prescription of running and sprinting, the application of adjuncts in rehabilitation and treatment of kinetic chain HSI factors.

London International Consensus and Delphi study on hamstring injuries part 2: operative management.

The key indications for surgical repair of hamstring injuries (HSIs) remain unclear in the literature due to a lack of high-level evidence and expert knowledge. The 2020 London International Hamstring Consensus meeting aimed to highlight clear surgical indications and to create a foundation for future research. A literature review was conducted followed by a modified Delphi process, with an international expert panel. Purposive sampling was used with two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering (round 1) questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15) comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion of each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. The consensus threshold was set a priori at 70% agreement. Rounds 1 and 2 survey respondents were 35/46 (76%) and 99/112 (88.4%), respectively. The consensus group agreed that the indications for operative intervention included: gapping at the zone of tendinous injury (87.2% agreement) and loss of tension (70.7%); symptomatic displaced bony avulsions (72.8%); and proximal free tendon injuries with functional compromise refractory to non-operative treatment (72.2%). Other important considerations for operative intervention included: the demands of the athlete/patient and the expected functional outcome (87.1%) based on the anatomy of the injury; the risk of functional loss/performance deficit with non-operative management (72.2%); and the capacity to restore anatomy and function (87.1%). Further research is needed to determine whether surgery can reduce the risk of reinjury as consensus was not reached within the whole group (48.2%) but was agreed by surgeons (70%) in the cohort. The consensus group did not support the use of corticosteroids or endoscopic surgery without further evidence. These guidelines will help standardise treatment of HSIs, specifically the indications and decision-making for surgical intervention.

London International Consensus and Delphi study on hamstring injuries part 1: classification.

Muscle injury classification systems for hamstring injuries have evolved to use anatomy and imaging information to aid management and prognosis. However, classification systems lack reliability and validity data and are not specific to individual hamstring muscles, potentially missing parameters vital for sport-specific and activity-specific decision making. A narrative evidence review was conducted followed by a modified Delphi study to build an international consensus on best-practice decision-making for the classification of hamstring injuries. This comprised a digital information gathering survey to a cohort of 46 international hamstring experts (sports medicine physicians, physiotherapists, surgeons, trainers and sports scientists) who were also invited to a face-to-face consensus group meeting in London . Fifteen of these expert clinicians attended to synthesise and refine statements around the management of hamstring injury. A second digital survey was sent to a wider group of 112 international experts. Acceptance was set at 70% agreement. Rounds 1 and 2 survey response rates were 35/46 (76%) and 99/112 (88.4%) of experts responding. Most commonly, experts used the British Athletics Muscle Injury Classification (BAMIC) (58%), Munich (12%) and Barcelona (6%) classification systems for hamstring injury. Issues identified to advance imaging classifications systems include: detailing individual hamstring muscles, establishing optimal use of imaging in diagnosis and classification, and testing the validity and reliability of classification systems. The most used hamstring injury classification system is the BAMIC. This consensus panel recommends hamstring injury classification systems evolve to integrate imaging and clinical parameters around: individual muscles, injury mechanism, sporting demand, functional criteria and patient-reported outcome measures. More research is needed on surgical referral and effectiveness criteria, and validity and reliability of classification systems to guide management.

Prevalence of sport specialisation and association with injury history in youth football.

OBJECTIVES: The aims of this study were to determine the prevalence of sport specialisation in youth football, and to investigate the associations of sport specialisation and volume of sport participation with injury history. DESIGN: Cross-sectional questionnaire. SETTING: New Zealand youth football teams. PARTICIPANTS: 414 youth football players aged 10-15 years. MAIN OUTCOME MEASURES: The level of specialisation, average weekly sport participation and free-play volume were recorded. 12-month injury history was captured and grouped by injury type. Associations between level of specialisation and demographic variables were analysed using chi square tests. Logistic regression was used to investigate associations between injury history, level of specialisation, and volume of participation. RESULTS: Participants were classified as high (43%), moderate (38%), or low (19%) specialised (n = 399 complete). High specialisation was more likely in boys, older participants, and those from large schools. Highly specialised participants were more likely to report a history of gradual onset injury than those who were low specialised (n = 340 with complete injury data). Odds of reporting a gradual onset injury also increased with greater weekly and annual sport participation volume. CONCLUSIONS: There is a high prevalence of sport specialisation in youth football, and it is associated with increased incidence of gradual onset injury.

Repetitions in Reserve Is a Reliable Tool for Prescribing Resistance Training Load.

ABSTRACT: Lovegrove, S, Hughes, L, Mansfield, S, Read, P, Price, P, and Patterson, SD. Repetitions in reserve is a reliable tool for prescribing resistance training load. J Strength Cond Res 36(10): 2696-2700, 2022-This study investigated the reliability of repetitions in reserve (RIR) as a method for prescribing resistance training load for the deadlift and bench press exercises. Fifteen novice trained men (age: 17.3 ± 0.9 years, height: 176.0 ± 8.8 cm, body mass: 71.3 ± 10.7 kg) were assessed for 1 repetition maximum (1RM) for deadlift (118.1 ± 27.3 kg) and bench press (58.2 ± 18.6 kg). Subsequently, they completed 3 identical sessions (one familiarization session and 2 testing sessions) comprising sets of 3, 5, and 8 repetitions. For each repetition scheme, the load was progressively increased in successive sets until subjects felt they reached 1-RIR at the end of the set. Test-retest reliability of load prescription between the 2 testing sessions was determined using intraclass correlation coefficient (ICC) and coefficient of variation (CV). A 2-way analysis of variance with repeated measures was used for each exercise to assess differences in the load corresponding to 1-RIR within each repetition scheme. All test-retest comparisons demonstrated a high level of reliability (deadlift: ICC = 0.95-0.99, CV = 2.7-5.7% and bench press: ICC = 0.97-0.99, CV = 3.8-6.2%). Although there were no differences between time points, there was a difference for load corresponding to 1-RIR across the 3 repetition schemes (deadlift: 88.2, 84.3, and 79.2% 1RM; bench press: 93.0, 87.3, and 79.6% 1RM for the 3-, 5-, and 8-repetition sets, respectively). These results suggest that RIR is a reliable tool for load prescription in a young novice population. Furthermore, the between-repetition scheme differences highlight that practitioners can effectively manipulate load and volume (repetitions in a set) throughout a training program to target specific resistance training adaptations.

Biomechanical Analysis of the Tuck Jump Assessment.

ABSTRACT: Nascimento, N, Sideris, V, and Read, PJ. Biomechanical analysis of the tuck jump assessment. J Strength Cond Res 36(10): 2946-2949, 2022-The tuck jump assessment (TJA) examines plyometric technique flaws associated with the increased risk of anterior cruciate ligament injury. Biomechanical data to investigate the mechanics used during the TJA are limited and assessing each jump individually across the entire test period is time inefficient. This study examined performance characteristics and movement mechanics in 16 professional soccer players during a standardized TJA protocol (10 jumps) to determine if sensitive periods exist within the test period (first 5 vs. last 5). Jump height, average power (PW) reactive strength index (RSI), frontal plane projection angle (FPPA), knee angular velocity (AV), and peak knee flexion angle (PKA) were analyzed using an optoelectrical and inertial measurement unit device. Jump height and PW increased in the past 5 jumps displaying a medium effect size (d = > 0.5). A trend was observed of increased AV, FPPA, and PKA during the past 5 jumps; however, no meaningful differences were observed between respective jump phases, and effect sizes were small (d ≤ 0.2). This study indicates that performance metrics increase during the past 5 jumps of a standardized TJA 10-jump protocol; thus, analyzing the entire test period may not be required, providing a time-efficient approach. Caution should be applied if using this protocol as an injury risk screening tool or to identify fatigue related alterations in male professional soccer players as no obvious movement abnormalities were apparent and minimal differences were present between jump phases in a range of kinematic variables across the recorded test duration.

The Acute Effects of Accentuated Eccentric Loading on Drop Jump Kinetics in Adolescent Athletes.

ABSTRACT: Lloyd, RS, Howard, SW, Pedley, JS, Read, PJ, Gould, ZI, and Oliver, JL. The acute effects of accentuated eccentric loading on drop jump kinetics in adolescent athletes. J Strength Cond Res 36(9): 2381-2386, 2022-The purpose of the study was to determine the acute effects of accentuated eccentric loading (AEL) on drop jump kinetics in adolescent athletes. Fifteen male rugby players (mean ± SD: age = 16.2 ± 1.01, body mass = 73.38 ± 9.94, and height = 178.91 ± 6.74) completed 3 trials of a drop jump with and without an accentuated eccentric load using a dumbbell release technique that equated to 15% body mass. The addition of the AEL stimulus resulted in significant, moderate increases in jump height (p < 0.05; Wilcoxon r = 0.47) and braking and propulsive impulse (p < 0.05, Hedges' g = 0.43; p < 0.05, g = 0.61, respectively) but did not significantly influence reactive strength index. Concurrently, there were significant, moderate increases in ground contact times (p < 0.05; r = 0.45) and reductions in spring-like correlations (p < 0.05; g = 0.94). Neither the magnitude nor timing of peak landing force were significantly altered in the AEL protocol (p < 0.05, g = 0.38; p < 0.05, r = 0.10, respectively). Cumulatively, these data indicate that implementation of AEL resulted in meaningful improvements in jump height, driven by significant increases in braking and propulsive impulse. Despite extensions in ground contact times and reductions in spring-like behavior, neither peak landing force nor time to peak force were negatively altered by the AEL. These results indicate that adolescent athletes can realize superior vertical jump heights during drop jumps using AEL, without displaying marked changes in the magnitude or timing of peak landing force.

Bilateral vs. Unilateral Countermovement Jumps: Comparing the Magnitude and Direction of Asymmetry in Elite Academy Soccer Players.

ABSTRACT: Bishop, C, Abbott, W, Brashill, C, Turner, A, Lake, J, and Read, P. Bilateral vs. unilateral countermovement jumps: comparing the magnitude and direction of asymmetry in elite academy soccer players. J Strength Cond Res 36(6): 1660-1666, 2022-The aims of this study were to compare the magnitude and direction of asymmetry in comparable bilateral and unilateral countermovement jumps (CMJs). Forty-five elite academy soccer players from under-23 (n = 15), under-18 (n = 16), and under-16 (n = 14) age groups performed bilateral and unilateral CMJs as part of their routine preseason fitness testing. For the magnitude of asymmetry, no significant differences were evident for any metric between tests. However, the eccentric impulse asymmetry was significantly greater than mean force and concentric impulse in both bilateral and unilateral tests (p < 0.01). For the direction of asymmetry, Kappa coefficients showed poor levels of agreement between test measures for all metrics (mean force = -0.15, concentric impulse = -0.07, and eccentric impulse = -0.13). The mean jump data were also presented relative to the body mass for each group. For the bilateral CMJ, significant differences were evident between groups but showed little consistency in the same group performing better or worse across metrics. For the unilateral CMJ, eccentric impulse was the only metric to show meaningful differences between groups, with the under-18 group performing significantly worse than under-23 and under-16 players. This study highlights that despite the magnitude of asymmetry being similar for each metric between comparable bilateral and unilateral CMJs, consistency in the direction of asymmetry was poor. In essence, if the right limb produced the larger force or impulse during a bilateral CMJ, it was rare for the same limb to perform superior during the unilateral task. Thus, practitioners should be aware that bilateral and unilateral CMJs present different limb dominance characteristics and should not use 1 test to represent the other when measuring between-limb asymmetries.

Impaired Stretch-Shortening Cycle Function Persists Despite Improvements in Reactive Strength After Anterior Cruciate Ligament Reconstruction.

ABSTRACT: Read, PJ, Pedley, JS, Eirug, I, Sideris, V, and Oliver, JL. Impaired stretch-shortening cycle function persists despite improvements in reactive strength followingafter anterior cruciate ligament reconstruction. J Strength Cond Res 36(5): 1238-1244, 2022-Reactive strength index (RSI) during a single-leg drop jump (SLDJ) has been indicated to determine return-to-sport readiness after anterior cruciate ligament (ACL) reconstruction, but only cross-sectional studies are available. Ground reaction force data and characterization of stretch-shortening cycle (SSC) function also remain sparse. Single-leg drop jump performance, ground reaction force, and SSC function were examined in soccer players with ACL reconstruction (n = 26) and matched controls (n = 25). Injured players were tested at 2 time points (32 and 42 weeks postsurgery). Stretch-shortening cycle function was classified as good (no impact peak and spring like), moderate (impact peak but still spring like or no impact peak and not spring like), or poor (impact peak and not spring like). The involved limb displayed lower-jump height, poorer RSI, less spring-like behavior, earlier peak landing force, and a greater ratio of landing peak to take-off peak force compared with the uninvolved limb and controls at the initial assessment (p < 0.001). Proportionally, more involved limbs were categorized as poor or moderate at the initial assessment (69.2%) and follow-up (50%) in comparison with the control limbs (14%). The reactive strength index was the only variable to change significantly between the initial assessment and follow-up on the involved limb (p < 0.05). No changes in the proportion of ACL reconstructed individuals categorized as poor or moderate SSC function at the follow-up assessment were observed. Residual deficits are present in SLDJ performance, SSC function, and ground reaction force characteristics after ACL reconstruction. The reactive strength index should not be the sole metric, as observed increases did not correspond with changes in SSC function.

Shared Decision-Making: Some cautionary observations in the context of elite sport.

The concept of shared decision-making (SDM) has emerged as a key component in the return to play interface as a hallmark of good practice that is athlete focused and allows greater engagement from the athlete. SDM is an appealing, well-intentioned framework that would seemingly lend itself to effectively being implemented. However, in this editorial, we have identified concerns surrounding the social complexities of elite sports and the difficulties of truly applying this concept in practice. In what follows, we explain the dynamics associated, discuss the importance of context when considering the efficacy of this practice and lastly offer what we see as certain key issues that might impede effective SDM.

The use of wearable technology as an assessment tool to identify between-limb differences during functional tasks following ACL reconstruction. A scoping review.

OBJECTIVE: To report how wearable sensors have been used to identify between-limb deficits during functional tasks following ACL reconstruction and critically examine the methods used. METHODS: We performed a scoping review of studies including participants with ACL reconstruction as the primary surgical procedure, who were assessed using wearable sensors during functional movement tasks (e.g., balance, walking or running, jumping and landing) at all postsurgical time frames. RESULTS: Eleven studies met the inclusion criteria. The majority examined jumping-landing tasks and reported kinematic and kinetic differences between limbs (involved vs. unninvolved) and groups (injured vs. controls). Excellent reliability and moderate-strong agreement with laboratory protocols was indicated, with IMU sensors providing an accurate estimation of kinetics, but the number of studies and range of tasks used were limited. Methodological differences were present including, sensor placement, sampling rate, time post-surgery and type of assessment which appear to affect the outcome. CONCLUSIONS: Wearable sensors consistently identified between-limb and group deficits following ACL reconstruction. Preliminary evidence suggests these technologies could be used to monitor knee function during rehabilitation, but further research is needed including, validation against criterion measures. Practitioners should also consider how the methods used can affect the accuracy of the outcome.

Angle specific analysis of hamstrings and quadriceps isokinetic torque identify residual deficits in soccer players following ACL reconstruction: a longitudinal investigation.

 Analysing the isokinetic curve is important following ACL reconstruction as there may be deficits in torque production at specific points throughout the range of motion. We examined isokinetic (60°.s-1) torque-angle characteristics in 27 male soccer players (24.5 ± 3.9 years) at 3 time-points (17 ± 5; 25 ± 6; and 34 ± 7 weeks post-surgery). Extracted data included knee flexor and extensor peak torque, conventional hamstrings: quadriceps (H/Q) ratio, and angle-specific torque using Statistical Parametric Mapping (SPM). There were significant involved limb increases in extension peak torque at each assessment (p<0.001); however, asymmetry favouring the un-involved limb was observed (p<0.01). Flexion peak torque was greater on the un-involved limb at assessments 1 and 2 only (p<0.05). The angle of peak torque was not significantly different at individual time-points or within-limbs across the 3 assessments. SPM revealed involved limb angle-specific reductions in extension torque across the full range of motion at time-points 1 and 2 (p<0.001) but only in angles [51-80°] at assessment 3 (p<0.05). Between limb H/Q angle differences [33-45°] were shown at assessments 2 and 3. The ratio ranged from 1.60-0.74 depending on the angle tested. Angle-specific moment curves are useful for monitoring patterns of strength development during rehabilitation.