Jump Landing Kinematics: Establishing Normative Ranges For Male And Female Athletes.

CONTEXT: Lower extremity joint (LE) kinematics during landing tasks are important predictors of injury risk and performance outcomes in athletes. OBJECTIVE: To establish sex-related differences and normative ranges for LE kinematics during the jump-landing task in a large cohort of healthy military service academy cadets. DESIGN: Cross-Sectional Study. SETTING: US Air Force, Naval, and Military Academies. PARTICIPANTS: 5308 cadets (2062 females [38.8%]). MAIN OUTCOME MEASURE(S): Sex-related differences in LE kinematics were analyzed using independent samples t-tests. Mean differences (MD) and effect sizes (d) were reported for interpretability. Normative ranges for hip and knee joint angles were established separately for males and females at initial contact (IC) and 50% of the stance phase. RESULTS: Compared to males, moderate effect sizes (d ≥ .5) were observed for knee external rotation (negative value) where females displayed greater motion at IC and at 50% stance (MD: - 3.9˚ and -5.0˚, respectively, p < .001). The following findings were of small effect size (.2 ≥ d > .5). Females exhibited less knee and hip flexion at IC (MD: -1.8˚ and -0.5˚, respectively, p < .001) and at 50% stance (MD: -4.1˚ and -4.6˚, respectfully, p < .001). This was accompanied by females having greater knee valgus (negative value) and hip adduction at IC (MD: -2.2˚ and 1.06˚, respectively, p < .001) and at 50% stance (MD: -3.2˚ and 1.8˚, respectfully, p < .001). CONCLUSION: This study establishes normative ranges for LE kinematics during the jump-landing task in a large cohort of healthy military service academy cadets entering their first year. Sex- related differences in LE kinematics were observed, highlighting the importance of considering sex as a factor in the evaluation of lower extremity movement quality and management of injury risk.

Modeling Risk for Lower Extremity Musculoskeletal Injury in U.S. Military Academy Cadet Basic Training.

INTRODUCTION: Sport and tactical populations are often impacted by musculoskeletal injury. Many publications have highlighted that risk is correlated with multiple variables. There do not appear to be existing studies that have evaluated a predetermined combination of risk factors that provide a pragmatic model for application in tactical and/or sports settings. PURPOSE: To develop and test the predictive capability of multivariable risk models of lower extremity musculoskeletal injury during cadet basic training at the U.S.Military Academy. MATERIALS AND METHODS: Cadets from the class of 2022 served as the study population. Sex and injury history were collected by questionnaire. Body Mass Index (BMI) and aerobic fitness were calculated during testing in the first week of training. Movement screening was performed using the Landing Error Scoring System during week 1 and cadence was collected using an accelerometer worn throughout initial training. Kaplan-Meier survival curves estimated group differences in time to the first musculoskeletal injury during training. Cox regression was used to estimate hazard ratios (HRs) and Akaike Information Criterion (AIC) was used to compare model fit. RESULTS: Cox modeling using HRs indicated that the following variables were associated with injury risk : Sex, history of injury, Landing Error Scoring System Score Category, and Physical Fitness Test (PT) Run Score. When controlling for sex and history of injury, amodel including aerobic fitness and BMI outperformed the model including movement screening risk and cadence (AIC: 1068.56 vs. 1074.11) and a model containing all variables that were significant in the univariable analysis was the most precise (AIC: 1063.68). CONCLUSIONS: In addition to variables typically collected in this tactical setting (Injury History, BMI, and aerobic fitness), the inclusion of kinematic testing appears to enhance the precision of the risk identification model and will likely continue to be included in screening cadets at greater risk.

Longitudinal Changes in Quadriceps Morphology over the First 3 Months after Anterior Cruciate Ligament Reconstruction.

PURPOSE: Neuromuscular deficits and atrophy after anterior cruciate ligament reconstruction (ACLR) may be accompanied by changes in muscle composition and poor quadriceps muscle quality (QMQ). Quadriceps atrophy occurs after ACLR but improves within the first three postoperative months, yet this hypertrophy could be attributable to increases in noncontractile tissue (i.e., poor QMQ). The purposes of this study were to evaluate changes in QMQ after ACLR and to determine if changes in QMQ and cross-sectional area (CSA) occur in parallel or independently. METHODS: A longitudinal prospective cohort design was implemented to evaluate QMQ and CSA in 20 individuals with ACLR and 12 healthy controls. Participants completed three testing sessions (baseline/presurgery, 1 month, and 3 months) during which ultrasound images were obtained from the vastus lateralis (VL) and rectus femoris (RF). QMQ was calculated as the echo intensity (EI) of each image, with high EI representing poorer QMQ. Anatomical CSA was also obtained from each image. RESULTS: RF and VL EI were greater at 1 and 3 months in the ACLR limb compared with baseline and the contralateral limb and did not change between 1 and 3 months. VL and RF CSA in the ACLR limb were smaller at 1 and 3 months compared with the contralateral limb and controls (VL only) but increased from 1 to 3 months. Changes in QMQ and CSA were not correlated. CONCLUSIONS: QMQ declines within the first month after ACLR and does not improve by 3 months although hypertrophy occurs, suggesting that these morphological characteristics change independently after ACLR. Poorer QMQ represents greater concentration of noncontractile tissues within the muscle and potentially contributes to chronic quadriceps dysfunction observed after ACLR.

The feasibility of workload monitoring among law enforcement officers: A multi-methodological approach.

This study examined the feasibility of workload monitoring to assess internal workload in law enforcement officers (LEO) using a multi-methodological approach. Fifty front-line LEO completed workload surveys on workdays for eight weeks. Retention and adherence were assessed across the survey period. LEO completed usability and likelihood to continue questionnaires, while departmental administrators (n = 8) received workload reports and completed utility and sustainability questionnaires. A subsample of LEO and administrators participated in semi-structured interviews, following consensual qualitative research design. LEO retention (96%), survey adherence (94%), and usability scores (88.3/100) were high, with a moderate likelihood to continue to use the survey. Administration reported high utility and sustainability. The high adherence rates and usability scores, coupled with strong administrative support, suggest that workload monitoring may be a feasible strategy among LEO to monitor occupational workloads. The LEO and administration feedback highlight areas of improvement (e.g., data transparency, departmental collaboration) to inform future implementation.

Association of Dynamic Knee Valgus and Bone Stress Injury in US Military Academy Cadets.

CONTEXT: Early identification of incoming military personnel at elevated odds for bone stress injury (BSI) is important for the health and readiness of the US military. DESIGN: Prospective cohort study. METHODS: Knee kinematic data of the incoming US Military Academy cadets were collected while performing a jump-landing task (The Landing Error Scoring System) using a markerless motion capture system and depth camera. Data on incidence of lower-extremity injury, including BSI, were collected throughout the study period. RESULTS: A total of 1905 participants (452 females, 23.7%) were examined for knee valgus and BSI status. A total of 50 BSI occurred during the study period (incidence proportion = 2.6%). The unadjusted odds ratio for BSI at initial contact was 1.03 (95% confidence interval [CI], 0.94-1.14; P = .49). Adjusted for sex, the odds ratio for BSI at initial contact was 0.97 (95% CI, 0.87-1.06; P = .47). At the instant of maximum knee-flexion angle, the unadjusted odds ratio was 1.06 (95% CI, 1.02-1.10; P = .01), and the odds ratio was 1.02 (95% CI, 0.98-1.07; P = .29) after adjusting for sex. This suggests that there was not a significant enough association for an increase in the odds of BSI based on either degree of knee valgus. CONCLUSIONS: Our results did not demonstrate an association between knee valgus angle data during a jump-landing task and future increased odds of BSI in a military training population. Further analysis is warranted, but the results suggests the association between kinematics and BSI cannot be effectively screened by knee valgus angle data in isolation.

Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement.

After an anterior cruciate ligament (ACL) injury, people need secondary prevention strategies to identify osteoarthritis at its earliest stages so that interventions can be implemented to halt or slow the progression toward its long-term burden. The Osteoarthritis Action Alliance formed an interdisciplinary Secondary Prevention Task Group to develop a consensus on recommendations to provide clinicians with secondary prevention strategies that are intended to reduce the risk of osteoarthritis after a person has an ACL injury. The group achieved consensus on 15 out of 16 recommendations that address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. We hope this statement raises awareness among clinicians and researchers on the importance of taking steps to mitigate the risk of osteoarthritis after an ACL injury.

Evidence Review for Preventing Osteoarthritis After an Anterior Cruciate Ligament Injury: An Osteoarthritis Action Alliance Consensus Statement.

CONTEXT: The Osteoarthritis Action Alliance formed a secondary prevention task group to develop a consensus on secondary prevention recommendations to reduce the risk of osteoarthritis after a knee injury. OBJECTIVE: Our goal was to provide clinicians with secondary prevention recommendations that are intended to reduce the risk of osteoarthritis after a person has sustained an anterior cruciate ligament injury. Specifically, this manuscript describes our methods, literature reviews, and dissenting opinions to elaborate on the rationale for our recommendations and to identify critical gaps. DESIGN: Consensus process. SETTING: Virtual video conference calls and online voting. PATIENTS OR OTHER PARTICIPANTS: The Secondary Prevention Task Group consisted of 29 members from various clinical backgrounds. MAIN OUTCOME MEASURE(S): The group initially convened online in August 2020 to discuss the target population, goals, and key topics. After a second call, the task group divided into 9 subgroups to draft the recommendations and supportive text for crucial content areas. Twenty-one members completed 2 rounds of voting and revising the recommendations and supportive text between February and April 2021. A virtual meeting was held to review the wording of the recommendations and obtain final votes. We defined consensus as >80% of voting members supporting a proposed recommendation. RESULTS: The group achieved consensus on 15 of 16 recommendations. The recommendations address patient education, exercise and rehabilitation, psychological skills training, graded-exposure therapy, cognitive-behavioral counseling (lacked consensus), outcomes to monitor, secondary injury prevention, system-level social support, leveraging technology, and coordinated care models. CONCLUSIONS: This consensus statement reflects information synthesized from an interdisciplinary group of experts based on the best available evidence from the literature or personal experience. We hope this document raises awareness among clinicians and researchers to take steps to mitigate the risk of osteoarthritis after an anterior cruciate ligament injury.

Impact Magnitude and Symmetry in Females During Return to Sport Tasks Measured With Inertial Sensors.

CONTEXT: Impact magnitude, such as peak tibial acceleration, may be associated with lower extremity injury risk and can be measured with an inertial sensor. An understanding of impact magnitude across functional tasks could guide clinicians in exercise prescription during rehabilitation of lower extremity injuries. OBJECTIVES: To determine (1) differences in impact magnitude based on task and (2) which tasks have asymmetrical impact magnitude based on limb dominance. DESIGN: Observational cohort design. Thirty-three healthy, recreationally active adult females participated in 1 testing session on a basketball court. METHODS: Participants wore inertial sensors with embedded accelerometers on bilateral distal shanks. Participants completed 9 plyometric, speed, and agility tasks commonly utilized during the return to sport phase of lower extremity rehabilitation. MAIN OUTCOME MEASURES: Average impact magnitude (peak tibial acceleration in multiples of gravity, g) for each limb for each task. ANALYSES: We used a repeated-measures analysis of variance (factor: task) to determine the differences in impact magnitude based on task. We categorized tasks by magnitude of impact into low, medium, high, and very high impact. We utilized paired t tests for each task to compare limbs (dominant vs nondominant). RESULTS: Impact magnitude differed based on task (P < .001). We classified tasks as low impact (≤10g; single-leg [SL] lateral jump, double-leg [DL] lateral jump); medium impact (11-20g; SL vertical jump, box drill); high impact (21-30g; modified T test, DL forward jump, SL forward jump); and very high impact (≥31g; sprint, DL tuck jump). Impact magnitude differed by limb in 3 tasks (DL forward jump, DL lateral jump, and box drill), with a higher impact on the dominant limb in each task. CONCLUSIONS: Impact magnitude differed based on task. While most tasks had symmetric impact magnitude between limbs, 3 tasks had a higher impact magnitude on the dominant limb.

Association of Traumatic Knee Injury With Radiographic Evidence of Knee Osteoarthritis in Military Officers.

OBJECTIVE: The association between knee injury and knee osteoarthritis (OA) is understudied relative to its importance, particularly in younger populations. This study was undertaken to examine the association of knee injury with radiographic features of knee OA in military officers, who have a physically demanding profession and high rates of knee injury. METHODS: Participants were recruited in 2015-2017 from an existing program that enrolled 6,452 military officers during 2004-2009. Officers with a history of knee ligament or meniscal injuries (n = 117 via medical record review) were compared to officers with no history of knee injury (n = 143). Bilateral posteroanterior knee radiographs were obtained using a standardized fixed-flexion positioning frame. All images were read for Kellgren/Lawrence (K/L) grade, osteophyte (OST), and joint space narrowing (JSN) scores. Data were analyzed using linear-risk regression models with generalized estimating equations. RESULTS: Injured and noninjured participants were similar (mean age 28 years, mean body mass index 25 kg/m2 , ~40% female). The mean time from first knee injury to imaging among injured participants was 9.2 years. Compared with noninjured knees, greater prevalence of radiographic OA (K/L grade ≥ 2), OST (grade ≥ 1), and JSN (grade ≥ 1) was observed among injured knees, with prevalence differences of +16% (95% confidence interval [95% CI] 10%, 22%), +29% (95% CI 20%, 38%), and + 17% (95% CI 10%, 24%), respectively. Approximately 1 in 6 officers with prior knee injury progressed to radiographic OA by age 30 years. CONCLUSION: At the midpoint of a projected 20-year military career, officers with a history of traumatic knee injury have a markedly increased prevalence of knee radiographic OA compared to officers without injury.

Mechanical and Sensorimotor Outcomes Associated With Talar Cartilage Deformation After Static Loading in Those With Chronic Ankle Instability.

CONTEXT: Those with chronic ankle instability (CAI) demonstrate deleterious changes in talar cartilage composition, resulting in alterations of talar cartilage loading behavior. Common impairments associated with CAI may play a role in cartilage behavior in response to mechanical loading. OBJECTIVE: To identify mechanical and sensorimotor outcomes that are linked with the magnitude of talar cartilage deformation after a static loading protocol in patients with and those without CAI. DESIGN: Cross-sectional study. SETTING: Laboratory setting. PATIENTS OR OTHER PARTICIPANTS: Thirty individuals with CAI and 30 healthy individuals. MAIN OUTCOME MEASURES(S): After a 60-minute off-loading period, ultrasonographic images of the talar cartilage were acquired immediately before and after a 2-minute static loading protocol (single-legged stance). Talar cartilage images were obtained and manually segmented to enable calculation of medial, lateral, and overall average talar thickness. The percentage change, relative to the average baseline thickness, was used for further analysis. Mechanical (ankle joint laxity) and sensorimotor (static balance and Star Excursion Balance Test) outcomes were captured. Partial correlations were computed to determine associations between cartilage deformation magnitude and the mechanical and sensorimotor outcomes after accounting for body weight. RESULTS: In the CAI group, greater inversion laxity was associated with greater overall (r = -0.42, P = .03) and medial (r = -0.48, P = .01) talar cartilage deformation after a 2-minute static loading protocol. Similarly, poorer medial-lateral static balance was linked with greater overall (r = 0.47, P = .01) and lateral (r = 0.50, P = .01) talar cartilage deformation. In the control group, shorter posterolateral Star Excursion Balance Test reach distance was associated with greater lateral cartilage deformation (r = 0.42, P = .03). No other significant associations were observed. CONCLUSIONS: In those with CAI, inversion laxity and poor static postural control were moderately associated with greater talar cartilage deformation after a 2-minute static loading protocol. These results suggest that targeting mechanical instability and poor balance in those with CAI via intervention strategies may improve how the talar cartilage responds to static loading conditions.

Association Between Head Impact Biomechanics and Physical Load in College Football.

Head impacts and physical exertion are ubiquitous in American football, but the relationship between these factors is poorly understood across a competitive season or even within an individual session. Gameplay characteristics, including player position and session type, may contribute to these relationships but have not been prospectively examined. The current study aimed to determine if an association exists between head impact biomechanics and physical load metrics. We prospectively studied college football players during the 2017-2021 football seasons across representative playing positions (15 offensive and defensive linemen, 11 linebackers and tight ends, and 15 defensive backs, running backs, and receivers). Participants wore halters embedded with Catapult Vector GPS monitoring systems to quantify player load and participant helmets were equipped with the Head Impact Telemetry System to quantify head impact biomechanics and repetitive head impact exposure (RHIE). Generalized linear models and linear regression models were employed to analyze in-session and season-long outcomes, while addressing factors such as player position and session type on our data. Player load was associated with RHIE (p < 0.001). Season-long player load predicted season-long RHIE (R2 = 0.31; p < 0.001). Position group affected in-session player load (p = 0.025). Both player load and RHIE were greater in games than in practices (p < 0.001), and position group did not affect RHIE (p = 0.343). Physical load burden was associated with RHIE within sessions and across an entire season. Session type affected both RHIE and player load, while position group only affected player load. Our data point to tracking physical load burden as a potential proxy for monitoring anticipated RHIE during the season.

Association Between Landing Error Scoring System (LESS) Items and the Incidence Rate of Lower Extremity Stress Fracture.

Background: Lower extremity stress fracture injuries are a major cause of morbidity in physically active populations. The ability to screen for modifiable risk factors associated with injury is critical in developing injury-prevention programs. Purpose: To determine if baseline Landing Error Scoring System (LESS) scores are associated with the incidence rate of lower extremity stress fracture. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 1772 participants with no history of lower extremity stress fracture were included. At preinjury baseline, the authors conducted a lower extremity movement assessment during a jump-landing task using the LESS. Incident lower extremity stress fractures were identified during a 4-year follow-up period. Potential incident cases were reviewed by 2 sports medicine fellowship-trained orthopaedic surgeons blinded to baseline LESS data. Univariate and multivariable Poisson regression models were used to estimate the association between baseline total LESS scores, individual LESS items, and the incidence rate ratio (IRR) of lower extremity stress fracture. Results: A total of 94 incident lower extremity stress fractures were documented, for a 5.3% (95% CI, 4.3%-6.5%) cumulative incidence. The overall LESS score was associated with the incidence rate of lower extremity stress fracture. For every additional movement error documented at baseline, there was a 15% increase in the incidence rate of lower extremity stress fracture (IRR, 1.15 [95% CI, 1.02-1.31]; P = .025). In univariate analyses, ankle flexion, stance width, asymmetrical landing, and trunk flexion at initial contact, in addition to overall impression, were associated with the incidence rate of stress fracture. After controlling for sex and year of entry into the study cohort, participants who consistently landed flat-footed or heel-to-toe were 2.33 times (95% CI, 1.36-3.97; P = .002) more likely to sustain a lower extremity stress fracture. Similarly, participants who consistently demonstrated asymmetric landing at initial contact were 2.53 times (95% CI, 1.34-4.74; P = .004) more likely to sustain a stress fracture. Conclusion: Components of the LESS may be associated with increased lower extremity stress fracture risk and may be helpful in efficiently assessing high-risk lower extremity biomechanics in large groups.

Dorsiflexion and Hop Biomechanics Associate with Greater Talar Cartilage Deformation in Those with Chronic Ankle Instability.

PURPOSE: This study aimed to identify associations between dorsiflexion range of motion (DFROM), functional hop test performance, and hopping biomechanics with the magnitude of talar cartilage deformation after a standardized hopping protocol in individuals with and without chronic ankle instability (CAI). METHODS: Thirty CAI and 30 healthy individuals participated. Ankle DFROM was assessed using the weight-bearing lunge test. Four different functional hop tests were assessed. Three-dimensional kinematics and kinetics were sampled during a 60-cm single-leg hop. We calculated cartilage deformation after a dynamic loading protocol consisting of sixty 60-cm single-leg forward hops by assessing the change in average thickness for the overall, medial, and lateral talar cartilage. Linear regressions examined the associations between cartilage deformation magnitude and DFROM, functional hop tests, and hop biomechanical variables after accounting for body weight and time since the initial ankle sprain. RESULTS: In CAI group, lesser static DFROM (ΔR2 = 0.22) and smaller peak ankle dorsiflexion angle (ΔR2 = 0.17) was associated with greater medial deformation. Greater peak vertical ground reaction force (vGRF) (ΔR2 = 0.26-0.28) was associated with greater medial and overall deformation. Greater vGRF loading rate (ΔR2 = 0.23-0.35) was associated with greater lateral and overall deformation. Greater side hop test times (ΔR2 = 0.31-0.36) and ankle plantarflexion at initial contact (ΔR2 = 0.23-0.38) were associated with greater medial, lateral, and overall deformation. In the control group, lesser side hop test times (ΔR2 = 0.14), greater crossover hop distances (ΔR2 = 0.14), and greater single-hop distances (ΔR2 = 0.21) were associated with greater overall deformation. CONCLUSIONS: Our results indicate that lesser static DFROM, poorer functional hop test performance, and hop biomechanics associate with greater talar cartilage deformation after a dynamic loading protocol in those with CAI. These factors may represent targets for therapeutic interventions within this population to slow ankle posttraumatic osteoarthritis progression.

Are Elite Collegiate Female Athletes PRIME for a Safe Return to Sport after ACLR? An Investigation of Physical Readiness and Integrated Movement Efficiency (PRIME).

Background: Elite female athletes who successfully return to sport after anterior cruciate ligament reconstruction (ACLR) represent a high-risk group for secondary injury. Little is known about how the functional profile of these athletes compares to their teammates who have not sustained ACL injuries. Purpose: To compare elite collegiate female athletes who were able to successfully return to sport for at least one season following ACLR to their teammates with no history of ACLR with regard to self-reported knee function, kinetics, and kinematics during a double limb jump-landing task. Study Design: Cross-Sectional Study. Level of Evidence: Level 3. Methods: Eighty-two female collegiate athletes (17 ACLR, 65 control) completed the knee-specific SANE (single assessment numeric evaluation) and three trials of a jump-landing task prior to their competitive season. vGRF data on each limb and the LESS (Landing Error Scoring System) score were collected from the jump-landing task. Knee-SANE, vGRF data, and LESS scores were compared between groups. All athletes were monitored for the duration of their competitive season for ACL injuries. Results: Athletes after ACLR reported worse knee-specific function. Based on vGRF data, they unloaded their involved limb during the impact phase of the landing, and they were more asymmetrical between limbs during the propulsion phase as compared to the control group. The ACLR group, however, had lower LESS scores, indicative of better movement quality. No athletes in either group sustained ACL injuries during the following season. Conclusion: Despite reporting worse knee function and demonstrating worse kinetics, the ACLR group demonstrated better movement quality relative to their uninjured teammates. This functional profile may correspond to short-term successful outcomes following ACLR, given that no athletes sustained ACL injuries in the competition season following assessment.

The validation of contemporary body composition methods in various races and ethnicities.

Few investigations have evaluated the validity of current body composition technology among racially and ethnically diverse populations. This study assessed the validity of common body composition methods in a multi-ethnic sample stratified by race and ethnicity. One hundred and ten individuals (55 % female, age: 26·5 (sd 6·9) years) identifying as Asian, African American/Black, Caucasian/White, Hispanic, Multi-racial and Native American were enrolled. Seven body composition models (dual-energy X-ray absorptiometry (DXA), air displacement plethysmography (ADP), two bioelectrical impedance devices (BIS, IB) and three multi-compartment models) were evaluated against a four-compartment criterion model by assessing total error (TE) and standard error of the estimate. For the total sample, measures of % fat and fat-free mass (FFM) from multi-compartment models were all excellent to ideal (% fat: TE = 0·94-2·37 %; FFM: TE = 0·72-1·78 kg) compared with the criterion. % fat measures were very good to excellent for DXA, ADP and IB (TE = 2·52-2·89 %) and fairly good for BIS (TE = 4·12 %). For FFM, single device estimates were good (BIS; TE = 3·12 kg) to ideal (DXA, ADP, IB; TE = 1·21-2·15 kg). Results did not vary meaningfully between each race and ethnicity, except BIS was not valid for African American/Black, Caucasian/White and Multi-racial participants for % fat (TE = 4·3-4·9 %). The multi-compartment models evaluated can be utilised in a multi-ethnic sample and in each individual race and ethnicity to obtain highly valid results for % fat and FFM. Estimates from DXA, ADP and IB were also valid. The BIS may demonstrate greater TE for all racial and ethnic cohorts and results should be interpreted cautiously.

Automated Landing Error Scoring System Performance and the Risk of Bone Stress Injury in Military Trainees.

CONTEXT: Lower extremity bone stress injuries (BSIs) place a significant burden on the health and readiness of the US Armed Forces. OBJECTIVE: To determine if preinjury baseline performance on an expanded and automated 22-item version of the Landing Error Scoring System (LESS-22) was associated with the incidence of BSIs in a military training population. DESIGN: Prospective cohort study. SETTING: US Military Academy at West Point, NY. PATIENTS OR OTHER PARTICIPANTS: A total of 2235 incoming cadets (510 females [22.8%]). MAIN OUTCOME MEASURE(S): Multivariable Poisson regression models were used to produce adjusted incidence rate ratios (IRRs) to quantify the association between preinjury LESS scores and BSI incidence rate during follow-up and were adjusted for pertinent risk factors. Risk factors were included as covariates in the final model if the 95% CI for the crude IRR did not contain 1.00. RESULTS: A total of 54 BSIs occurred during the study period, resulting in an overall incidence rate of 0.07 BSI per 1000 person-days (95% CI = 0.05, 0.09). The mean number of exposure days was 345.4 ± 61.12 (range = 3-368 days). The final model was adjusted for sex and body mass index and yielded an adjusted IRR for a LESS-22 score of 1.06 (95% CI = 1.002, 1.13; P = .04), indicating that each additional LESS error documented at baseline was associated with a 6.0% increase in the incidence rate of BSI during the follow-up period. In addition, 6 individual LESS-22 items, including 2 newly added items, were significantly associated with the BSI incidence. CONCLUSIONS: We provided evidence that performance on the expanded and automated version of the LESS was associated with the BSI incidence in a military training population. The automated LESS-22 may be a scalable solution for screening military training populations for BSI risk.

Examining the Dynamic Nature of Anterior Cruciate Ligament Injury Risk Factors in Women's Collegiate Soccer.

CONTEXT: Anterior cruciate ligament (ACL) injuries are a common and devastating injury in women's soccer. Several risk factors for ACL injury have been identified, but have not yet been examined as potentially dynamic risk factors, which may change throughout a collegiate soccer season. DESIGN: Prospective cohort study. METHODS: Nine common clinical screening assessments for ACL injury risk, consisting of range of motion, movement quality, and power, were assessed in 29 Division I collegiate women's soccer players. Preseason and midseason values were compared for significant differences. Change scores for each risk factor were also correlated with cumulative training loads during the first 10 weeks of a competitive soccer season. RESULTS: Hip external rotation range of motion and power had statistically significant and meaningful differences at midseason compared with preseason, indicating they are dynamic risk factors. There were no significant associations between the observed risk factor changes and cumulative training load. CONCLUSIONS: Hip external rotation range of motion and power are dynamic risk factors for ACL injury in women's collegiate soccer athletes. Serial screening of these risk factors may elucidate stronger associations with injury risk and improve prognostic accuracy of screening tools.

Think outside the box: Incorporating secondary cognitive tasks into return to sport testing after ACL reconstruction.

The optimal set of return to sport (RTS) tests after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) remains elusive. Many athletes fail to pass current RTS test batteries, fail to RTS, or sustain secondary ACL injuries if they do RTS. The purpose of this review is to summarize current literature regarding functional RTS testing after ACLR and to encourage clinicians to have patients "think" (add a secondary cognitive task) outside the "box" (in reference to the box used during the drop vertical jump task) when performing functional RTS tests. We review important criteria for functional tests in RTS testing, including task-specificity and measurability. Firstly, tests should replicate the sport-specific demands the athlete will encounter when they RTS. Many ACL injuries occur when the athlete is performing a dual cognitive-motor task (e.g., attending to an opponent while performing a cutting maneuver). However, most functional RTS tests do not incorporate a secondary cognitive load. Secondly, tests should be measurable, both through the athlete's ability to complete the task safely (through biomechanical analyses) and efficiently (through measures of performance). We highlight and critically examine three examples of functional tests that are commonly used for RTS testing: the drop vertical jump, single-leg hop tests, and cutting tasks. We discuss how biomechanics and performance can be measured during these tasks, including the relationship these variables may have with injury. We then discuss how cognitive demands can be added to these tasks, and how these demands influence both biomechanics and performance. Lastly, we provide clinicians with practical recommendations on how to implement secondary cognitive tasks into functional testing and how to assess athletes' biomechanics and performance.

Understanding Youth Sport Coaches' Perceptions of Evidence-Based Injury-Prevention Training Programs: A Systematic Literature Review.

OBJECTIVE: To systematically review and summarize the knowledge, attitudes, beliefs, and contextual perceptions of youth sport coaches toward injury-prevention training programs by using the Theoretical Domains Framework to guide the organization of results. DATA SOURCES: Systematic searches of PubMed and Google Scholar were undertaken in November 2021. STUDY SELECTION: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was followed. Results were limited to full-text articles that were published in peer-reviewed journals and printed in English. Additional studies were added after a citation search of included studies. Studies were eligible for inclusion if researchers evaluated youth sport coaches' knowledge, beliefs, contextual perceptions, or all 3 of anterior cruciate ligament injury-prevention training programs. DATA EXTRACTION: Data charting was performed by 1 author and confirmed by a separate author. DATA SYNTHESIS: Of the 1194 articles identified, 19 were included in the final sample. Among articles in which researchers assessed knowledge (n = 19), coaches' awareness of the existence and components of injury-prevention training programs was inconsistent. Among articles in which researchers assessed beliefs (n = 19), many coaches had positive attitudes toward injury-prevention training programs, but few believed youth athletes are at a high risk of injury. Among articles in which researchers assessed contextual perceptions (n = 13), many coaches did not feel they had access to information about injury-prevention training programs and cited a lack of time, space, support, and other resources as barriers to implementation. CONCLUSIONS: Our findings support the need for programs, protocols, and policies to enhance knowledge of and support for youth sport coaches who wish to implement injury-prevention training programs. A gap exists in the research about addressing the needs of youth sport coaches in the United States high school sports setting. The use of multilevel implementation science frameworks (such as the Theoretical Domains Framework) will be beneficial for identifying constructs that affect implementation and developing train-the-trainer programming to meet the needs of individual youth sport coaches.

Lower Extremity Musculoskeletal Injury in US Military Academy Cadet Basic Training: A Survival Analysis Evaluating Sex, History of Injury, and Body Mass Index.

BACKGROUND: Injury incidence for physically active populations with a high volume of physical load can exceed 79%. There is little existing research focused on timing of injury and how that timing differs based on certain risk factors. PURPOSE/HYPOTHESIS: The purpose of this study was to report both the incidence and timing of lower extremity injuries during cadet basic training. We hypothesized that women, those with a history of injury, and those in underweight and obese body mass index (BMI) categories would sustain lower extremity musculoskeletal injury earlier in the training period than men, those without injury history, and those in the normal-weight BMI category. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Cadets from the class of 2022, arriving in 2018, served as the study population. Baseline information on sex and injury history was collected via questionnaire, and BMI was calculated from height and weight taken during week 1 at the United States Military Academy. Categories were underweight (BMI <20), middleweight (20-29.99), and obese (≥30). Injury surveillance was performed over the first 60 days of training via electronic medical record review and monitoring. Kaplan-Meier survival curves were used to estimate group differences in time to the first musculoskeletal injury. Cox proportional hazard regression was used to estimate hazard ratios (HRs). RESULTS: A total of 595 cadets participated. The cohort was 76.8% male, with 29.9% reporting previous injury history and 93.3% having a BMI between 20 and 30. Overall, 16.3% of cadets (12.3% of male cadets and 29.7% of female cadets) experienced an injury during the follow-up period. Women experienced significantly greater incident injury than did men (P < .001). Separation of survival curves comparing the sexes and injury history occurred at weeks 3 and 4, respectively. Hazards for first musculoskeletal injury were significantly greater for women versus men (HR, 2.63; 95% CI, 1.76-3.94) and for those who reported a history of injury versus no injury history (HR, 1.76; 95% CI, 1.18-2.64). No differences were observed between BMI categories. CONCLUSION: Female cadets and those reporting previous musculoskeletal injury demonstrated a greater hazard of musculoskeletal injury during cadet basic training. This study did not observe an association between BMI and injury.