scholarly journals RELIABILITY OF A NEW LANDING ERROR SCORING SYSTEM: THE LESS-RMC

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0009
Author(s):  
Ryan S. Wexler ◽  
Sean Higinbotham ◽  
Danny Blake ◽  
Carlie Harrison ◽  
Justin Hollenbeck ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Scoring System ◽  
Injury Risk ◽  
Knee Injury ◽  
Assessment Tool ◽  
Acl Injury ◽  
Knee Valgus ◽  
Jump Landing ◽  
Acl Injury Risk ◽  
The Mean

BACKGROUND Several biomechanical deficits have been shown to increase non-contact knee injury risk of the anterior cruciate ligament (ACL). The Landing Error Scoring System (LESS) is a clinical assessment tool that has been successfully used to predict the individuals that are at a high risk for injury and evaluate changes in landing technique after participation in a neuromuscular preventive training program. The LESS-RT is a shortened version of the LESS and is a method to score landing technique without the use of video. The current study proposes a new tool for the evaluation of landing technique and ACL injury risk that blends the LESS and LESS-RT protocols but emphasizes the movement features that contribute to high knee valgus moments including movement asymmetry. The LESS-RMC (Rocky Mountain Consortium) consists of evaluating 11 comprehensive landing errors that are related to ACL injury risk. Consolidating questions pertaining to the opposite ends of joint motion such as “toe in” and “toe out” into “maximum foot rotation position” and adding a global asymmetry score were performed to reduce the time demands for evaluation yet capture the salient factors of the LESS; whereas the penalty for knee valgus severity was pulled from the LESS-RT but implemented for both knees in the new LESS-RMC to ultimately stratify knee injury risk during the jump landing task. The purpose of this study was to determine the reliability of the new LESS-RMC assessment tool. METHODS Thirty-seven, elite female soccer athletes (13.2 +/- 0.4 y) performed three drop-jumps from a height of 30 cm. Front and side views of the landing were recorded with digital video cameras. Movement quality was rated by 4 researchers evaluating 17 components of the landing with the LESS and a modified, 11 component version of the LESS (LESS-RMC). The 4 raters were novel to the evaluation of both scoring systems. Each rater was trained how to score each test and was instructed to evaluate the landing trials from the first 10 participants. After a group video review and discussion, the raters repeated the scoring procedures for the same 10 participants 48 hours after the original review. After another 48 hours, the raters evaluated the landing trials for all 37 participants (111 trials). Inter-rater reliability of the LESS and LESS-RMC were determined using the ICC (3,1) equations and the output from a two-way ANOVA (SPSS, version 25). RESULTS The mean LESS score was 6.45 +/- 0.55 (rater 1, 6.42; rater 2, 7.15; rater 3, 5.79; rater 4, 6.45). The ICC agreement between raters of scoring the LESS was .389 whereas the ICC agreement for the mean of the four raters was .718. The ICC for scoring consistency was .382 and Cronbach’s a was .735. The mean LESS-RMC score was 6.19 +/- 0.74 (rater 1, 5.65; rater 2, 6.99; rater 3, 5.48; rater 4, 6.64). The ICC agreement of scoring the LESS-RMC was .585 whereas the ICC agreement for the mean of the four raters was .849. The ICC for scoring consistency was .574 and Cronbach’s a was .884. CONCLUSION On average, the raters scored the LESS and the LESS-RMC with moderate reliability across the group of athletes. The LESS-RMC was scored with greater reliability than the LESS for this group of relatively novice raters. This is likely due to the simplification of the overall protocol in terms of quantity of questions, the ability of a novel rater to understand scenarios which elicit specific scores and the clear separation of body segments (e.g. hip and trunk flexion). In conjunction with this, it was reported by the raters that LESS-RMC was less redundant and more effective at assessing crucial aspects of a jump landing pattern. Overall, LESS RMC was objectively and subjectively more reliable and easier to use than the LESS for the four raters involved in this study. It is concluded that the LESS-RMC is a quick, easy and reliable clinical assessment tool that may be used to stratify individuals who may be at risk for ACL injury.

Optimizing Whole-Body Kinematics During Single-Leg Jump Landing to Reduce Peak Abduction/Adduction and Internal Rotation Knee Moments: Implications for Anterior Cruciate Ligament Injury Risk

2021 ◽  
pp. 1-8
Author(s):  
Dhruv Gupta ◽  
Jeffrey A. Reinbolt ◽  
Cyril J. Donnelly
Keyword(s):  
Internal Rotation ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Whole Body ◽  
Jump Landing ◽  
Peak Knee ◽  
Knee Abduction ◽  
Acl Injury Risk ◽  
Anterior Cruciate

Knee abduction/adduction moment and knee internal rotation moment are known surrogate measures of anterior cruciate ligament (ACL) load during tasks like sidestepping and single-leg landing. Previous experimental literature has shown that a variety of kinematic strategies are associated or correlated with ACL injury risk; however, the optimal kinematic strategies needed to reduce peak knee moments and ACL injury are not well understood. To understand the complex, multifaceted kinematic factors underpinning ACL injury risk and to optimize kinematics to prevent the ACL injury, a musculoskeletal modeling and simulation experimental design was used. A 14-segment, 37-degree-of-freedom, dynamically consistent skeletal model driven by force/torque actuators was used to simulate whole-body single-leg jump landing kinematics. Using the residual reduction algorithm in OpenSim, whole-body kinematics were optimized to reduce the peak knee abduction/adduction and internal/external rotation moments simultaneously. This optimization was repeated across 30 single-leg jump landing trials from 10 participants. The general optimal kinematic strategy was to bring the knee to a more neutral alignment in the transverse plane and frontal plane (featured by reduced hip adduction angle and increased knee adduction angle). This optimized whole-body kinematic strategy significantly reduced the peak knee abduction/adduction and internal rotation moments, transferring most of the knee load to the hip.

Preliminary Evaluation of Knee Kinetics in Female Athletes on Hormonal Contraceptives

2019 ◽  
Vol 41 (02) ◽  
pp. 113-118
Author(s):  
Gabrielle Gilmer ◽  
Gretchen D. Oliver
Keyword(s):  
Injury Risk ◽  
Female Athletes ◽  
Cruciate Ligament ◽  
Reaction Force ◽  
Acl Injury ◽  
Hormonal Contraceptives ◽  
Preliminary Evaluation ◽  
Knee Valgus ◽  
Time Points ◽  
Acl Injury Risk

AbstractRecently, an emphasis has been placed on understanding how ovarian sex hormones and hormonal contraceptives affect risk for anterior cruciate ligament (ACL) injury. The literature presents large discrepancies in whether or not hormonal contraceptives affect ACL injury risk; therefore, the purpose of this study was to evaluate whether vertical ground reaction force (GRF) and knee valgus force are different between athletes who do and do not use hormonal contraceptives. Twenty-two female athletes volunteered to participate and were divided into two groups based on their answers to a health history questionnaire: those who use hormonal contraceptives and those who do not. Participants performed a drop vertical jump (DVJ) and single leg crossover dropdown (SCD) at two different time points in their menstrual cycle (pre-ovulatory phase and mid-luteal phase). Kinetic data were collected at 1000 Hz. Independent samples t-tests revealed no significant differences between groups in vertical GRF and knee valgus force at both time points. Findings from this study suggest that hormonal contraceptives do not elicit detectable changes in vertical GRF and knee valgus force. Ultimately, this calls for further studies on the relationship between hormones and ACL injury risk and physicians to consider hormonal screening in addition to neuromuscular and biomechanical screening.

Clinical Assessment of Drop-Jump Landing for Determination of Risk for Knee Injury

2013 ◽  
Vol 18 (3) ◽  
pp. 10-13 ◽  
Author(s):  
Nelson Cortes ◽  
James Onate
Keyword(s):  
Clinical Assessment ◽  
Injury Risk ◽  
Knee Injury ◽  
Collegiate Athletes ◽  
Assessment Tools ◽  
Ligament Injury ◽  
Drop Jump ◽  
Jump Landing ◽  
Level Of Agreement

Context:Clinical assessment tools are needed to identify individual athletes who possess elevated risk for anterior cruciate ligament injury. Existing methods require expensive equipment and the investment of a large amount of time for data processing, which makes them unfeasible for preparticipation screening of a large number of athletes.Objective:To assess the extent of agreement between LESS and the iLESS classifications of jump landing performance and the level of agreement between ratings assigned by a novice evaluator and an expert evaluator.Methods:Ratings of drop-jump landings from 20 video recordings of NCAA Division I collegiate athletes, which were randomly selected from a large database.Results:The dichotomous iLESS score corresponded to the dichotomous classification of LESS score for 15 of 20 cases rated by the expert evaluator and 17 of 20 cases rated by the novice evaluator. For the iLESS, only 2 scores out of 20 differed between the evaluators.Conclusions:A high level of agreement was observed between the LESS and iLESS methods for classification of jump- landing performance. Because the iLESS method is inexpensive and efficient, it may prove to be valuable for preparticipation assessment of knee injury risk.

scholarly journals The Effect of a Knee-ankle Restraint on ACL Injury Risk Reduction during Jump-landing

2013 ◽  
Vol 60 ◽  
pp. 300-306
Author(s):  
Phillis S.P. Teng ◽  
K.F. Leong ◽  
P.Y. Huang ◽  
J. McLaren
Keyword(s):  
Risk Reduction ◽  
Injury Risk ◽  
Acl Injury ◽  
Jump Landing ◽  
Acl Injury Risk

scholarly journals CAN A WEARABLE NEUROMUSCUAR DEVICE REPLACE NEUROMUSCULAR TRAINING PROGRAMS?

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0012
Author(s):  
Sean Higinbotham ◽  
Ryan S. Wexler ◽  
Danny Blake ◽  
Carlie Harrison ◽  
Justin Hollenbeck ◽  
...  
Keyword(s):  
Injury Risk ◽  
Acl Injury ◽  
Young Female ◽  
Risk Scores ◽  
Neuromuscular Training ◽  
Video Cameras ◽  
Jump Landing ◽  
Post Test ◽  
Acl Injury Risk ◽  
Factor Difference

Background: Scientific studies have shown female soccer athletes to be 3 times more likely to injure their anterior cruciate ligament (ACL) than their male counterparts and the majority of these injuries are from a non-contact mechanism. The biomechanical factors of this phenomenon have been extensively studied in a laboratory-based setting, but there has been little progress in reducing the incidence of ACL injury in young female athletes. It is plausible, therefore, to suggest that the biomechanical improvements noted in a laboratory-based setting do not directly translate to a field-based setting. Preventive neuromuscular training programs are typically field-based and have been shown to be an effective intervention for reducing ACL injury risk by improving dynamic, frontal-plane knee stability. However, these programs are time consuming and prone to compliance and implementation issues. For these reasons, researchers have attempted to identify the minimum viable training program or wearable device that can be studied in the field using video cameras to determine their influence on movement-related risk factors for ACL injury. Purpose: The aim of this study was to evaluate the effectiveness of a wearable neuromuscular device (WND) with or without the addition of a field-based, preventive neuromuscular training program on jump-landing risk assessment in young female soccer athletes. Methods: Thirty-nine female soccer players (161.0 +/- 6.6 cm; 49.4 kg +/- 5.9; 13.3 +/- 0.5 y) from two different teams in a local soccer club volunteered to participate in this study. Team 1 (n = 25) performed a 6-week, field-based NMT program while wearing a WND. The NMT was instructed by a trained exercise specialist. The NMT program was divided into three, two-week blocks of progressively increasing levels of exercise complexity and intensity focused on improving the strength and activation behavior of the trunk, hip and thigh muscles. Field-based movement testing was performed in the first week before training began (pre-test) and in the seventh week upon completion of the NMT program (post-test). During testing video cameras recorded a jump-landing task in the frontal and sagittal planes. The Landing Error Scoring System (LESS) and a novel version of the LESS (LESS-RMC) was used to asses movement quality related to ACL injury risk. Team 2 (n=14) wore the WND for an equal amount of athletic exposures over 7 weeks but did not perform the NMT program. Four different raters were recruited to visually score all jump landing trials using the two different rating protocols during the pre-test and post-test. For each visual assessment (LESS & LESS-RMC) a repeated measures ANOVA was conducted to explore within group (test) and between group (team) differences. Results: Repeated measure ANOVA results for the LESS score scale indicated a significant within factor difference in pretest and post test scores F(7.398, 27.533) = 8.598, P < 0.05. Pretest scores for team 1 (6.18 +/- 1.68) and team 2 (6.95 +/- 0.94) both saw a significant reduction in ACL risk scores to 5.44 +/- 1.70 and 6.31 +/- 1.75, respectively. ANOVA results for the LESS-RMC scale also indicated a significant within factor difference in pretest and posttests F(6.756, 35.624) = 6.069, p < 0.05. Pretest scores for Team 1 (6.02 +/- 1.99) and Team 2 (6.49 +/- 1.33) both saw a significant reduction in ACL risk scores to 5.10 +/- 1.77 and 6.09 +/- 1.50, respectively. ANOVA results revealed no significant differences between team scores for the LESS (F(0.031,27.533) = 0.036, p > 0.05) or LESS-RMC (F(1.053,35.624) = .946, p > 0.05) scales. Conclusion: The results reveal that the NMT program utilized in this study had no statistically significant additive effect on the visual risk assessment scores for Team 1 compared to Team 2, who had no NMT intervention and only wore the WND. Collectively, these results suggest that simply wearing a WND during 6 weeks of practice may be a less evasive and cheaper alternative to a NMT program.

scholarly journals Expert Versus Novice Interrater Reliability and Criterion Validity of the Landing Error Scoring System

2010 ◽  
Vol 19 (1) ◽  
pp. 41-56 ◽  
Author(s):  
James Onate ◽  
Nelson Cortes ◽  
Cailee Welch ◽  
Bonnie Van Lunen
Keyword(s):  
Range Of Motion ◽  
Scoring System ◽  
Knee Flexion ◽  
Interrater Reliability ◽  
Assessment Tool ◽  
Outcome Measurement ◽  
Acl Injury ◽  
Initial Contact ◽  
Knee Valgus ◽  
Trunk Flexion

Context:A clinical assessment tool that would allow for efficient large-group screening is needed to identify individuals potentially at risk for anterior cruciate ligament (ACL) injury.Objective:To assess the criterion validity of a jumplanding assessment tool compared with 3-dimensional (3D) motion analysis and evaluate interrater reliability across an expert vs novice rater using the Landing Error Scoring System (LESS).Design:Validity protocol.Setting:Controlled, laboratory.Participants:Nineteen female (age 19.58 ± .84 y, height 1.67 ± .05 m, mass 63.66 ± 10.11 kg) college soccer athletes volunteered.Main Outcome Measurement:Interrater reliability between expert rater (5 y LESS experience) vs novice rater (no LESS experience). LESS scores across 13 items and total score. 3D lower extremity kinematics were reduced to dichotomous values to match LESS items.Interventions:Participants performed drop-box landings from a 30-cm height with standard video-camera and 3D kinematic assessment.Results:Intrarater item reliability, assessed by kappa correlation, between novice and experienced LESS raters ranged from moderate to excellent (κ = .459–.875). Overall LESS score, assessed by intraclass correlation coefficient, was excellent (ICC2,1 = .835, P < .001). Statistically significant phi correlation (P < .05) was found between rater and 3D scores for knee-valgus range of motion; however, percent agreement between expert rater and 3D scores revealed excellent agreement (range of 84–100%) for ankle flexion at initial contact, knee-flexion range of motion, trunk flexion at maximum knee flexion, and foot position at initial contact for both external and internal rotation of tibia. Moderate agreement was found between rater and 3D scores for trunk flexion at initial contact, stance width less than shoulder width, knee valgus at initial contact, and knee-valgus range of motion.Conclusions:Our findings support moderate to excellent validity and excellent expert vs novice interrater reliability of the LESS to accurately assess 3D kinematic motion patterns. Future research should evaluate the efficacy of the LESS to assess individuals at risk for ACL injury.

The Landing Error Scoring System (LESS) Is a Valid and Reliable Clinical Assessment Tool of Jump-Landing Biomechanics

2009 ◽  
Vol 37 (10) ◽  
pp. 1996-2002 ◽  
Author(s):  
Darin A. Padua ◽  
Stephen W. Marshall ◽  
Michelle C. Boling ◽  
Charles A. Thigpen ◽  
William E. Garrett ◽  
...  
Keyword(s):  
Clinical Assessment ◽  
Scoring System ◽  
Assessment Tool ◽  
Jump Landing ◽  
Landing Biomechanics

scholarly journals Reliability of the Landing Error Scoring System-Real Time, a Clinical Assessment Tool of Jump-Landing Biomechanics

2011 ◽  
Vol 20 (2) ◽  
pp. 145-156 ◽  
Author(s):  
Darin A. Padua ◽  
Michelle C. Boling ◽  
Lindsay J. DiStefano ◽  
James A. Onate ◽  
Anthony I. Beutler ◽  
...  
Keyword(s):  
At Risk ◽  
Lower Extremity ◽  
Real Time ◽  
Clinical Assessment ◽  
Scoring System ◽  
Interrater Reliability ◽  
Assessment Tool ◽  
Lower Extremity Injuries ◽  
Jump Landing ◽  
Extremity Injuries

Context:There is a need for reliable clinical assessment tools that can be used to identify individuals who may be at risk for injury. The Landing Error Scoring System (LESS) is a reliable and valid clinical assessment tool that was developed to identify individuals at risk for lower extremity injuries. One limitation of this tool is that it cannot be assessed in real time and requires the use of video cameras.Objective:To determine the interrater reliability of a real-time version of the LESS, the LESS-RT.Design:Reliability study.Setting:Controlled research laboratory.Participants:43 healthy volunteers (24 women, 19 men) between the ages of 18 and 23.Intervention:The LESS-RT evaluates 10 jump-landing characteristics that may predispose an individual to lower extremity injuries. Two sets of raters used the LESS-RT to evaluate participants as they performed 4 trials of a jump-landing task.Main Outcome Measures:Intraclass correlation coefficient (ICC2,1) values for the final composite score of the LESS-RT were calculated to assess interrater reliability of the LESS-RT.Results:Interrater reliability (ICC2,1) for the LESS-RT ranged from .72 to .81 with standard error of measurements ranging from .69 to .79.Conclusions:The LESS-RT is a quick, easy, and reliable clinical assessment tool that may be used by clinicians to identify individuals who may be at risk for lower extremity injuries.

Sign in / Sign up

Export Citation Format

Share Document