Clinical correlates to laboratory measures for use in non-contact anterior cruciate ligament injury risk prediction algorithm

Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
Clinical biomechanics (Bristol, Avon) (Impact Factor: 1.97). 08/2010; 25(7):693-9. DOI: 10.1016/j.clinbiomech.2010.04.016
Source: PubMed


Prospective measures of high knee abduction moment during landing identify female athletes at high risk for non-contact anterior cruciate ligament injury. Biomechanical laboratory measurements predict high knee abduction moment landing mechanics with high sensitivity (85%) and specificity (93%). The purpose of this study was to identify correlates to laboratory-based predictors of high knee abduction moment for use in a clinic-based anterior cruciate ligament injury risk prediction algorithm. The hypothesis was that clinically obtainable correlates derived from the highly predictive laboratory-based models would demonstrate high accuracy to determine high knee abduction moment status.
Female basketball and soccer players (N=744) were tested for anthropometrics, strength and landing biomechanics. Pearson correlation was used to identify clinically feasible correlates and logistic regression to obtain optimal models for high knee abduction moment prediction.
Clinical correlates to laboratory-based measures were identified and predicted high knee abduction moment status with 73% sensitivity and 70% specificity. The clinic-based prediction algorithm, including (Odds Ratio: 95% confidence interval) knee valgus motion (1.43:1.30-1.59 cm), knee flexion range of motion (0.98:0.96-1.01 degrees ), body mass (1.04:1.02-1.06 kg), tibia length (1.38:1.25-1.52 cm) and quadriceps to hamstring ratio (1.70:1.06-2.70) predicted high knee abduction moment status with C statistic 0.81.
The combined correlates of increased knee valgus motion, knee flexion range of motion, body mass, tibia length and quadriceps to hamstrings ratio predict high knee abduction moment status in female athletes with high sensitivity and specificity.
Utilization of clinically obtainable correlates with the prediction algorithm facilitates high non-contact anterior cruciate ligament injury risk athletes' entry into appropriate interventions with the greatest potential to prevent injury.

Download full-text


Available from: Paul Succop
  • Source
    • "Despite the different ages seen between the two sports, we do not believe this would have affected our results. All athletes tested were over 16 years of age and would therefore be classed as late or postpubertal by which time any changes in landing strategies normally seen during maturation would already have taken place (Ford, Shapiro, Myer, Van den Bogert, & Hewett, 2010; Hewett et al., 2004). As a result we do not feel that the differences in age or anthropometrics in the current study would affect dynamic knee valgus values observed. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate landing strategies of female football and basketball athletes with relation to possible injury mechanisms and disparity in injury. Descriptive laboratory study. 52 female football players and 41 female basketball players. Frontal plane projection angle (FPPA) was measured during the single leg land (SLL) and drop jump (DJ) screening tasks. 2 × 2 × 2 mixed factorial ANOVA showed significant main effects were observed for sport, whilst significant interaction effects were seen between sport and task. Females in both sports exhibited significantly greater FPPA values during the SLL task than the DJ task (p < 0.001). Basketball players demonstrated significantly greater FPPA values during SLL than football players (p < 0.001), whilst no differences were found between sports in the DJ task (p = 0.328). Female basketball players display greater FPPA values during unilateral landing tasks than female football players which may reflect the greater ACL injury occurrence in this population. Injury prevention programs in these athletes should incorporate unilateral deceleration and landing tasks and should consider the specific injury mechanisms in each sport.
    Full-text · Article · Nov 2012 · Physical therapy in sport: official journal of the Association of Chartered Physiotherapists in Sports Medicine
  • Source
    • "While recent efforts to integrate laboratory-based findings into injury prevention studies are being made [37-39], the explicit integration of theoretical study insights remains sparse. Unlike laboratory-based studies, theoretical investigations can provide explicit information on the magnitude of impact loading change that may be incurred by systematic changes to a regulatory loading mechanism. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Gymnasts are exposed to a high incidence of impact landings due to the execution of repeated dismount performances. Biomechanical research can help inform recent discussions surrounding a proposed rule change in potentially injurious gymnastic dismounting. The review examines existing understanding of the mechanisms influencing the impact loads incurred in gymnastic-style landings achieved using biomechanical approaches. Laboratory-based and theoretical modelling research of inherent and regulatory mechanisms is appraised. The integration of the existing insights into injury prevention interventions studies is further considered in the appraisals. While laboratory-based studies have traditionally been favoured, the difficulty in controlling and isolating mechanisms of interest has partially restricted the understanding gained. An increase in the use of theoretical approaches has been evident over the past two decades, which has successfully enhanced insight into less readily modified mechanisms. For example, the important contribution of mass compositions and 'tuned' mass coupling responses to impact loading has been evidenced. While theoretical studies have advanced knowledge in impact landing mechanics, restrictions in the availability of laboratory-based input data have suppressed the benefits gained. The advantages of integrating laboratory-based and theoretical approaches in furthering scientific understanding of loading mechanisms have been recognised in the literature. Since a multi-mechanism contribution to impact loading has been evident, a deviation away from studies examining isolated mechanisms may be supported for the future. A further scientific understanding of the use of regulatory mechanisms in alleviating a performer's inherent injury predisposition may subsequently be gained and used to inform potential rule changes in gymnastics. While the use of controlled studies for providing scientific evidence for the effectiveness of gymnastics injury counter measures has been advocated over the past decade, a lack of information based on randomised controlled studies or actual evaluation of counter measures in the field setting has been highlighted. The subsequent integration of insight into biomechanical risk factors of landing with clinical practice interventions has been recently advocated.
    Full-text · Article · Jan 2012 · Sports Medicine Arthroscopy Rehabilitation Therapy & Technology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Context: Accurate, efficient, and reliable measurement methods are essential to prospectively identify risk factors for knee injuries in large cohorts. Objective: To determine tester reliability using digital photographs for the measurement of static lower extremity alignment (LEA) and whether values quantified with an electromagnetic motion-tracking system are in agreement with those quantified with clinical methods and digital photographs. Design: Descriptive laboratory study. Setting: Laboratory. Patients or Other Participants: Thirty-three individuals participated and included 17 (10 women, 7 men; age = 21.7 ± 2.7 years, height = 163.4 ± 6.4 cm, mass = 59.7 ± 7.8 kg, body mass index = 23.7 ± 2.6 kg/m(2)) in study 1, in which we examined the reliability between clinical measures and digital photographs in 1 trained and 1 novice investigator, and 16 (11 women, 5 men; age = 22.3 ± 1.6 years, height = 170.3 ± 6.9 cm, mass = 72.9 ± 16.4 kg, body mass index = 25.2 ± 5.4 kg/m(2)) in study 2, in which we examined the agreement among clinical measures, digital photographs, and an electromagnetic tracking system. Intervention(s): We evaluated measures of pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length, and tibia length. Clinical measures were assessed using clinically accepted methods. Frontal- and sagittal-plane digital images were captured and imported into a computer software program. Anatomic landmarks were digitized using an electromagnetic tracking system to calculate static LEA. Main Outcome Measure(s): Intraclass correlation coefficients and standard errors of measurement were calculated to examine tester reliability. We calculated 95% limits of agreement and used Bland-Altman plots to examine agreement among clinical measures, digital photographs, and an electromagnetic tracking system. Results: Using digital photographs, fair to excellent intratester (intraclass correlation coefficient range = 0.70-0.99) and intertester (intraclass correlation coefficient range = 0.75-0.97) reliability were observed for static knee alignment and limb-length measures. An acceptable level of agreement was observed between clinical measures and digital pictures for limb-length measures. When comparing clinical measures and digital photographs with the electromagnetic tracking system, an acceptable level of agreement was observed in measures of static knee angles and limb-length measures. Conclusions: The use of digital photographs and an electromagnetic tracking system appears to be an efficient and reliable method to assess static knee alignment and limb-length measurements.
    No preview · Article · Mar 2013 · Journal of athletic training
Show more