A systematic evaluation of field-based screening methods for the assessment of anterior cruciate ligament (ACL) injury risk

Fox, Aaron S., Bonacci, Jason, McLean, Scott G., Spittle, Michael and Saunders, Natalie (2016) A systematic evaluation of field-based screening methods for the assessment of anterior cruciate ligament (ACL) injury risk. Sports Medicine, 46 5: 715-735. doi:10.1007/s40279-015-0443-3

Author Fox, Aaron S.
Bonacci, Jason
McLean, Scott G.
Spittle, Michael
Saunders, Natalie
Title A systematic evaluation of field-based screening methods for the assessment of anterior cruciate ligament (ACL) injury risk
Journal name Sports Medicine   Check publisher's open access policy
ISSN 0112-1642
Publication date 2016-05
Year available 2015
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1007/s40279-015-0443-3
Open Access Status Not Open Access
Volume 46
Issue 5
Start page 715
End page 735
Total pages 21
Place of publication Auckland, New Zealand
Publisher Adis International
Collection year 2017
Language eng
Formatted abstract
Background: Laboratory-based measures provide an accurate method to identify risk factors for anterior cruciate ligament (ACL) injury; however, these methods are generally prohibitive to the wider community. Screening methods that can be completed in a field or clinical setting may be more applicable for wider community use. Examination of field-based screening methods for ACL injury risk can aid in identifying the most applicable method(s) for use in these settings.

Objective: The objective of this systematic review was to evaluate and compare field-based screening methods for ACL injury risk to determine their efficacy of use in wider community settings.

Data Sources: An electronic database search was conducted on the SPORTDiscus™, MEDLINE, AMED and CINAHL databases (January 1990–July 2015) using a combination of relevant keywords. A secondary search of the same databases, using relevant keywords from identified screening methods, was also undertaken.

Study Selection: Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined screening methods for ACL injury risk that could be undertaken outside of a laboratory setting were included for review.

Study Appraisal and Synthesis Methods: Two reviewers independently assessed the quality of included studies. Included studies were categorized according to the screening method they examined. A description of each screening method, and data pertaining to the ability to prospectively identify ACL injuries, validity and reliability, recommendations for identifying ‘at-risk’ athletes, equipment and training required to complete screening, time taken to screen athletes, and applicability of the screening method across sports and athletes were extracted from relevant studies.

Results: Of 1077 citations from the initial search, a total of 25 articles were identified as potentially relevant, with 12 meeting all inclusion/exclusion criteria. From the secondary search, eight further studies met all criteria, resulting in 20 studies being included for review. Five ACL-screening methods—the Landing Error Scoring System (LESS), Clinic-Based Algorithm, Observational Screening of Dynamic Knee Valgus (OSDKV), 2D-Cam Method, and Tuck Jump Assessment—were identified. There was limited evidence supporting the use of field-based screening methods in predicting ACL injuries across a range of populations. Differences relating to the equipment and time required to complete screening methods were identified.

Limitations: Only screening methods for ACL injury risk were included for review. Field-based screening methods developed for lower-limb injury risk in general may also incorporate, and be useful in, screening for ACL injury risk.

Conclusions: Limited studies were available relating to the OSDKV and 2D-Cam Method. The LESS showed predictive validity in identifying ACL injuries, however only in a youth athlete population. The LESS also appears practical for community-wide use due to the minimal equipment and set-up/analysis time required. The Clinic-Based Algorithm may have predictive value for ACL injury risk as it identifies athletes who exhibit high frontal plane knee loads during a landing task, but requires extensive additional equipment and time, which may limit its application to wider community settings.
Keyword Anterior cruciate ligament (ACL)
Landing Error Scoring System (LESS)
Youth athlete population
Sports-related injury
Injury prevention methods
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: HERDC Pre-Audit
School of Human Movement and Nutrition Sciences Publications
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Created: Tue, 19 Jul 2016, 12:05:40 EST by Sandrine Ducrot on behalf of Learning and Research Services (UQ Library)