Identifying risk factors for Achilles Tendon Rupture (ATR) is one of the first necessary steps for its prevention. This systematic review aimed to update the systematic review published in 2014 in ...

There is a gap in the literature regarding the complex interrelationships among hamstring injury (HI) risk factors. System dynamics (SD) modeling is considered an appropriate approach for understanding the complex etiology of HI for effective injury prevention. This study adopted the SD method and developed a causal loop model (CLD) to elucidate the intricate relationships among HI risk factors. This is performed by combining literature evidence and insights from expert stakeholders through a group model building (GMB) approach. The GMB methodology facilitated the identification of sixty-five critical factors influencing the HI risk, revealing the dynamic interplay between factors. Stakeholder engagement underscored the importance of previous injury characteristics (level of influence of previous injury, severity of previous injury, quality and size of scar tissue) and the quality of rehabilitation. HI-CLD revealed that many factors had indirect effects on HI risk. The HI-causal loop model establishes a foundation for a future stock and flow quantitative SD model aiming to advance HI prevention strategies through an interdisciplinary collaborative effort. These findings underscore the complexity of HI prevention, necessitating a holistic approach that integrates the views of diverse professional expertise. Appropriate inter-professional collaboration and continuous athlete screening are important for effective injury prevention strategies.

This study aimed to identify football players at high risk (HR) for anterior cruciate ligament (ACL) injury via a four-test battery and assess possible factors affecting classification. Ninety-one professional and semi-professional male athletes participated in a field-based pre-season screening. The cut-off points of the test battery were 10% acknowledged inter-limb asymmetry limit for quadriceps and hamstring isometric strength and single-leg triple hop for distance, in addition to the upper limit of 6 errors in the landing error scoring system (LESS). Additional assessment of hip adductors and core stability completed the global functional profile of the players. Sixty-one players were identified as HR and thirty as low-risk (LR) for ACL injury. Discriminant analysis showed that the proposed test battery classified accurately 78.0% of them, with 91.8 sensitivity and 61.9% specificity. Only four misclassified players in the LR group were at risk of inadequate treatment. All participants were considered healthy, and history of a previously rehabilitated injury did not interfere with the results. LESS seems to be the best predictor for injury-risk grouping. Prone bridge time was also a whole-body variable discriminating between groups. The proposed test battery provides a promising option for field-based pre-season ACL risk assessment of football players and needs to be studied prospectively.

Background/Objectives: Given the complex nature of Anterior Cruciate Ligament (ACL) injury, it is important to analyze its etiology with suitable approaches in order to formulate intervention strategies for effective prevention. The present study employs system thinking techniques to develop a Causal Loop Diagram (CLD) Model for investigating the risk factors for ACL Injury (CLD-ACLI), through a Group Model Building approach. Methods: A two-stage procedure was applied involving a comprehensive literature review followed by several systems thinking group-modeling co-creation workshops with stakeholders. Results: Based on input from experts and stakeholders, combined with the latest scientific findings, the derived CLD-ACLI model revealed a series of interesting complex nonlinear interrelationships causal loops between the likelihood of ACL injury and the number of risk factors. Particularly, the interaction among institutional, psychological, neurocognitive, neuromuscular, malalignment factors, and trauma history seem to affect neuromuscular control, which subsequently may alter the biomechanics of landing, predisposing the ACL to injury. Further, according to the proposed CLD-ACLI model, the risk for injury may increase further if specific environmental and anatomical factors affect the shear forces imposed on the ACL. Conclusions: The proposed CLD-ACLI model constitutes a rigorous useful conceptual presentation agreed upon among experts on the dynamic interactions among potential intrinsic and extrinsic risk factors for ACL injury. The presented causal loop model constitutes a vital step for developing a validated quantitative system dynamics simulation model for evaluating ACL injury-prevention strategies prior to implementation.

It is essential for physical sports therapists to use reliable field-based tests to identify potential injury risk factors in athletes. The purpose of this study was to compare the inter- and intra-rater reliability of experienced and novice raters during use of the Landing Error Scoring System (LESS) in a field-based examination of professional football athletes. Thirty-seven male football athletes underwent pre-season LESS assessment. Two raters independently evaluated the recorded landing techniques at two separate intervals, two months apart, following the LESS standard protocol. Inter-and intra-rater values were calculated for the LESS total scores and individual scoring items. The overall LESS scores had excellent intra-rater reliability values for both the experienced (interclass correlation coefficient (ICC) = 0.95, 95% CI, 0.89–0.97; p < 0.001) and novice rater (ICC = 0.95, 95% CI, 0.90–0.97; p < 0.001), and very good to excellent inter-rater values for the first (ICC = 0.90, 95% CI, 0.77–0.95; p < 0.001) and second (ICC = 0.86, 95% CI, 0.71–0.93; p < 0.001) evaluation. Most of the individual scoring items ranged from moderate to perfect agreement. In conclusion, sports physical therapists, regardless of experience, can reliably use the LESS’s total score, through video analysis of the regime. Individual scoring items can inform clinicians about impairments in the landing mechanism but data should be interpreted cautiously.

Background and Objectives: Recent research has highlighted the importance of examining risk factors and their complex interrelationships in the development of lower limb injuries. This study aimed to investigate the direct, indirect, and mediating effects of endogenous neuromuscular and psychological risk factors on the incidence of non-contact lower limb injuries in football players. Materials and Methods: A sample of ninety-seven male football players underwent a structured preseason, on-field assessment. Demographic characteristics, injury history, and athlete burnout were collected through standardized questionnaires. Preseason evaluations included assessments of lower limb flexibility; isometric strength assessment of hamstring, hip abductors, and quadriceps using a handheld dynamometer; hamstring and core endurance; and the single-leg triple hop for distance test. All non-contact lower limb injuries were prospectively recorded throughout the competitive season. Partial Least Squares Structural Equation Modeling (PLS-SEM) method was applied to examine both direct and indirect associations between preseason risk factors and injury incidence. Results: Lower limb strength asymmetries (path coefficient (PC) 0.293, p = 0.004) and previous injuries (PC 0.233, p = 0.015) exhibited the strongest direct effects on the occurrence of new non-contact lower limb injuries. In addition, age acted as a moderating factor, amplifying the effect of lower limb strength asymmetries on injury risk. Moreover, previous injuries demonstrated both direct and indirect effects on neuromuscular characteristics and perceived burnout. Core and hamstring endurance tended to influence new injuries indirectly through strength asymmetries and were significantly affected by hamstring strength (PC 0.248, p = 0.015) and prior injuries (PC −0.207, p = 0.029). Conclusions: Injury prevention strategies should prioritize the improvement of core and hamstring endurance and the reduction in lower limb Strength Asymmetries, particularly among older football players. Furthermore, individualized preventive interventions for athletes with a previous history of injury are strongly recommended.