A 2D qualitative movement assessment of a deceleration task detects football players with high knee joint loading

Stefano Di Paolo, Stefano Zaffagnini, Filippo Tosarelli, Fabrizio Aggio, Laura Bragonzoni, Alberto Grassi, Francesco Della Villa, Stefano Di Paolo, Stefano Zaffagnini, Filippo Tosarelli, Fabrizio Aggio, Laura Bragonzoni, Alberto Grassi, Francesco Della Villa

Abstract

Purpose: The deceleration (pressing) is a common situational pattern leading to anterior cruciate ligament (ACL) injury in football. Although mainly assessed for performance purposes, a stronger focus on movement quality might support the screening of at-risk athletes. The aim of the present study was to describe a 2D scoring system for the assessment of the deceleration task and to associate it with the knee joint loading (knee abduction moment) evaluated through the gold standard 3D motion capture. The hypothesis was that lower 2D scores would be associated with higher knee joint loading.

Methods: Thirty-four competitive football (soccer) players (age 22.8 ± 4.1, 16 females) performed a series of deceleration tasks. 3D motion analysis was recorded using ten stereophotogrammetric cameras, a force platform, and three high-speed cameras. The 2D qualitative assessment was performed via a scoring system based on the video analysis of frontal and lateral planes joint kinematics for five scoring criteria. The intra- and inter-rater reliabilities were calculated for each 2D scoring criteria. The peak knee abduction moment was extracted and grouped according to the results of the 2D evaluation.

Results: An ICC > 0.94 was found for all the 2D scoring criteria, both for intra-rater and inter-rater reliability. The players with low 2D frontal plane scores and low total scores (0-4) showed significantly higher peak knee abduction moment values (p < 0.001). A significant negative rank correlation was found between the total score and the peak knee abduction moment (ρ = - 0.25, p < 0.001).

Conclusions: The qualitative 2D scoring system described successfully discerned between athletes with high and low knee joint loading during a deceleration task. The application of this qualitative movement assessment based on a detailed and accurate scoring system is suitable to identify players and patients with high knee joint loading (high knee abduction moments) and target additional training in the scenario of the primary and secondary ACL injury risk reduction.

Level of evidence: Level IV.

Keywords: 2D video analysis; ACL; ACL injury prevention; Deceleration; Return to sport; Soccer.

Conflict of interest statement

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Rate of frontal plane 2D scores classified according to the peak knee abduction moment (KAM) values out of the interquartile range (IQR). High KAM and low KAM represent the values (N*m/BW) between third quartile and maximum and first quartile and minimum, respectively
Fig. 2
Fig. 2
A–B Example of deceleration tasks performed with low knee abduction moment and corresponding high 2D score; C–D example of deceleration tasks performed with high knee abduction moment and corresponding low 2D score
Fig. 3
Fig. 3
Knee abduction moment (KAM) based on the 2D scoring criteria: limb stability, frontal plane knee projection angle, ground reaction force (GRF) vector, total score. Bars with asterisk represent statistically significant differences (p < 0.05) from the lowest scored group (i.e., 0, > 33°, 0–4)

References

    1. Allen MM, Pareek A, Krych AJ, Hewett TE, Levy BA, Stuart MJ, Dahm DL. Are female soccer players at an increased risk of second anterior cruciate ligament injury compared with their athletic peers? Am J Sports Med. 2016;44:2492–2498. doi: 10.1177/0363546516648439.
    1. Anand M, Diekfuss JA, Slutsky-Ganesh AB, Grooms DR, Bonnette S, Barber Foss KD, DiCesare CA, Hunnicutt JL, Myer GD. Integrated 3D motion analysis with functional magnetic resonance neuroimaging to identify neural correlates of lower extremity movement. J Neurosci Methods. 2021 doi: 10.1016/j.jneumeth.2021.109108.
    1. Ardern CL, Ekås GR, Grindem H, Moksnes H, Anderson A, Chotel F, Cohen M, Forssblad M, Ganley TJ, Feller JA, Karlsson J, Kocher MS, LaPrade RF, McNamee M, Mandelbaum B, Micheli L, Mohtadi NGH, Reider B, Roe JP, Seil R, Siebold R, Silvers-Granelli HJ, Soligard T, Witvrouw E, Engebretsen L. Prevention, diagnosis and management of paediatric ACL injuries. Br J Sports Med. 2018;52:1297–1298. doi: 10.1136/bjsports-2018-099493.
    1. Bahr R. Why screening tests to predict injury do not work-and probably never will: a critical review. Br J Sports Med. 2016;50:776–780. doi: 10.1136/bjsports-2016-096256.
    1. Bates NA, Myer GD, Hale RF, Schilaty ND, Hewett TE. Prospective frontal plane angles used to predict ACL strain and identify those at high risk for sports-related ACL injury. Orthop J Sports Med. 2020;8:2325967120957646. doi: 10.1177/2325967120957646.
    1. Brophy RH, Stepan JG, Silvers HJ, Mandelbaum BR. Defending puts the anterior cruciate ligament at risk during soccer: a gender-based analysis. Sports Health. 2015;7:244–249. doi: 10.1177/1941738114535184.
    1. Buckthorpe M. Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sports Med. 2019;49:1043–1058. doi: 10.1007/s40279-019-01102-z.
    1. Buckthorpe M, Della Villa F, Della Villa S, Roi GS. On-field rehabilitation part 1: 4 pillars of high-quality on-field rehabilitation are restoring movement quality, physical conditioning, restoring sport-specific skills, and progressively developing chronic training load. J Orthop Sports Phys Ther. 2019;49:565–569. doi: 10.2519/jospt.2019.8954.
    1. Criss CR, Melton MS, Ulloa SA, Simon JE, Clark BC, France CR, Grooms DR. Rupture, reconstruction, and rehabilitation: a multi-disciplinary review of mechanisms for central nervous system adaptations following anterior cruciate ligament injury. Knee. 2021;30:78–89. doi: 10.1016/j.knee.2021.03.009.
    1. Criss CR, Onate JA, Grooms DR. Neural activity for hip-knee control in those with anterior cruciate ligament reconstruction: a task-based functional connectivity analysis. Neurosci Lett. 2020 doi: 10.1016/j.neulet.2020.134985.
    1. Della Villa F, Buckthorpe M, Grassi A, Nabiuzzi A, Tosarelli F, Zaffagnini S, Della Villa S. Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. Br J Sports Med. 2020 doi: 10.1136/bjsports-2019-101247.
    1. Della Villa F, Di Paolo S, Santagati D, Della Croce E, Lopomo NF, Grassi A, Zaffagnini S. A 2D video-analysis scoring system of 90° change of direction technique identifies football players with high knee abduction moment. Knee Surg Sports Traumatol Arthrosc. 2021 doi: 10.1007/s00167-021-06571-2.
    1. Della Villa F, Hägglund M, Della Villa S, Ekstrand J, Waldén M. High rate of second ACL injury following ACL reconstruction in male professional footballers: an updated longitudinal analysis from 118 players in the UEFA Elite Club Injury Study. Br J Sports Med. 2021 doi: 10.1136/bjsports-2020-103555.
    1. Di Paolo S, Lopomo NF, Della Villa F, Paolini G, Figari G, Bragonzoni L, Grassi A, Zaffagnini S. Rehabilitation and return to sport assessment after anterior cruciate ligament injury: quantifying joint kinematics during complex high-speed tasks through wearable sensors. Sensors. 2021;21:2331. doi: 10.3390/s21072331.
    1. Dix C, Arundale A, Silvers-Granelli H, Marmon A, Zarzycki R, Snyder-Mackler L. biomechanical measures during two sport-specific tasks differentiate between soccer players who go on to anterior cruciate ligament injury and those who do not: a prospective cohort analysis. Int J Sports Phys Ther. 2020;15:928–935. doi: 10.26603/ijspt20200928.
    1. Dos’Santos T, McBurnie A, Donelon T, Thomas C, Comfort P, Jones PA. A qualitative screening tool to identify athletes with “high-risk” movement mechanics during cutting: the cutting movement assessment score (CMAS) Phys Ther Sport. 2019;38:152–161. doi: 10.1016/j.ptsp.2019.05.004.
    1. Dos’Santos T, Thomas C, McBurnie A, Comfort P, Jones PA. Biomechanical determinants of performance and injury risk during cutting: a performance-injury conflict? Sports Med. 2021 doi: 10.1007/s40279-021-01448-3.
    1. Grassi A, Smiley SP, Roberti di Sarsina T, Signorelli C, Marcheggiani Muccioli GM, Bondi A, Romagnoli M, Agostini A, Zaffagnini S. Mechanisms and situations of anterior cruciate ligament injuries in professional male soccer players: a YouTube-based video analysis. Eur J Orthop Surg Traumatol. 2017;27:967–981. doi: 10.1007/s00590-017-1905-0.
    1. Hewett TE, Bates NA. Preventive biomechanics: a paradigm shift with a translational approach to injury prevention. Am J Sports Med. 2017;45:2654–2664. doi: 10.1177/0363546516686080.
    1. Hewett TE, Ford KR, Xu YY, Khoury J, Myer GD. Effectiveness of neuromuscular training based on the neuromuscular risk profile. Am J Sports Med. 2017;45:2142–2147. doi: 10.1177/0363546517700128.
    1. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155–163. doi: 10.1016/j.jcm.2016.02.012.
    1. Lucarno S, Zago M, Buckthorpe M, Grassi A, Tosarelli F, Smith R, Della Villa F. Systematic video analysis of anterior cruciate ligament injuries in professional female soccer players. Am J Sports Med. 2021 doi: 10.1177/03635465211008169.
    1. Padua DA, DiStefano LJ, Beutler AI, de la Motte SJ, DiStefano MJ, Marshall SW. The landing error scoring system as a screening tool for an anterior cruciate ligament injury-prevention program in elite-youth soccer athletes. J Athl Train. 2015;50:589–595. doi: 10.4085/1062-6050-50.1.10.
    1. Paterno MV, Kiefer AW, Bonnette S, Riley MA, Schmitt LC, Ford KR, Myer GD, Shockley K, Hewett TE. Prospectively identified deficits in sagittal plane hip-ankle coordination in female athletes who sustain a second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Clin Biomech (Bristol, Avon) 2015;30:1094–1101. doi: 10.1016/j.clinbiomech.2015.08.019.
    1. Peel SA, Schroeder LE, Sievert ZA, Weinhandl JT. Comparing anterior cruciate ligament injury risk variables between unanticipated cutting and decelerating tasks. J Appl Biomech. 2019;35:101–106. doi: 10.1123/jab.2017-0343.
    1. Poston GR, Schmitt LC, Ithurburn MP, Hugentobler JA, Thomas S, Paterno MV. Reduced 2-D frontal plane motion during single-limb landing is associated with risk of future anterior cruciate ligament graft rupture after anterior cruciate ligament reconstruction and return to sport: a pilot study. J Orthop Sports Phys Ther. 2021;51:82–87. doi: 10.2519/jospt.2021.9302.
    1. Waldén M, Krosshaug T, Bjørneboe J, Andersen TE, Faul O, Hägglund M. Three distinct mechanisms predominate in non-contact anterior cruciate ligament injuries in male professional football players: a systematic video analysis of 39 cases. Br J Sports Med. 2015;49:1452–1460. doi: 10.1136/bjsports-2014-094573.
    1. Weir G, Alderson J, Smailes N, Elliott B, Donnelly C. A reliable video-based ACL injury screening tool for female team sport athletes. Int J Sports Med. 2019;40:191–199. doi: 10.1055/a-0756-9659.
    1. Weitz FK, Sillanpää PJ, Mattila VM. The incidence of paediatric ACL injury is increasing in Finland. Knee Surg Sports Traumatol Arthrosc. 2020;28:363–368. doi: 10.1007/s00167-019-05553-9.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren