Background: Identifying risk factors for lower limb injury is an important step in developing injury risk reduction training and testing for player monitoring. Female athletes are distinct from male athletes, warranting separate investigation into risk factors.Objective: To systematically review the literature and synthesise the evidence for intrinsic risk factors for lower limb injury in female team field and court sports.Method: Five online databases were searched from inception to April 2020. To be eligible for inclusion, studies were required to be a prospective study presenting intrinsic risk factors for lower limb injury in female team field or court sport athletes. Risk of bias was assessed using the Quality of Prognosis Studies tool. Results: Sixty-nine studies, capturing 2902 lower limb injuries in 14,492 female athletes, and analysing 80 distinct factors met the inclusion criteria. Risk factors for any lower limb injury included greater body mass (standardised mean difference [SMD]=0.24, 95% confidence interval [95%CI]=0.18-0.29), greater body mass index (BMI) (SMD=0.22, 95%CI=0.05-040), older age (SMD=0.20, 95%CI=0.09-0.31), greater star excursion balance test (SEBT)anterior reach distance (SMD=0.18, 95%CI=0.12-0.24), and smaller single-leg hop distance (SMD=-0.09, 95%CI=-0.12--0.06). Lower knee injury and osteoarthritis outcome score (KOOS) increased the risk of knee injury. Anterior cruciate ligament (ACL) injury risk factors included prior ACL injury (odds ratio [OR]=3.94, 95%CI=2.07-7.50), greater doubleleg postural sway (SMD=0.58, 95%CI=0.02-1.15), and greater body mass (SMD=0.25, 95%CI=0.12-0.39). Ankle injury risk factors included smaller SEBT anterior reach distance (SMD=-0.13, 95%CI=-0.14--0.13), greater single-leg hop distance asymmetry (OR=3.67, 95%CI=1.42-9.45), and slower agility course time (OR=0.20, 95%CI=0.05-0.88). Remaining factors were not associated with injury or had conflicting evidence. Key points• Prior injury, older age, greater body mass, greater body mass index, and lower KOOS are risk factors for lower limb injury in female athletes.• Performance tests associated with injury include star excursion balance test anterior reach, single-leg hop distance and asymmetry, double-leg postural sway, and agility course time.• The majority of test/factors commonly proposed to be associated with injury have limited evidence, predominantly due to conflicting results between studies.
Following hamstring autograft anterior cruciate ligament reconstruction (ACLR), muscle length, cross-sectional area, and volume are reduced. However, these discrete measures of morphology do not account for complex three-dimensional muscle shape. The primary aim of this study was to determine between-limb semitendinosus (ST) shape and regional morphology differences in young adults following tendon harvest for ACLR and to compare these differences with those in healthy controls. In this cross-sectional study, magnetic resonance imaging was performed on 18 individuals with unilateral ACLR and 18 healthy controls.Bilaterally, ST muscles were segmented, and shape differences assessed between limbs and compared between groups using Jaccard index (0-1) and Hausdorff distance (mm). Length (cm), peak cross-sectional area (cm 2 ), and volume (cm 3 ) were measured for the entire muscle and proximal, middle, and distal regions, and compared between limbs and groups. Compared to healthy controls, the ACLR group had significantly (p < 0.001, Cohen's d = −2.33) lower bilateral ST shape similarity and shape deviation was significantly (p < 0.001, d = 2.12) greater. Shape deviation was greatest within the distal region of the ACLR (Hausdorff: 23.1 ± 8.68 mm). Compared to both the uninjured contralateral limb and healthy controls, deficits in peak crosssectional area and volume in ACLR group were largest in proximal (p < 0.001, d = −2.52 to −1.28) and middle (p < 0.001, d = −1.81 to −1.04) regions of the ST.Overall, shape analysis provides unique insight into regional adaptations in ST morphology post-ACLR. Findings highlight morphological features in distal ST not identified by traditional discrete morphology measures. Clinical significance:Following ACLR, risk of a secondary knee or primary hamstring injury has been reported to be between 2-to-5 times greater compared to those without ACLR.Change in semitendinosus (ST) shape following ACLR may affect force transmission and distribution within the hamstrings and might contribute to persistent deficits in knee flexor and internal rotator strength.
The risk of harmful levels of radiation exposure at eye level to orthopaedic surgeons is low. This risk is greatest during insertion of femoral intramedullary nails and pelvic fixation, and it is recommended that in these situations, surgeons take all reasonable precautions to minimize radiation dose. The orthopaedic trainees in this study were not subjected to higher doses of radiation than their consultant trainers. On the basis of these results, most of the orthopaedic surgeons remain well below the yearly radiation dose of 20 mSv as recommended by the International Commission on Radiological Protection.
Purpose: This study aimed to determine if a preseason field-based test battery was prospectively associated with noncontact anterior cruciate ligament (ACL) injury in elite female footballers. Methods: In total, 322 elite senior and junior female Australian Rules Football and soccer players had their isometric hip adductor and abductor strength, eccentric knee flexor strength, countermovement jump (CMJ) kinetics, and single-leg hop kinematics assessed during the 2019 preseason. Demographic and injury history details were also collected. Footballers were subsequently followed for 18 months for ACL injury. Results: Fifteen noncontact ACL injuries occurred during the follow-up period. Prior ACL injury (odds ratio [OR], 9.68; 95% confidence interval (95% CI), 2.67-31.46), a lower isometric hip adductor to abductor strength ratio (OR, 1.98; 95% CI, 1.09-3.61), greater CMJ peak take-off force (OR, 1.74; 95% CI, 1.09-3.61), and greater single-leg triple vertical hop average dynamic knee valgus (OR, 1.97; 95% CI, 1.06-3.63) and ipsilateral trunk flexion (OR, 1.60; 95% CI, 1.01-2.55) were independently associated with an increased risk of subsequent ACL injury. A multivariable prediction model consisting of CMJ peak take-off force, dynamic knee valgus, and ACL injury history that was internally validated classified ACL injured from uninjured footballers with 78% total accuracy. Between-leg asymmetry in lower limb strength and CMJ kinetics were not associated with subsequent ACL injury risk. Conclusions: Preseason field-based measures of lower limb muscle strength and biomechanics were associated with future noncontact ACL injury in elite female footballers. These risk factors can be used to guide ACL injury screening practices and inform the design of targeted injury prevention training in elite female footballers.
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