title: The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury-Prevention Program in Elite-Youth Soccer Athletes.
abstract: BACKGROUND
  Identifying neuromuscular screening factors for anterior cruciate ligament (ACL) injury is a critical step toward large-scale deployment of effective ACL injury-prevention programs. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment of jump-landing biomechanics.
  
  
  OBJECTIVE
  To investigate the ability of the LESS to identify individuals at risk for ACL injury in an elite-youth soccer population.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Field-based functional movement screening performed at soccer practice facilities.
  
  
  METHODS
  A total of 829 elite-youth soccer athletes (348 boys, 481 girls; age = 13.9 ± 1.8 years, age range = 11 to 18 years), of whom 25% (n = 207) were less than 13 years of age.
  
  
  METHODS
  Baseline preseason testing for all participants consisted of a jump-landing task (3 trials). Participants were followed prospectively throughout their soccer seasons for diagnosis of ACL injuries (1217 athlete-seasons of follow-up).
  
  
  METHODS
  Landings were scored for "errors" in technique using the LESS. We used receiver operator characteristic curves to determine a cutpoint on the LESS. Sensitivity and specificity of the LESS in predicting ACL injury were assessed.
  
  
  RESULTS
  Seven participants sustained ACL injuries during the follow-up period; the mechanism of injury was noncontact or indirect contact for all injuries. Uninjured participants had lower LESS scores (4.43 ± 1.71) than injured participants (6.24 ± 1.75; t1215 = -2.784, P = .005). The receiver operator characteristic curve analyses suggested that 5 was the optimal cutpoint for the LESS, generating a sensitivity of 86% and a specificity of 64%.
  
  
  CONCLUSIONS
  Despite sample-size limitations, the LESS showed potential as a screening tool to determine ACL injury risk in elite-youth soccer athletes.
authors: Department of Exercise and Sport Science, University of North Carolina at Chapel Hill;
authors: Darin A
authors: DA
authors: Padua
authors: University of Connecticut, Storrs;
authors: Lindsay J
authors: LJ
authors: DiStefano
authors: Uniformed Services University of the Health Sciences, Bethesda, MD.
authors: Anthony I
authors: AI
authors: Beutler
authors: Uniformed Services University of the Health Sciences, Bethesda, MD.
authors: Sarah J
authors: SJ
authors: de la Motte
authors: Department of Exercise and Sport Science, University of North Carolina at Chapel Hill;
authors: Michael J
authors: MJ
authors: DiStefano
authors: Department of Exercise and Sport Science, University of North Carolina at Chapel Hill;
authors: Steven W
authors: SW
authors: Marshall
mesh_terms: D000293:Adolescent; D000070598:Anterior Cruciate Ligament Injuries; D056352:Athletes; D001265:Athletic Injuries / Q000517:prevention & control; D001696:Biomechanical Phenomena / Q000502:physiology; D016022:Case-Control Studies; D002648:Child; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000517:prevention & control; D008297:Male; D009068:Movement / Q000502:physiology; D011446:Prospective Studies; D012307:Risk Factors; D012916:Soccer / Q000293:injuries*; D013178:Sports Medicine / Q000379:methods*; D014741:Video Recording
keywords: biomechanics; children; knee; movement patterns