Krosshaug Tron, Steffen Kathrin, Kristianslund Eirik, Nilstad Agnethe, Mok Kam-Ming, Myklebust Grethe, Andersen Thor Einar, Holme Ingar, Engebretsen Lars, Bahr Roald
Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
Am J Sports Med. 2016 Apr;44(4):874-83. doi: 10.1177/0363546515625048. Epub 2016 Feb 11.
The evidence linking knee kinematics and kinetics during a vertical drop jump (VDJ) to anterior cruciate ligament (ACL) injury risk is restricted to a single small sample. Still, the VDJ test continues to be advocated for clinical screening purposes.
To test whether 5 selected kinematic and kinetic variables were associated with future ACL injuries in a large cohort of Norwegian female elite soccer and handball players. Furthermore, we wanted to assess whether the VDJ test can be recommended as a screening test to identify players with increased risk.
Cohort study; Level of evidence, 2.
Elite female soccer and handball players participated in preseason screening tests from 2007 through 2014. The tests included marker-based 3-dimensional motion analysis of a drop-jump landing. We followed a predefined statistical protocol in which we included the following candidate risk factors in 5 separate logistic regression analyses, with new ACL injury as the outcome: (1) knee valgus angle at initial contact, (2) peak knee abduction moment, (3) peak knee flexion angle, (4) peak vertical ground-reaction force, and (5) medial knee displacement.
A total of 782 players were tested (age, 21 ± 4 years; height, 170 ± 7 cm; body mass, 67 ± 8 kg), of which 710 were included in the analyses. We registered 42 new noncontact ACL injuries, including 12 in previously ACL-injured players. Previous ACL injury (relative risk, 3.8; 95% CI, 2.1-7.1) and medial knee displacement (odds ratio, 1.40; 95% CI, 1.12-1.74 per 1-SD change) were associated with increased risk for injury. However, among the 643 players without previous injury, we found no association with medial knee displacement. A receiver operating characteristic curve analysis of medial knee displacement showed an area under the curve of 0.6, indicating a poor-to-failed combined sensitivity and specificity of the test, even when including previously injured players.
Of the 5 risk factors considered, medial knee displacement was the only factor associated with increased risk for ACL. However, receiver operating characteristic curve analysis indicated a poor combined sensitivity and specificity when medial knee displacement was used as a screening test for predicting ACL injury. For players with no previous injury, none of the VDJ variables were associated with increased injury risk.
VDJ tests cannot predict ACL injuries in female elite soccer and handball players.
垂直纵跳（VDJ）过程中膝关节运动学和动力学与前交叉韧带（ACL）损伤风险之间的关联证据仅限于一个小样本。尽管如此，VDJ测试仍继续被推荐用于临床筛查。
测试在一大群挪威女子精英足球和手球运动员中，5个选定的运动学和动力学变量是否与未来的ACL损伤相关。此外，我们想评估VDJ测试是否可作为一种筛查测试，用于识别风险增加的运动员。
队列研究；证据等级，2级。
2007年至2014年期间，精英女子足球和手球运动员参加了季前筛查测试。测试包括基于标记物的纵跳落地三维运动分析。我们遵循了一个预定义的统计方案，在5项单独的逻辑回归分析中纳入以下候选风险因素，以新发ACL损伤作为结果：（1）初始接触时的膝外翻角度，（2）膝关节外展力矩峰值，（3）膝关节屈曲角度峰值，（4）垂直地面反作用力峰值，以及（5）膝关节内侧位移。
总共782名运动员接受了测试（年龄，21±4岁；身高，170±7厘米；体重，67±8千克），其中710名纳入分析。我们记录了42例新发非接触性ACL损伤，包括12例既往有ACL损伤的运动员。既往ACL损伤（相对风险，3.8；95%CI，2.1-7.1）和膝关节内侧位移（比值比，1.40；每1个标准差变化的95%CI，1.12-1.74）与损伤风险增加相关。然而，在643名既往无损伤的运动员中，我们未发现膝关节内侧位移与之相关。对膝关节内侧位移进行的受试者工作特征曲线分析显示曲线下面积为0.6，表明即使纳入既往受伤的运动员，该测试的综合敏感性和特异性也较差。
在所考虑的5个风险因素中，膝关节内侧位移是唯一与ACL损伤风险增加相关的因素。然而，受试者工作特征曲线分析表明，当将膝关节内侧位移用作预测ACL损伤的筛查测试时，其综合敏感性和特异性较差。对于既往无损伤的运动员，VDJ变量均与损伤风险增加无关。
VDJ测试无法预测女子精英足球和手球运动员的ACL损伤。
