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@physicaltherapyresearch
522 Likes22 Comments
522 Likes22 Comments

📚🔬
ACL Tear Risk…Is it Predictable?
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INTRO:
The vertical drop jump (VDJ) test is widely used for clinical assessment of ACL injury risk.
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Based on landing mechanics and control of the trunk and lower limb, it is proposed risk of ACL rupture can be identified.
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However, whether such assessments are valid is unclear.
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Mørtvedt et al (2019), examined if various sports medicine professionals and coaches were able to identify ACL injury risk in players, by visually assessing a VDJ test.
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METHODS: 
102 video clips of elite female handball and football players performing a VDJ test were randomly selected from 738 recorded VDJ tests.
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20 out of 102 went on to suffer an ACL injury. .
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Sports medicine professionals and coaches were invited to rate each clip with a risk-level of ACL tear between 1 and 10
1=Low
10=High
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RESULTS: 
237 assessors completed the survey. .
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Accuracy ranged from 36-60%
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Average was 47%, which is similar to random guessing. .
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No signifiant differences in classification between professionals:
Physicians
Coaches
Certified Athletic Trainers
Researchers
Physical Therapists
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CONCLUSION: 
There was poor predictive ability (no better than chance).

Visual assessment of a VDJ test, alone, is a poor test for assessing ACL injury risk in elite female handball and football players.

Is there a battery of tests which could have better predicted ACL Injury?
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Thoughts? Questions? Comments?
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Write them below. .
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SOURCE:
Mørtvedt, et al. 2019. BJSM. 2019 Oct 14. doi: 10.1136/bjsports-2019-100602

31 Oct 2019

Comments
  • @drbriancox

    Agree. But valgus collapse and posture is prevalent with people with foot, ankle, knee and hip dysfunction and arthritis. I was going extreme to be absurd. Like one study showing asymmetrical findings in elite runners and many use that to negate the impact of imbalances in everyone.

    03 Nov 2019

  • @physicaltherapyresearch

    They assessed based on likelihood when rated on their ability to perform the test well. More knee valgus and less control got higher likelihood scores. Then compared to acl injuries

    03 Nov 2019

  • @j_rich_86

    How was the accuracy actually measured? Were they guessing more players would have a tear and a lower percent didnt? Were they guessing different players? We’re they mixed guesses? Who was more accurate with guesses? Were the ACL year contact or non-contact tears?

    01 Nov 2019

  • @bo_brawner

    I wanna know what the mechanism was. I highly doubt they tore the acl landing off a box. Prolly with I rotation deceleration moment in single leg stance. With cleats in grass . But the same test for the mechanism of injury.

    31 Oct 2019

  • @jason_hamera

    👋🏻 great post, and thanks for asking the question as this is what we as an industry should be asking! It’s no surprise that one test yielded sub optimal results given the complexity of tasks the ACL is responsible for and therefore can be injured performing. I believe having a more 3 dimensional test including both ends of the planes (sag/front/trans so 6 angulations) coupled with the ACL having to both produce and reduce the mass and momentum of the body while locomotionig in all three planes would give the assessor a comprehensive view of the knee as it exposes its mobility and stability. 👍🏻

    31 Oct 2019

  • @kaszanas

    I don't know how people could land like that.

    31 Oct 2019

  • @dan_reprimefitness

    The problem with this is they’re trying to take a complex system like the body and pin a very severe injury (it takes a lot for a complete year to occur) to one factor. A lot of things have to happen for an ACL tear to occur, so predicting is an impossible task. One could look at these results and say they don’t indicate much. To me, 30% plus is a MASSIVE indicator that knee Valgus puts someone at serious risk. Let’s compare that to the ACL injury rate of someone who has good knee alignment and I bet we see a massive difference between the two

    31 Oct 2019

  • @drbriancox

    It affects function and resistance. If not, let’s start teaching squats and deadlifts promoting knee valgus.

    31 Oct 2019

  • @jakevenes

    Still a good test, even if predictive because if done right, shows what needs to be addressed musculoskeletally and neurally. It’s like the saying goes: If you aren’t testing you are just guessing. And while, tests can be cheated or guessed upon, better to have measureables without ever testing at all. Heck, do FIFA 11+ and never test. ACL risk reduces to 53%. Stats always can be manipulated. Continue to test VDJ in addition to others and you’ll be better off.

    31 Oct 2019

  • @jackiejaayyy

    Assessing ecc control of HS?

    31 Oct 2019

  • @andrewgfitnesscoaching

    Bit like the FMS screen.

    31 Oct 2019

  • @physicaltherapyresearch

    . . #rehab #pain #painscience #physiology #physicaltherapy #physiotherapy #massage #orthopedic #chiropractic #medicine #sportsmedicine #science #research #health #wellness #nervoussystem #neuroscience #brain #physicaltherapyresearch #dpt #dptstudent #exercise #fitness #workout #acl #acltear #aclrehab

    31 Oct 2019