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A Systematic Evaluation of Field-Based Screening Methods for the Assessment of Anterior Cruciate Ligament (ACL) Injury Risk

  • Systematic Review
  • Published:
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Abstract

Background

Laboratory-based measures provide an accurate method to identify risk factors for anterior cruciate ligament (ACL) injury; however, these methods are generally prohibitive to the wider community. Screening methods that can be completed in a field or clinical setting may be more applicable for wider community use. Examination of field-based screening methods for ACL injury risk can aid in identifying the most applicable method(s) for use in these settings.

Objective

The objective of this systematic review was to evaluate and compare field-based screening methods for ACL injury risk to determine their efficacy of use in wider community settings.

Data Sources

An electronic database search was conducted on the SPORTDiscus™, MEDLINE, AMED and CINAHL databases (January 1990–July 2015) using a combination of relevant keywords. A secondary search of the same databases, using relevant keywords from identified screening methods, was also undertaken.

Study Selection

Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined screening methods for ACL injury risk that could be undertaken outside of a laboratory setting were included for review.

Study Appraisal and Synthesis Methods

Two reviewers independently assessed the quality of included studies. Included studies were categorized according to the screening method they examined. A description of each screening method, and data pertaining to the ability to prospectively identify ACL injuries, validity and reliability, recommendations for identifying ‘at-risk’ athletes, equipment and training required to complete screening, time taken to screen athletes, and applicability of the screening method across sports and athletes were extracted from relevant studies.

Results

Of 1077 citations from the initial search, a total of 25 articles were identified as potentially relevant, with 12 meeting all inclusion/exclusion criteria. From the secondary search, eight further studies met all criteria, resulting in 20 studies being included for review. Five ACL-screening methods—the Landing Error Scoring System (LESS), Clinic-Based Algorithm, Observational Screening of Dynamic Knee Valgus (OSDKV), 2D-Cam Method, and Tuck Jump Assessment—were identified. There was limited evidence supporting the use of field-based screening methods in predicting ACL injuries across a range of populations. Differences relating to the equipment and time required to complete screening methods were identified.

Limitations

Only screening methods for ACL injury risk were included for review. Field-based screening methods developed for lower-limb injury risk in general may also incorporate, and be useful in, screening for ACL injury risk.

Conclusions

Limited studies were available relating to the OSDKV and 2D-Cam Method. The LESS showed predictive validity in identifying ACL injuries, however only in a youth athlete population. The LESS also appears practical for community-wide use due to the minimal equipment and set-up/analysis time required. The Clinic-Based Algorithm may have predictive value for ACL injury risk as it identifies athletes who exhibit high frontal plane knee loads during a landing task, but requires extensive additional equipment and time, which may limit its application to wider community settings.

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Authors and Affiliations

  1. School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia

    Aaron S. Fox, Jason Bonacci & Natalie Saunders

  2. School of Kinesiology, University of Michigan, Ann Arbor, MI, USA

    Scott G. McLean

  3. College of Sport and Exercise Science, Victoria University, Melbourne, VIC, Australia

    Michael Spittle

Authors
  1. Aaron S. Fox
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  2. Jason Bonacci
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  3. Scott G. McLean
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  4. Michael Spittle
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  5. Natalie Saunders
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Corresponding author

Correspondence to Natalie Saunders.

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No external funding was provided for the production of this review.

Conflicts of interest

Aaron Fox, Jason Bonacci, Scott McLean, Michael Spittle and Natalie Saunders declare there are no conflicts of interest directly relevant to the content of this review.

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Fox, A.S., Bonacci, J., McLean, S.G. et al. A Systematic Evaluation of Field-Based Screening Methods for the Assessment of Anterior Cruciate Ligament (ACL) Injury Risk. Sports Med 46, 715–735 (2016). https://doi.org/10.1007/s40279-015-0443-3

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  • DOI: https://doi.org/10.1007/s40279-015-0443-3

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