The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury–Prevention Program in Elite-Youth Soccer Athletes

TLDR

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 study investigates whether the Landing Error Scoring System can identify elite‑youth soccer athletes at risk for ACL injury. The authors conducted a prospective cohort study of 829 elite‑youth soccer athletes, scoring jump‑landing errors with the LESS during preseason practice and following them through their seasons to identify ACL injuries. The LESS achieved an 86 % sensitivity and 64 % specificity at a cutpoint of 5, distinguishing injured from uninjured athletes and indicating its potential as a screening tool despite limited sample size.

Abstract

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.To investigate the ability of the LESS to identify individuals at risk for ACL injury in an elite-youth soccer population.Cohort study.Field-based functional movement screening performed at soccer practice facilities.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.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).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.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%.Despite sample-size limitations, the LESS showed potential as a screening tool to determine ACL injury risk in elite-youth soccer athletes.