IDENTIFYING FEMALE ATHLETES AT HIGH RISK FOR ACL INJURY

Summary

Principal Investigator: Timothy Hewett
Affiliation: Cincinnati Children's Hospital Medical Center
Country: USA
Abstract: DESCRIPTION (provided by applicant): It is now widely recognized that gender-based differences can play a major role in the predisposition to disease and injury, yet this remains an understudied phenomenon. Adolescent females who participate in jumping and pivoting sports suffer anterior cruciate ligament (ACL) injury at a 4 to 6-fold greater rate than adolescent males participating in the same sports. The reason(s) for this ACL injury disparity remain(s) obscure. Prior to puberty, male and female injury risk appears equal. Our long-term objectives are to determine how female athletes become more susceptible to non-contact ACL injury, prospectively identify those female athletes who are more susceptible to injury and to determine the underlying mechanistic cause(s) of increased risk at the biomechanical and biochemical levels and to optimize the effectiveness of treatments designed to prevent ACL injuries. Towards these goals, we propose to test the central hypothesis that the increases in lower extremity bone length and body mass that occur during puberty, without the neuromuscular performance spurt that most males demonstrate, will increase dynamic valgus, knee joint loading and injury risk in a subset of female athletes. It will also test the hypothesis that measures relating to dynamic valgus will prove predictive of ACL injury risk in high-risk female athletes. Specific Aim 1 will determine if following the onset of pubertal growth, increases in tibia and femur length and body mass, in the absence of increases in strength and recruitment of the musculature at the hip and knee that controls knee position and load, will lead to decreased neuromuscular control as measured by increased dynamic valgus in a subset of maturing female athletes. Specific Aim 2 will determine if objective biomechanical measures can predict relative ACL injury risk in female athletes. We hypothesize that a model that incorporates measures of dynamic valgus and variables that contribute to neuromuscular control of valgus (hip adduction moment) and increased knee joint load (knee abduction moment) will prove both sensitive and specific predictors of ACL injury risk in female athletes. These data should provide a foundation for approaching both the mechanistic questions underlying risk disparity, as well as increase our ability to direct high-risk athletes to effective, targeted interventions, which are proposed. Prevention of female rates from 5 times to equal males' would allow >30,000 females annually to continue the benefits of sports participation and to avoid the long-term complications of osteoarthritis, which may occur with a 10-fold greater incidence in the ACL-injured population.
Funding Period: 2004-09-21 - 2009-08-31
more information: NIH RePORT

Top Publications

  1. pmc Development and validation of a clinic-based prediction tool to identify female athletes at high risk for anterior cruciate ligament injury
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    Am J Sports Med 38:2025-33. 2010
  2. doi Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses
    Dai Sugimoto
    Department of Sports Medicine, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    Br J Sports Med 46:979-88. 2012
  3. doi The effects of isolated and integrated 'core stability' training on athletic performance measures: a systematic review
    Casey A Reed
    Cincinnati Childrens Hospital Medical Center, Sports Medicine Biodynamics Center, Human Performance Laboratory, Cincinnati, OH, USA
    Sports Med 42:697-706. 2012
  4. pmc The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction
    Laura C Schmitt
    Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH 43210, USA
    J Orthop Sports Phys Ther 42:750-9. 2012
  5. ncbi No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction: evidence for objective return-to-sport criteria
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center, 3333 Burnet Ave MLC 10001, Cincinnati, OH 45229, USA
    Am J Sports Med 40:2256-63. 2012
  6. pmc Longitudinal documentation of serum cartilage oligomeric matrix protein and patient-reported outcomes in collegiate soccer athletes over the course of an athletic season
    Johanna M Hoch
    Division of Athletic Training and Rehabilitation Sciences Doctoral Program, College of Health Sciences, University of Kentucky, Lexington, USA
    Am J Sports Med 40:2583-9. 2012
  7. pmc Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction
    Timothy E Hewett
    The Sports Health and Performance Institute, The Ohio State University, Columbus, 43221, USA
    Am J Sports Med 41:216-24. 2013
  8. pmc The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a meta-analysis
    Gregory D Myer
    Division of Sports Medicine, Cincinnati Children s Hospital Medical Center, Ohio, USA
    Am J Sports Med 41:203-15. 2013
  9. ncbi Biomechanical outcomes of cartilage repair of the knee
    Carmen E Quatman
    Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA
    J Knee Surg 25:197-206. 2012
  10. pmc Expected prevalence from the differential diagnosis of anterior knee pain in adolescent female athletes during preparticipation screening
    Kim D Barber Foss
    Cincinnati Children s Hospital Medical Center, OH, USA
    J Athl Train 47:519-24. 2012

Scientific Experts

Detail Information

Publications125 found, 100 shown here

  1. pmc Development and validation of a clinic-based prediction tool to identify female athletes at high risk for anterior cruciate ligament injury
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    Am J Sports Med 38:2025-33. 2010
    ..Clinic-based prediction algorithms that employ correlates derived from laboratory-based measurements also demonstrate high accuracy for prediction of high KAM mechanics during landing...
  2. doi Evaluation of the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a critical review of relative risk reduction and numbers-needed-to-treat analyses
    Dai Sugimoto
    Department of Sports Medicine, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    Br J Sports Med 46:979-88. 2012
    ..A future direction to reduce NNT and improve the efficiency of ACL injury-prevention strategies is to develop a screening system for identifying at-risk athletes...
  3. doi The effects of isolated and integrated 'core stability' training on athletic performance measures: a systematic review
    Casey A Reed
    Cincinnati Childrens Hospital Medical Center, Sports Medicine Biodynamics Center, Human Performance Laboratory, Cincinnati, OH, USA
    Sports Med 42:697-706. 2012
    ..Core stability training, operationally defined as training focused to improve trunk and hip control, is an integral part of athletic development, yet little is known about its direct relation to athletic performance...
  4. pmc The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction
    Laura C Schmitt
    Division of Physical Therapy, School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH 43210, USA
    J Orthop Sports Phys Ther 42:750-9. 2012
    ..Cross-sectional study...
  5. ncbi No association of time from surgery with functional deficits in athletes after anterior cruciate ligament reconstruction: evidence for objective return-to-sport criteria
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center, 3333 Burnet Ave MLC 10001, Cincinnati, OH 45229, USA
    Am J Sports Med 40:2256-63. 2012
    ..Temporal guidelines for return to sport may not accurately identify impaired strength and neuromuscular control, which are associated with increased risk for second injury (contralateral and/or ipsilateral limb) after ACLR in athletes...
  6. pmc Longitudinal documentation of serum cartilage oligomeric matrix protein and patient-reported outcomes in collegiate soccer athletes over the course of an athletic season
    Johanna M Hoch
    Division of Athletic Training and Rehabilitation Sciences Doctoral Program, College of Health Sciences, University of Kentucky, Lexington, USA
    Am J Sports Med 40:2583-9. 2012
    ..It is unknown what effect intense, continuous physical activity has on sCOMP levels and PRO values in athletes over the duration of a soccer season. Hypothesis/..
  7. pmc Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction
    Timothy E Hewett
    The Sports Health and Performance Institute, The Ohio State University, Columbus, 43221, USA
    Am J Sports Med 41:216-24. 2013
    ....
  8. pmc The influence of age on the effectiveness of neuromuscular training to reduce anterior cruciate ligament injury in female athletes: a meta-analysis
    Gregory D Myer
    Division of Sports Medicine, Cincinnati Children s Hospital Medical Center, Ohio, USA
    Am J Sports Med 41:203-15. 2013
    ..The hypothesis tested was that NMT would show a greater effect in younger populations...
  9. ncbi Biomechanical outcomes of cartilage repair of the knee
    Carmen E Quatman
    Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA
    J Knee Surg 25:197-206. 2012
    ..The focus of the following review is to evaluate the current evidence available on biomechanical functional outcomes after cartilage repair with clinical applications to the rehabilitation process...
  10. pmc Expected prevalence from the differential diagnosis of anterior knee pain in adolescent female athletes during preparticipation screening
    Kim D Barber Foss
    Cincinnati Children s Hospital Medical Center, OH, USA
    J Athl Train 47:519-24. 2012
    ..Anterior knee pain is a common disorder in female athletes with an undefined cause. The relative prevalence of specific patellofemoral disorders associated with anterior knee pain in adolescent females remains undetermined...
  11. ncbi The effect of sex and age on isokinetic hip-abduction torques
    Jensen L Brent
    Academy of Sports Performance, Cincinnati, OH, USA
    J Sport Rehabil 22:41-6. 2013
    ....
  12. ncbi Arthrometric curve-shape variables to assess anterior cruciate ligament deficiency
    Samuel C Wordeman
    The Ohio State University, Department of Biomedical Engineering, Columbus, OH, USA
    Clin Biomech (Bristol, Avon) 27:830-6. 2012
    ..We hypothesized that linear stiffness and compliance after positive curve inflection would be more sensitive and specific to anterior cruciate ligament injury than current measures and would require data from the involved limb only...
  13. ncbi Pediatric resistance training: benefits, concerns, and program design considerations
    Avery D Faigenbaum
    Department of Health and Exercise Science, The College of New Jersey, Ewing, NJ 08628, USA
    Curr Sports Med Rep 9:161-8. 2010
    ..The sensible integration of different training methods along with the periodic manipulation of programs design variables over time will keep the training stimulus effective, challenging, and enjoyable for the participants...
  14. doi Three-dimensional motion analysis validation of a clinic-based nomogram designed to identify high ACL injury risk in female athletes
    Gregory D Myer
    Cincinnati Children s Hospital, Cincinnati, OH, USA
    Phys Sportsmed 39:19-28. 2011
    ..Laboratory-driven measurements predict high KAM with 90% accuracy. This study aimed to validate the clinic-based variables against 3-dimensional motion analysis measurements...
  15. doi Integrative training for children and adolescents: techniques and practices for reducing sports-related injuries and enhancing athletic performance
    Gregory D Myer
    Cincinnati Children s Hospital, Cincinnati, OH, USA
    Phys Sportsmed 39:74-84. 2011
    ..The cornerstone of integrative training is age-appropriate education and instruction by qualified professionals who understand the physical and psychosocial uniqueness of children and adolescents...
  16. pmc Longitudinal effects of maturation on lower extremity joint stiffness in adolescent athletes
    Kevin R Ford
    Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    Am J Sports Med 38:1829-37. 2010
    ..Yearly changes in active joint stiffness may help explain when neuromuscular sex differences emerge in adolescent athletes that may relate to increased anterior cruciate ligament injury risk in females...
  17. ncbi Preferential quadriceps activation in female athletes with incremental increases in landing intensity
    Kevin R Ford
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Medical Center, and with the Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
    J Appl Biomech 27:215-22. 2011
    ..The resultant decreased activation ratio of the hamstrings relative to quadriceps before landing may represent altered dynamic knee stability and may contribute to the increased risk of ACL injury in female athletes...
  18. pmc Multiple risk factors related to familial predisposition to anterior cruciate ligament injury: fraternal twin sisters with anterior cruciate ligament ruptures
    T E Hewett
    Cincinnati Children s Hospital Medical Center and Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio 45229, USA
    Br J Sports Med 44:848-55. 2010
    ..The objective of this twin study was to examine these risk factors to identify commonalities in risk factors that predisposed female fraternal twins to ACL injury...
  19. doi In vivo evidence for tibial plateau slope as a risk factor for anterior cruciate ligament injury: a systematic review and meta-analysis
    Samuel C Wordeman
    Sports Health and Performance Institute, The Ohio State University, Columbus, OH 43221, USA
    Am J Sports Med 40:1673-81. 2012
    ..In vivo studies reporting tibial plateau slope as a risk factor for anterior cruciate ligament (ACL) injury have been published with greatly increasing frequency...
  20. pmc An integrated approach to change the outcome part I: neuromuscular screening methods to identify high ACL injury risk athletes
    Gregory D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio, USA
    J Strength Cond Res 26:2265-71. 2012
    ..The field-based measurements and software analyses were used in a prediction algorithm to identify those at potential risk of noncontact ACL injury that may directly benefit from neuromuscular training...
  21. pmc An integrated approach to change the outcome part II: targeted neuromuscular training techniques to reduce identified ACL injury risk factors
    Gregory D Myer
    Human Performance Laboratory, Sports Medicine Biodynamics Center, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio, USA
    J Strength Cond Res 26:2272-92. 2012
    ..If these integrated techniques are employed on a widespread basis, prevention strategies for noncontact ACL injury among young female athletes may prove both more effective and efficient...
  22. pmc Increased plantar force and impulse in American football players with high arch compared to normal arch
    Daniel W Carson
    Cincinnati Children s Hospital Medical Center, Human Performance Laboratory, Cincinnati, OH, United States
    Foot (Edinb) 22:310-4. 2012
    ..While the effect of arch structure on dynamic function has been examined in straight line walking and running, the relationship between the two during multi-directional movements remains unstudied...
  23. pmc Clinically relevant injury patterns after an anterior cruciate ligament injury provide insight into injury mechanisms
    Jason W Levine
    Engineering Center for Orthopaedic Research Excellence, The University of Toledo, 2801 West Bancroft Street, 5035 Nitschke Hall, MS 303, Toledo, OH 43606, USA
    Am J Sports Med 41:385-95. 2013
    ..Secondary bone bruises have been reported in over 80% of partial and complete ACL ruptures...
  24. pmc Compliance with neuromuscular training and anterior cruciate ligament injury risk reduction in female athletes: a meta-analysis
    Dai Sugimoto
    Cincinnati Children s Hospital Sports Medicine, Sports Medicine Biodynamics Center and Human Performance Laboratory, OH, USA
    J Athl Train 47:714-23. 2012
    ..No consensus exists about the influence of compliance with neuromuscular training programs on reduction of the risk of anterior cruciate ligament (ACL) injury...
  25. pmc Prevention of overuse sports injuries in the young athlete
    Mark V Paterno
    Human Performance Lab, Division of Sports Medicine, Sports Medicine Biodynamics Center, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA Division of Occupational Therapy and Physical Therapy, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA Electronic address
    Orthop Clin North Am 44:553-64. 2013
    ..This information provides valuable insight into the state of the current evidence regarding overuse injuries in young athletes as well as the potential future directions in the development of overuse injury prevention interventions. ..
  26. pmc Preferential Loading of the ACL Compared With the MCL During Landing: A Novel In Sim Approach Yields the Multiplanar Mechanism of Dynamic Valgus During ACL Injuries
    Carmen E Quatman
    Timothy E Hewett, Sports Health and Performance Institute, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221
    Am J Sports Med 42:177-86. 2014
    ..However, a concomitant injury to the medial collateral ligament (MCL) would be expected under valgus collapse, based on the MCL's anatomic orientation and biomechanical role in knee stability. Purpose/..
  27. pmc Prevalence and location of bone bruises associated with anterior cruciate ligament injury and implications for mechanism of injury: a systematic review
    Sonika A Patel
    Sports Medicine and Sports Health and Performance Institute, The Ohio State University, Columbus, 2050 Kenny Road, Suite 3100, Columbus, OH, 43221, USA
    Sports Med 44:281-93. 2014
    ..Bone bruising is commonly observed on magnetic resonance imaging (MRI) after non-contact anterior cruciate ligament (ACL) injury...
  28. ncbi Effects of compliance on trunk and hip integrative neuromuscular training on hip abductor strength in female athletes
    Dai Sugimoto
    1Division of Sports Medicine, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 2Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio 3The Michele Center for Sports Injury Prevention, Waltham, Massachusetts 4Division of Sports Medicine, Boston Children s Hospital, Boston, Massachusetts 5Department of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio 6Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky 7Sports Medicine Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio 8Athletic Training Division, The Ohio State University, Columbus, Ohio and 9Departments of Physiology and Cell Biology, Orthopaedic Surgery Family Medicine and Biomedical Engineering, Sports Medicine, The Ohio State University, Columbus, Ohio
    J Strength Cond Res 28:1187-94. 2014
    ..Compliance of trunk and hip-focused INT is an important aspect of increasing hip abductor strength increase in young women athletes...
  29. ncbi Neuromuscular training to target deficits associated with second anterior cruciate ligament injury
    Stephanie Di Stasi
    Sports Health and Performance Institute, The Ohio State University, Columbus, OH Department of Orthopaedics, Division of Sports Medicine, The Ohio State University, Columbus, OH
    J Orthop Sports Phys Ther 43:777-792, A1-11. 2013
    ..Future validation of this evidence-based, late-phase rehabilitation program may be a critical factor in maximizing return-to-activity success and reduction of second-injury risk in highly active individuals...
  30. ncbi Timing sequence of multi-planar knee kinematics revealed by physiologic cadaveric simulation of landing: implications for ACL injury mechanism
    Ata M Kiapour
    Sports Medicine Research Laboratory, Department of Orthopaedic Surgery, Boston Children s Hospital, Harvard Medical School, Boston, MA, United States Engineering Center for Orthopaedic Research Excellence ECORE, Departments of Orthopaedics and Bioengineering, University of Toledo, Toledo, OH, United States
    Clin Biomech (Bristol, Avon) 29:75-82. 2014
    ..This study seeks to investigate the detailed interactions between tibiofemoral joint multi-planar kinematics and anterior cruciate ligament strain in a cadaveric model of landing using a validated physiologic drop-stand apparatus...
  31. pmc Diagnostic value of knee arthrometry in the prediction of anterior cruciate ligament strain during landing
    Ata M Kiapour
    Timothy E Hewett, Sports Health and Performance Institute, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221
    Am J Sports Med 42:312-9. 2014
    ..Despite the frequent clinical use of knee arthrometry in the evaluation of knee laxity, little data exist to correlate instrumented laxity measures and ACL strain during dynamic high-risk activities. Purpose/..
  32. pmc Integrative neuromuscular training and sex-specific fitness performance in 7-year-old children: an exploratory investigation
    Avery D Faigenbaum
    Department of Health and Exercise Science, The College of New Jersey, Ewing
    J Athl Train 49:145-53. 2014
    ..If not addressed at the proper time, low levels of physical fitness and abnormal mechanics may predispose female athletes to an increased risk of musculoskeletal injuries...
  33. ncbi Feedback techniques to target functional deficits following anterior cruciate ligament reconstruction: implications for motor control and reduction of second injury risk
    Alli Gokeler
    University of Groningen, University Medical Center Groningen, Center for Rehabilitation, P O Box 30 001, 9700 RB, Groningen, The Netherlands
    Sports Med 43:1065-74. 2013
    ..This article presents new insights gained from the motor learning domain that may improve neuromuscular training programmes via increased retention from improved techniques and may ultimately reduce the incidence of second ACL injuries. ..
  34. doi Timing differences in the generation of ground reaction forces between the initial and secondary landing phases of the drop vertical jump
    Nathaniel A Bates
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH, USA University of Cincinnati, Department of Biomedical Engineering, Cincinnati, OH, USA
    Clin Biomech (Bristol, Avon) 28:796-9. 2013
    ..We examined the first and second landings of a drop vertical jump for differences in landing phase duration, time to peak force, and rate of force development...
  35. pmc Altered postural sway persists after anterior cruciate ligament reconstruction and return to sport
    Mark V Paterno
    Cincinnati Children s Hospital Medical Center, Cincinnati, OH, United States Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH, United States
    Gait Posture 38:136-40. 2013
    ..Further investigation is needed to determine if deficits in postural sway can be used as an effective criterion to assist in the decision to safely RTS after ACLR...
  36. pmc Inter-segmental postural coordination measures differentiate athletes with ACL reconstruction from uninjured athletes
    Adam W Kiefer
    Center for Cognition, Action, and Perception, Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
    Gait Posture 37:149-53. 2013
    ..The results also indicate that dynamical coordination measures may provide objective measures of sensorimotor deficits following ACL reconstruction and can potentially guide rehabilitation interventions following reconstruction...
  37. ncbi Effects of task-specific augmented feedback on deficit modification during performance of the tuck-jump exercise
    Benjamin W Stroube
    Div of Sports Medicine, Cincinnati Children s Hospital, Cincinnati, OH, USA
    J Sport Rehabil 22:7-18. 2013
    ..Specific factors have possible links to increasing a female athlete's chances of suffering an ACL injury. However, it is unclear if augmented feedback may be able to decrease possible risk factors...
  38. pmc Dosage effects of neuromuscular training intervention to reduce anterior cruciate ligament injuries in female athletes: meta- and sub-group analyses
    Dai Sugimoto
    The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
    Sports Med 44:551-62. 2014
    ..Although a series of meta-analyses demonstrated neuromuscular training (NMT) is an effective intervention to reduce anterior cruciate ligament (ACL) injury in female athletes, the potential existence of a dosage effect remains unknown...
  39. doi Augmented feedback supports skill transfer and reduces high-risk injury landing mechanics: a double-blind, randomized controlled laboratory study
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    Am J Sports Med 41:669-77. 2013
    ..There is a current need to produce a simple, yet effective method for screening and targeting possible deficiencies related to increased anterior cruciate ligament (ACL) injury risk...
  40. pmc Impact differences in ground reaction force and center of mass between the first and second landing phases of a drop vertical jump and their implications for injury risk assessment
    Nathaniel A Bates
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, and University of Cincinnati, Department of Biomedical Engineering, Cincinnati, OH, USA
    J Biomech 46:1237-41. 2013
    ..Greater side-to-side asymmetry in vGRF and higher CoM during impact indicate the second landing of a DVJ may exhibit greater perturbation and better represent in-game mechanics associated with ACL injury risk...
  41. pmc Exercise deficit disorder in youth: a paradigm shift toward disease prevention and comprehensive care
    Gregory D Myer
    Division of Sports Medicine, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    Curr Sports Med Rep 12:248-55. 2013
    ....
  42. ncbi Kinetic and kinematic differences between first and second landings of a drop vertical jump task: implications for injury risk assessments
    Nathaniel A Bates
    Cincinnati Children s Hospital Medical Center, Human Performance Laboratory, Cincinnati, OH, United States
    Clin Biomech (Bristol, Avon) 28:459-66. 2013
    ..We examined the first and second landings of a drop vertical jump for differences in kinetic and kinematic behaviors at the hip and knee...
  43. pmc A longitudinal evaluation of maturational effects on lower extremity strength in female adolescent athletes
    Catherine C Quatman-Yates
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Research Foundation, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    Pediatr Phys Ther 25:271-6. 2013
    ..Our purpose was to investigate the longitudinal trajectories of lower extremity strength across maturational stages for a cohort of female student athletes...
  44. doi Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport
    Mark V Paterno
    Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    Am J Sports Med 38:1968-78. 2010
    ....
  45. pmc Utilization of modified NFL combine testing to identify functional deficits in athletes following ACL reconstruction
    Gregory D Myer
    Division of Sports Medicine, Cincinnati Children s Hospital Medical Center, Cincinnati, OH, USA
    J Orthop Sports Phys Ther 41:377-87. 2011
    ..Case control...
  46. doi New method to identify athletes at high risk of ACL injury using clinic-based measurements and freeware computer analysis
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    Br J Sports Med 45:238-44. 2011
    ..High knee abduction moment (KAM) landing mechanics, measured in the biomechanics laboratory, can successfully identify female athletes at increased risk for anterior cruciate ligament (ACL) injury...
  47. pmc Noncontact anterior cruciate ligament injuries: mechanisms and risk factors
    Barry P Boden
    Orthopaedic Center, Rockville, MD, USA
    J Am Acad Orthop Surg 18:520-7. 2010
    ..A complete understanding of the forces and risk factors associated with noncontact ACL injury should lead to the development of improved preventive strategies for this devastating injury...
  48. doi A 'plane' explanation of anterior cruciate ligament injury mechanisms: a systematic review
    Carmen E Quatman
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio 45229, USA
    Sports Med 40:729-46. 2010
    ..Collectively, the studies indicate that it is highly probable that ACL injuries are more likely to occur during multi-planar rather than single-planar mechanisms of injury...
  49. pmc Neuromuscular training improves performance on the star excursion balance test in young female athletes
    Alyson Filipa
    Sports Medicine Biodynamics Center, Cincinnati Children s Hospital Medical Center, Cincinnati, OH, USA
    J Orthop Sports Phys Ther 40:551-8. 2010
    ..Controlled cohort repeated-measures experimental design...
  50. pmc A systematic review of sensorimotor function during adolescence: a developmental stage of increased motor awkwardness?
    Catherine C Quatman-Yates
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Medical Center Research Foundation, Ohio, USA
    Br J Sports Med 46:649-55. 2012
    ..literature relative to two questions: (1) Which sensorimotor mechanisms are not fully mature by the time children reach adolescence? and (2) Is adolescence a period when children exhibit delays or regressions in sensorimotor mechanisms?..
  51. doi Landing adaptations following isolated lateral meniscectomy in athletes
    Kevin R Ford
    Cincinnati Children s Hospital Medical Center Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    Knee Surg Sports Traumatol Arthrosc 19:1716-21. 2011
    ..We hypothesized that following lateral meniscectomy, athletes aged 14-25 years old would demonstrate altered landing biomechanics compared to sex, age, height, weight, and sport-matched controls...
  52. pmc Is body composition associated with an increased risk of developing anterior knee pain in adolescent female athletes?
    Kim D Barber Foss
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    Phys Sportsmed 40:13-9. 2012
    ..To determine the relationship between relative body composition and body mass to height, anterior knee pain, or patellofemoral pain (PFP) in adolescent female athletes...
  53. doi Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport
    Mark V Paterno
    Sports Health and Performance Institute, The Ohio State University Medical Center, Columbus, Ohio, USA
    Clin J Sport Med 22:116-21. 2012
    ..The hypotheses were that the IR of anterior cruciate ligament (ACL) injury after ACLR would be greater than the IR in an uninjured cohort of athletes and would be greater in female athletes after ACLR than male athletes...
  54. pmc A between sex comparison of anterior-posterior knee laxity after anterior cruciate ligament reconstruction with patellar tendon or hamstrings autograft: a systematic review
    Mark V Paterno
    Sports Health and Performance Institute, The Ohio State University Medical Center, Columbus, OH 43221, USA
    Sports Med 42:135-52. 2012
    ..Future studies need to rigorously address this clinical question to confirm the results currently in the literature...
  55. pmc Reliability of the one-repetition-maximum power clean test in adolescent athletes
    Avery D Faigenbaum
    Department of Health and Exercise Science, The College of New Jersey, Ewing, New Jersey, USA
    J Strength Cond Res 26:432-7. 2012
    ..These findings indicate that 1RM power clean testing has a high degree of reproducibility in trained male adolescent athletes when standardized testing procedures are followed and qualified instruction is present...
  56. doi The mechanistic connection between the trunk, hip, knee, and anterior cruciate ligament injury
    Timothy E Hewett
    Departments of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine, and Biomedical Engineering, OSU Sports Health and Performance Institute, The Ohio State University, 2050 Kenny Road, Columbus, OH 43210, USA
    Exerc Sport Sci Rev 39:161-6. 2011
    ..The hypotheses explored are that lateral trunk motion increases load and that neuromuscular training that enhance trunk control will decrease load...
  57. doi Sex differences in proximal control of the knee joint
    Jurdan Mendiguchia
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Childrens Hospital Medical Center, Cincinnati, OH, USA
    Sports Med 41:541-57. 2011
    ..These differences may increase the risk of ACL injury among female athletes. Prevention programmes targeted towards trunk and hip neuromuscular control may decrease the risk for ACL injuries...
  58. pmc Cartilage pressure distributions provide a footprint to define female anterior cruciate ligament injury mechanisms
    Carmen E Quatman
    Departments of Physiology and Cell Biology, Sports Medicine Sports Health and Performance Institute, The Ohio State University, Columbus, Ohio, USA
    Am J Sports Med 39:1706-13. 2011
    ..The resultant footprint (location) of a bone bruise after ACL injury provides evidence of the inciting injury mechanism. Purpose/..
  59. pmc Biomechanics laboratory-based prediction algorithm to identify female athletes with high knee loads that increase risk of ACL injury
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, and Department of Pediatrics, College of Medicine, University of Cincinnati, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    Br J Sports Med 45:245-52. 2011
    ..The purpose of this study was to employ sensitive laboratory (lab-based) tools to determine predictive mechanisms that underlie increased KAM during landing...
  60. doi Clinical correlates to laboratory measures for use in non-contact anterior cruciate ligament injury risk prediction algorithm
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
    Clin Biomech (Bristol, Avon) 25:693-9. 2010
    ..The hypothesis was that clinically obtainable correlates derived from the highly predictive laboratory-based models would demonstrate high accuracy to determine high knee abduction moment status...
  61. pmc When to initiate integrative neuromuscular training to reduce sports-related injuries and enhance health in youth?
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
    Curr Sports Med Rep 10:155-66. 2011
    ....
  62. doi The incidence and potential pathomechanics of patellofemoral pain in female athletes
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
    Clin Biomech (Bristol, Avon) 25:700-7. 2010
    ..We hypothesized that increased dynamic knee abduction measured during preseason biomechanical testing would be increased in those who developed PFP relative to teammates who did not develop PFP...
  63. pmc Longitudinal sex differences during landing in knee abduction in young athletes
    Kevin R Ford
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    Med Sci Sports Exerc 42:1923-31. 2010
    ..The objective of this study was to determine whether biomechanical and neuromuscular risk factors related to abnormal movement patterns increased in females, but not males, during the adolescent growth spurt...
  64. pmc Sex differences in force attenuation: a clinical assessment of single-leg hop performance on a portable force plate
    A D Harrison
    Division of Occupational and Physical Therapy, The Sports Medicine Biodynamics Center, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229 3039, USA
    Br J Sports Med 45:198-202. 2011
    ..The authors hypothesised that females would demonstrate greater vGRF and force loading rate than males and show interlimb differences in force attenuation...
  65. ncbi Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase
    Gregory D Myer
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    J Orthop Sports Phys Ther 36:385-402. 2006
    ....
  66. ncbi Plyometric exercise in the rehabilitation of athletes: physiological responses and clinical application
    Terese L Chmielewski
    Department of Physical Therapy, University of Florida, Gainesville, FL 32610, USA
    J Orthop Sports Phys Ther 36:308-19. 2006
    ....
  67. ncbi The effects of plyometric vs. dynamic stabilization and balance training on power, balance, and landing force in female athletes
    Gregory D Myer
    Cincinnati Children s Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio 45229, USA
    J Strength Cond Res 20:345-53. 2006
    ..A combination of PLYO and BAL training may further maximize the effectiveness of preseason training for female athletes...
  68. ncbi Comparison of in-shoe foot loading patterns on natural grass and synthetic turf
    Kevin R Ford
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center, Human Performance Laboratory, Cincinnati, OH 45229, USA
    J Sci Med Sport 9:433-40. 2006
    ..Further epidemiological investigation is warranted to determine the effects of playing surfaces on sport specific injury mechanisms...
  69. ncbi Early rehabilitation following surgical fixation of a femoral shaft fracture
    Mark V Paterno
    Sports Medicine Biodynamics Center and Division of Occupational Therapy and Physical Therapy, Cincinnati Children s Hospital Medical Center, 3333 Burnett Ave, MLC 10001, Cincinnati, OH 45229 3039, USA
    Phys Ther 86:558-72. 2006
    ..The purpose of this case report is to describe the outcome of a patient following fixation of a midshaft femur fracture and an evaluation-based, immediate-weight-bearing approach to rehabilitation...
  70. ncbi Preparticipation physical examination using a box drop vertical jump test in young athletes: the effects of puberty and sex
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
    Clin J Sport Med 16:298-304. 2006
    ..This fact may underlie neuromuscular imbalances related to increased risk of injury in females. The hypothesis: female athletes would demonstrate mismatched landing force to power production compared with males...
  71. ncbi The effects of the menstrual cycle on anterior knee laxity: a systematic review
    Bohdanna T Zazulak
    Departments of Orthopedics and Rehabilitation Services, Yale New Haven Hospital, New Haven, Connecticut, USA
    Sports Med 36:847-62. 2006
    ....
  72. ncbi Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases
    Tron Krosshaug
    Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
    Am J Sports Med 35:359-67. 2007
    ..The mechanisms of anterior cruciate ligament injury in basketball are not well defined...
  73. ncbi Viscosupplementation for knee osteoarthritis: a systematic review
    Jon G Divine
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    Clin Orthop Relat Res 455:113-22. 2007
    ....
  74. ncbi The validation of a portable force plate for measuring force-time data during jumping and landing tasks
    Mark S Walsh
    Department of Physical Education, Health and Sport Studies, Miami University, Oxford, OH 45056, USA
    J Strength Cond Res 20:730-4. 2006
    ....
  75. ncbi A multidisciplinary approach to the evaluation, reconstruction and rehabilitation of the multi-ligament injured athlete
    Michael J Medvecky
    Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut 06510, USA
    Sports Med 37:169-87. 2007
    ....
  76. ncbi Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    Am J Sports Med 35:659-68. 2007
    ..These findings may lead to potential interventions targeted toward this phase of the menstrual cycle to reduce the incidence of anterior cruciate ligament injury...
  77. ncbi Gender differences in hip adduction motion and torque during a single-leg agility maneuver
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center, Division of Sports Medicine, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, MLC 10001, Cincinnati, Ohio 45229, USA
    J Orthop Res 24:416-21. 2006
    ..Females also exhibited significantly increased external hip adduction moments during landing 1, however, no differences were found between genders during landings 2 and 3...
  78. ncbi Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, OH 45229, USA
    Am J Sports Med 34:299-311. 2006
    ..Identification of both extrinsic and intrinsic risk factors associated with the anterior cruciate ligament injury mechanism may provide direction for targeted prophylactic treatment to high-risk individuals...
  79. ncbi Maturation leads to gender differences in landing force and vertical jump performance: a longitudinal study
    Carmen E Quatman
    Cincinnati Children s Hospital Research Foundation Sports Medicine Biodynamics Center, Cincinnati, OH 45229, USA
    Am J Sports Med 34:806-13. 2006
    ..Female athletes have increased risk of anterior cruciate ligament rupture after the onset of puberty...
  80. ncbi Gender differences in the kinematics of unanticipated cutting in young athletes
    Kevin R Ford
    Cincinnati Children s Hospital Research Foundation, 3333 Burnet Avenue, MLC 10001 Cincinnati, OH 45229, USA
    Med Sci Sports Exerc 37:124-9. 2005
    ..The hypotheses were that female athletes would display increased knee abduction, increased ankle eversion and decreased knee flexion during the unanticipated cutting maneuver compared with males...
  81. ncbi The effects of gender on quadriceps muscle activation strategies during a maneuver that mimics a high ACL injury risk position
    Gregory D Myer
    Division of Sports Medicine and Division of Molecular Cardiovascular Biology, Sports Medicine Biodynamics Center, Human Performance Laboratory, Cincinnati Children s Hospital Research Foundation, Cincinnati OH 45229, USA
    J Electromyogr Kinesiol 15:181-9. 2005
    ..05). The results of this study suggest that females utilize neuromuscular activation strategies which may contribute to "dynamic valgus" and ACL rupture when performing high-risk maneuvers...
  82. ncbi Neuromuscular training improves performance and lower-extremity biomechanics in female athletes
    Gregory D Myer
    Cincinnati Children s Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio 45229, USA
    J Strength Cond Res 19:51-60. 2005
    ..The results of this study support the hypothesis that the combination of multiple-injury prevention-training components into a comprehensive program improves measures of performance and movement biomechanics...
  83. ncbi Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center, Division of Molecular Cardiovascular Biology, Cincinatti Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    Am J Sports Med 33:492-501. 2005
    ..Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes...
  84. ncbi Reducing knee and anterior cruciate ligament injuries among female athletes: a systematic review of neuromuscular training interventions
    Timothy E Hewett
    Cincinnati Children s Hospital, Sports Medicine Biodynamics Center and Human Performance Laboratory, and the Department of Pediatrics, University of Cincinnati College of Medicine, College of Allied Health Sciences, Cincinnati, Ohio 45229, USA
    J Knee Surg 18:82-8. 2005
    ..It may be that prepubertal or early pubertal female athletes may have the potential to achieve optimal biomechanical changes and the greatest chance of injury-free sports participation throughout their careers...
  85. ncbi Use of an overhead goal alters vertical jump performance and biomechanics
    Kevin R Ford
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center, and Human Performance Laboratory, Cincinnati, Ohio 45229, USA
    J Strength Cond Res 19:394-9. 2005
    ..These results indicate that overhead goals may be incorporated during training and testing protocols to alter lower-extremity biomechanics and can increase performance...
  86. pmc A review of electromyographic activation levels, timing differences, and increased anterior cruciate ligament injury incidence in female athletes
    T E Hewett
    Cincinnati Children s Hospital, Sports Medicine Biodynamics Center, Cincinnati, OH 45229, USA
    Br J Sports Med 39:347-50. 2005
    ..The purpose of this review is to summarise the evidence for altered muscular activation and timing relative to ACL injury risk in female athletes...
  87. pmc Evaluation of a two dimensional analysis method as a screening and evaluation tool for anterior cruciate ligament injury
    S G McLean
    Department of Biomedical Engineering, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    Br J Sports Med 39:355-62. 2005
    ..Increased knee valgus predicts the risk of anterior cruciate ligament (ACL) injury, particularly in women. Reducing injury rates thus relies on detecting and continually evaluating people with relatively large valgus motions...
  88. ncbi Gender comparison of hip muscle activity during single-leg landing
    Bohdanna T Zazulak
    Yale New Haven Hospital, Department of Rehabilitation Services, New Haven, CT, USA
    J Orthop Sports Phys Ther 35:292-9. 2005
    ..Controlled laboratory study...
  89. ncbi A comparison of dynamic coronal plane excursion between matched male and female athletes when performing single leg landings
    Kevin R Ford
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Research Foundation, OH 45229, USA
    Clin Biomech (Bristol, Avon) 21:33-40. 2006
    ..The purpose of the current study was to identify gender and task differences in measures that may increase the risk of anterior cruciate ligament injury in female basketball and soccer athletes...
  90. ncbi The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics
    Gregory D Myer
    Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    Am J Sports Med 34:445-55. 2006
    ..The biomechanical effects of plyometric and balance training utilized separately are unknown...
  91. ncbi Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention
    Timothy E Hewett
    Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    Am J Sports Med 34:490-8. 2006
    ....
  92. ncbi Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study
    Bohdanna T Zazulak
    Department of Rehabilitation Services, Yale New Haven Hospital, New Haven, Connecticut 06510, USA
    Am J Sports Med 35:1123-30. 2007
    ..Female athletes are at significantly greater risk of anterior cruciate ligament (ACL) injury than male athletes in the same high-risk sports. Decreased trunk (core) neuromuscular control may compromise dynamic knee stability...
  93. pmc Differential neuromuscular training effects on ACL injury risk factors in"high-risk" versus "low-risk" athletes
    Gregory D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Medical Center, Cincinnati, USA
    BMC Musculoskelet Disord 8:39. 2007
    ..The hypothesis was that high-risk athletes would decrease knee abduction moments while low-risk and control athletes would not show measurable changes...
  94. pmc The effects of gender and pubertal status on generalized joint laxity in young athletes
    Carmen E Quatman
    Cincinnati Children s Hospital, Cincinnati, OH 45229, USA
    J Sci Med Sport 11:257-63. 2008
    ..Structural and physiological changes that occur during puberty such as alterations in passive joint restraints, may affect the type, severity and incidence of injuries in the maturing adolescent population...
  95. pmc Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism
    T E Hewett
    Cincinnati Children s Hospital, OH, USA
    Br J Sports Med 43:417-22. 2009
    ..The combined positioning of the trunk and knee in the coronal and sagittal planes during non-contact anterior cruciate ligament (ACL) injury has not been previously reported...
  96. ncbi Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors
    Eduard Alentorn-Geli
    Artroscopia G C, Hospital Quiron, Barcelona, Spain
    Knee Surg Sports Traumatol Arthrosc 17:705-29. 2009
    ..Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the sequelae of osteoarthritis associated with this traumatic injury...
  97. pmc Generalized joint laxity associated with increased medial foot loading in female athletes
    Kim D Barber Foss
    Sports Medicine Biodynamics Center, Cincinnati Children s Hospital, Cincinnati, OH 45229, USA
    J Athl Train 44:356-62. 2009
    ..The relationship between generalized joint laxity and plantar pressure distribution of the foot and the potential implications for lower extremity injury have not been studied...