![]() Consequently, screening tools and field-based interventions that can assist in ACL injury risk mitigation is of great interest, particularly for practitioners working in sports where cutting is the predominant mechanism of non-contact ACL injury. ![]() For example, 60–67% of non-contact ACL injuries in rugby, American football, and handball occur during side-step cutting, while this manoeuvre is also linked with non-contact ACL injury events in soccer, badminton, and Australian rules football. ![]() However, because side-steps are frequently performed movements in sports, and performed at high-intensity, and thus have the potential to generate high impact forces and knee joint loads, they are also commonly observed manoeuvres during non-contact ACL injury events. Side-step cutting (lateral foot plant) is an important high-intensity action performed in numerous sports, and is a pivotal action performed to evade opponents, penetrate defensive lines and gain territorial advantage in sports such as rugby, American football, and handball. Qualitative Screening: Why Assess Cutting Movement Quality?ĭue to the plethora of negative implications associated with non-contact ACL injury, being able to profile and classify athletes as potentially “high-risk” of injury is a crucial process in ACL injury mitigation. As such, the mechanism of ACL injury, from a knee joint loading perspective, has been stated as “multiplanar” highlighting the importance of reducing multiplanar joint loading during high-risk activities to mitigate ACL injury risk. Importantly, neuromuscular control and biomechanical deficits are modifiable through appropriate training and conditioning, which may reduce knee joint loading during high-impact actions and subsequent risk of non-contact ACL injury. These multiplanar knee joint loads are often used as surrogates of non-contact ACL injury risk, and are amplified during COD, landings, and decelerations when aberrant and “high-risk” neuromuscular control and biomechanical deficits are displayed (e.g., lateral trunk flexion, knee valgus, etc.). Non-contact ACL injuries generally occur during high-impact tasks such as change of directions (COD) (side-step, cut or turn, plant-and-cut manoeuvres), landing (predominantly single-leg weight bearing), and deceleration actions attributable to the potential generation of high multiplanar knee joint loading (flexion, rotation, abduction and translatory moments) during foot contact, thus increasing ACL strain. Mitigating ACL injury risk therefore is considered highly important in sports medicine and science environments. This process, without adequate rest and repair, can lead to micro damage and subsequent ACL failure from mechanical loads which previously could be tolerated. In simplistic terms, ACL injuries occur when a catastrophic applied load exceeds the ligament’s tolerance, or due to a “fatigue failure” mechanism whereby the accumulation of high magnitudes and repetitive cycles of knee joint loading. ACL injury risk factors are multifactorial (anatomical, hormonal, biomechanical, neuromuscular, environmental) and a complex interaction of both internal (within the body) and external (outside the body) factors. ![]() Additionally, this review provides guidance on CMAS methodological procedures, CMAS operational definitions, and training recommendations to assist in the development of more effective non-contact ACL injury risk mitigation programmes.Īn anterior cruciate ligament injury (ACL) is considered one of the most significant and debilitating injuries an athlete can experience, with an abundance of negative economic, psychological, and health implications. This article provides practitioners with a comprehensive and detailed overview regarding the rationale and implementation of the CMAS. The Cutting Movement Assessment Score (CMAS) is a recently validated field-based qualitative screening tool to identify athletes that display high-risk postures associated with increased non-contact ACL injury risk during side-step cutting. Importantly, biomechanical and neuromuscular deficits are modifiable thus, being able to profile and classify athletes as potentially “high-risk” of injury is a crucial process in ACL injury mitigation. Although ACL injury risk factors are multifactorial, biomechanical and neuromuscular deficits which contribute to “high-risk” and aberrant movement patterns are linked to ACL injury risk due to increasing knee joint loads and potential ACL loading. Side-step cutting is an action associated with non-contact anterior cruciate ligament (ACL) injury with a plethora of negative economical, health, and psychological implications.
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