Development and validation of a clinic-based prediction tool to identify female athletes at high risk for anterior cruciate ligament injury

Gregory D. Myer, Kevin R. Ford, Jane Khoury, Paul Succop, Timothy E. Hewett

Research output: Contribution to journalArticlepeer-review

126 Scopus citations


Background: Prospective measures of high knee abduction moment (KAM) during landing identify female athletes at high risk for anterior cruciate ligament injury. Laboratory-based measurements demonstrate 90% accuracy in prediction of high KAM. Clinic-based prediction algorithms that employ correlates derived from laboratory-based measurements also demonstrate high accuracy for prediction of high KAM mechanics during landing. Hypotheses: Clinic-based measures derived from highly predictive laboratory-based models are valid for the accurate prediction of high KAM status, and simultaneous measurements using laboratory-based and clinic-based techniques highly correlate. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: One hundred female athletes (basketball, soccer, volleyball players) were tested using laboratory-based measures to confirm the validity of identified laboratory-based correlate variables to clinic-based measures included in a prediction algorithm to determine high KAM status. To analyze selected clinic-based surrogate predictors, another cohort of 20 female athletes was simultaneously tested with both clinic-based and laboratory-based measures. Results: The prediction model (odds ratio: 95% confidence interval), derived from laboratory-based surrogates including (1) knee valgus motion (1.59: 1.17-2.16 cm), (2) knee flexion range of motion (0.94: 0.89°-1.00°), (3) body mass (0.98: 0.94-1.03 kg), (4) tibia length (1.55: 1.20-2.07 cm), and (5) quadriceps-to-hamstrings ratio (1.70: 0.48%-6.0%), predicted high KAM status with 84% sensitivity and 67% specificity (P <.001). Clinic-based techniques that used a calibrated physician's scale, a standard measuring tape, standard camcorder, ImageJ software, and an isokinetic dynamometer showed high correlation (knee valgus motion, r =.87; knee flexion range of motion, r =.95; and tibia length, r =.98) to simultaneous laboratory-based measurements. Body mass and quadriceps-to-hamstrings ratio were included in both methodologies and therefore had r values of 1.0. Conclusion: Clinically obtainable measures of increased knee valgus, knee flexion range of motion, body mass, tibia length, and quadriceps-to-hamstrings ratio predict high KAM status in female athletes with high sensitivity and specificity. Female athletes who demonstrate high KAM landing mechanics are at increased risk for anterior cruciate ligament injury and are more likely to benefit from neuromuscular training targeted to this risk factor. Use of the developed clinic-based assessment tool may facilitate high-risk athletes' entry into appropriate interventions that will have greater potential to reduce their injury risk.

Original languageEnglish (US)
Pages (from-to)2025-2033
Number of pages9
JournalAmerican Journal of Sports Medicine
Issue number10
StatePublished - Oct 2010


  • ACL injury prevention
  • ACL injury risk factors
  • assessment tools
  • clinician-friendly
  • high-risk biomechanics
  • targeted neuromuscular training

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Orthopedics and Sports Medicine


Dive into the research topics of 'Development and validation of a clinic-based prediction tool to identify female athletes at high risk for anterior cruciate ligament injury'. Together they form a unique fingerprint.

Cite this