Sports Medicine Research: In the Lab & In the Field: Screening with LESS (Sports Med Res)


Wednesday, April 29, 2015

Screening with LESS

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

Padua DA, DiStefano LJ, Beutler AI, de la Motte SJ, DiStefano M, & Marshall SW. Journal of Athletic Training. Online ahead of print, January 2015.

Take Home Message: The Landing Error Scoring System (LESS) can help us identify poor landing habits that may leave a young soccer athlete susceptible to an anterior cruciate ligament (ACL) injury. 

Anterior cruciate ligament (ACL) injuries are common in physically active and athletic populations.  Injury prevention programs are often implemented in high-risk groups such as soccer and basketball; however, there is limited research on screening tests that could be used to identify at-risk athletes. The authors of this study aimed to determine if the Landing Error Scoring System (LESS) can predict which young soccer players will have an ACL injury during a season. The LESS is a simple clinical test that requires a clinician to watch and score errors in landing technique as a participant lands and immediately jumps from a standardized height.  Two researchers completed the LESS assessment by video on 829 elite-youth soccer participants. The participants were recruited from two soccer leagues that had under-11 to under-18 age divisions between August 2006 and January 2009. Athletes who returned for a second season were retested at the beginning of each season. The researchers monitored athletes for injuries each season, resulting in a total 1217 athlete-season observations. All teams competed on natural grass and all participants were taking part in an injury-prevention warm up program.  Researchers verified by surgical report that 7 participants suffered an ACL injury, all during game participation.  It was determined that the mean LESS scores for those who suffered an ACL injury (6.24) was higher than those who did not suffer an ACL injury (4.43).  Furthermore, a participant with a LESS score of 5 or more was almost 10 times more likely to sustain a non-contact ACL injury in a season in comparison with those with a LESS scores of less than 5.  A LESS cut-point of 5.17 yielded an 86% sensitivity and 71% specificity, while using a LESS cut-point of 5 lowered the specificity to 64%. Based on the individual LESS items, the group that sustained ACL injuries had greater trunk-flexion displacement and were less likely to have a soft landing.
The LESS assessment has value as a screening tool for identifying young soccer players at high risk for an ACL injury.  It appears that those who landed softer did not have ACL issues; however, it would be interesting to see how landing stiffness related to performance variables – such as vertical jump height.  This same research group previously found no differences between those that tore their ACL or not pre-injury, but that injured individuals developed altered biomechanics post-injury.  The findings of this current study may implicate specific areas such as trunk-flexion displacement and soft landings that injury prevention programs should focus on.  It is difficult to determine the prognostic value of LESS assessment given the relatively low injury rates that were seen in this study population; therefore, the LESS should continue to be utilized in at-risk groups (e.g., women’s soccer, women’s basketball, gymnastics) because more ACL injuries occur prospectively.  Furthermore, it would be interesting to see the impact of injury prevention programs on improving LESS scores, especially in high-risk populations.  Clinicians may want to familiarize themselves with the LESS because it takes a minimal amount of tools and time, and may identify at-risk athletes with poor landing strategies.
Questions for Discussion:  Would you consider using the LESS to identify at-risk individuals in a pre-season screening?  Do you emphasize a stiff landing or knee flexion upon landing?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

Related Posts:
Padua, D., DiStefano, L., Beutler, A., de la Motte, S., DiStefano, M., & Marshall, S. (2015). The Landing Error Scoring System as a Screening Tool for an Anterior Cruciate Ligament Injury–Prevention Program in Elite-Youth Soccer Athletes Journal of Athletic Training DOI: 10.4085/1062-6050-50.1.10


Ada Weiss said...

The participant population here ranged in age from 11 to 18. Another area of future research related to these results that could be interesting would be to asses how LESS scores change/don't change through the course of puberty. Also, a survival analysis of the younger athletes who score above the cut-point of 5 observed here would be interesting to follow for ACL injury rates.

Nicole Cattano said...

Ada - I think you are right that each of those analyses would be interesting. Another layer of interest may be whether or not early sport specialization has any effects or relationships on LESS scores.

Thanks for your comment!

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