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

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?

by: Nicole Cattano
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