A systematic review of injuries in recreational field hockey: From injury problem to prevention

ABSTRACT

The purpose of this study was to gather information from scientific literature related to all steps of Van Mechelen’s “sequence of prevention” for injuries applied to youth and adult recreational field hockey players. A systematic review was conducted in Medline via Pubmed and in SPORTDiscus via EBSCOhost. Twenty-six original studies were included. Regarding injury incidence (step 1) results showed several overall injury incidence rates (youth: 1.47 per 1,000 Athlete Exposure (AE) time-loss (TL) injury up to 11.32 per 1,000 AE TL ánd non-time loss (NTL) injury, adults: 2.2 NTL injury per 1,000 AE, 15.2 injury per 1,000 hours of sports participation). Considering games and practices, most injuries were sustained in games (youth: 4.9, adults: 7.87 per 1,000 AE). Considering body parts, highest injury incidence rates were found in body parts in the lower extremities (youth: knee injuries in games (0.33 per 1,000 AE), adults: hamstring injuries in pre-season (0.75 per 1,000 AE)) and injuries in the head/face/eye (youth: 0.66 and adults: 0.94 head/face/eye, 0.71 head/face and 0.63 concussion per 1,000 AE). Regarding aetiology (step 2), no studies were found. Regarding the efficacy of available interventions (step 3 and 4), one study was found among youth players, describing a warm-up programme.     

Effects of strength training on physical fitness and sport-specific performance in recreational,sub-elite,and elite rowers: A systematic review with meta-analysis

ABSTRACT

The purpose of this systematic review with meta-analysis was to examine the effects of strength training (ST) on selected components of physical fitness (e.g., lower/upper limb maximal strength, muscular endurance, jump performance, cardiorespiratory endurance) and sport-specific performance in rowers. Only studies with an active control group were included if they examined the effects of ST on at least one proxy of physical fitness and/or sport-specific performance in rowers. Weighted and averaged standardized mean differences (SMD) were calculated using random-effects models. Subgroup analyses were computed to identify effects of ST type or expertise level on sport-specific performance. Our analyses revealed significant small effects of ST on lower limb maximal strength (SMD = 0.42, p = 0.05) and on sport-specific performance (SMD = 0.32, p = 0.05). Non-significant effects were found for upper limb maximal strength, upper/lower limb muscular endurance, jump performance, and cardiorespiratory endurance. Subgroup analyses for ST type and expertise level showed non-significant differences between the respective subgroups of rowers (p ≥ 0.32). Our systematic review with meta-analysis indicated that ST is an effective means for improving lower limb maximal strength and sport-specific performance in rowers. However, ST-induced effects are neither modulated by ST type nor rowers’ expertise level.     

Young,talented and injured: Injury perceptions,experiences and consequences in adolescent elite athletes

Even though injury is common in elite sports, there is still a lack of knowledge of young athletes’ injury perception both during and after injury. The aim of this mixed-method study was, therefore, to explore, in-depth, data on injury consequences and adolescent elite athletes’ perceptions and experience of injury. Three hundred and forty adolescent elite athletes (age range 15–19), from 16 different sports, were bi-weekly monitored over 52 weeks using a valid questionnaire. Twenty athletes from the same cohort were interviewed in focus groups about injury experience and perceptions. The results show that the average bi-weekly prevalence of injury was 38.7% (95% CI 37.3–40.1), with 30.0% (n?=?102) of the athletes injured for more than half of all reporting times. An overarching theme from the focus groups highlighted the risk among young athletes of a loss of identity while injured. The findings support several suggestions that may improve the rehabilitation process and enhance rehabilitation outcomes: (a) provide clear pathways to the medical team, (b) recognize the identity loss, (c) involve the injured athletes with the rest of the teammates and (d) educate athletes about how to interpret pain signals. Future research should explore and evaluate the effectiveness and generalization of such interventions.     

Incidence,aetiology and prevention of musculoskeletal injuries in volleyball: A systematic review of the literature

Currently, there is no overview of the incidence and (volleyball-specific) risk factors of musculoskeletal injuries among volleyball players, nor any insight into the effect of preventive measures on the incidence of injuries in volleyball. This study aimed to review systematically the scientific evidence on the incidence, prevalence, aetiology and preventive measures of volleyball injuries. To this end, a highly sensitive search strategy was built based on two groups of keywords (and their synonyms). Two electronic databases were searched, namely Medline (biomedical literature) via Pubmed, and SPORTDiscus (sports and sports medicine literature) via EBSCOhost. The results showed that ankle, knee and shoulder injuries are the most common injuries sustained while playing volleyball. Results are presented separately for acute and overuse injuries, as well as for contact and non-contact injuries. Measures to prevent musculoskeletal injuries, anterior knee injuries and ankle injuries were identified in the scientific literature. These preventive measures were found to have a significant effect on decreasing the occurrence of volleyball injuries (for instance on ankle injuries with a reduction from 0.9 to 0.5 injuries per 1000 player hours). Our systematic review showed that musculoskeletal injuries are common among volleyball players, while effective preventive measures remain scarce. Further epidemiological studies should focus on other specific injuries besides knee and ankle injuries, and should also report their prevalence and not only the incidence. Additionally, high-quality studies on the aetiology and prevention of shoulder injuries are lacking and should be a focus of future studies.     

Golf-related injuries: A systematic review

Abstract

A review was undertaken to assess the prevalence of musculoskeletal injuries in golf and to stimulate the discussion on possible injury mechanisms. The main conclusion of most published studies is that although professional and amateur golfers show a similar anatomical distribution of injuries by body segment, differences tend to be seen in the ranking of injury occurrence by anatomical site. This could be due to many things, including the player's handicap, age, golf swing biomechanics, and training or playing habits. The impact of golf injuries deserves special attention due to the interaction of the nature of the injury, practice routines, amount of practice, handicap, and frequency of activity. Individual differences and clinical and coaching procedures deserve investigation. Other epidemiological information should be regarded as insufficient with respect to a full understanding of injury mechanisms, which can give us a better insight into the evolutionary nature of the injury. Also, a better understanding of golf swing mechanisms and individual neuromuscular aspects can help explain why some individuals are more injury-prone than others.     

Movement concepts approach in studies on flamenco dancing: A systematic review

Background: Flamenco is a highly emotional and demanding dance form. It is important to understand how the dancer’s body works in order to improve fitness levels and reduce injuries. Thus, our investigation reviewed studies on kinesiological aspects of flamenco over recent years. Methods: The review was restricted to experimental studies. Literature searches were conducted using the following databases: PubMed, Scopus, and Ebsco: SPORTDiscus with Full Text, Medline, Health Source: Nursing/Academic Edition, Health Source – Consumer Edition. After limiting the search, 180 potential articles remained for analysis. Results: A total of 27 papers on different aspects of flamenco dance were finally selected: biomechanics (14), podiatry (6), injury incidence (3), anthropometry (2), and physiology (2). These studies have applied well-established methods from sports studies. However, we noted a number of potential limitations when applied to flamenco. Conclusions: The evidence from this review shows that flamenco dancing demands high levels of effort. Further research is required to understand how the dancer’s body works in order to improve fitness levels and reduce injuries. Most of the results presented here are consistent among studies. However, there is a great scarcity of research addressing flamenco movement in a more comprehensive perspective.     

Impact of touring,performance schedule,and definitions on 1-year injury rates in a modern dance company

There is ongoing debate about how to define injury in dance: the most encompassing one or a time-loss definition. We examined the relationship between touring, performance schedule and injury definition on injury rates in a professional modern dance company over one-year. In-house healthcare management tracked 35 dancers for work-related musculoskeletal injuries (WMSI), time-loss injuries (TLinj), complaints, and exposure. The year was divided into 6 segments to allow comparison of effects of performance, rehearsal, and touring. Injuries/segment were converted into injuries/1000-h dance exposure. We conducted negative binomial regression analysis to determine differences between segments, P ≤ 0.05. Twenty WMSI, 0.44 injuries/1000-h, were sustained over one-year. WMSI were 6 times more likely to occur in Segment-6, compared with other segments (incident rate ratio = 6.055, P = 0.031). The highest rate of TLinj and traumatic injuries also occurred in Segment-6, reflecting concentrated rehearsal, New York season and performances abroad. More overuse injuries occurred in Segment-2, an international tour, attributed to raked stages. Lack of methods to quantify performance other than injury may mask effects of touring on dancer’s well-being. Tracking complaints permits understanding of stressors to specific body regions and healthcare utilisation; however, TLinj remain the most important injuries to track because they impact other dancers and organisational costs.     

Injury and illness in short-course triathletes:A systematic review

Background:Determining the incidence and prevalence of injury and illness in short-course triathletes would improve understanding of their etiologies and therefore assist in the development and implementation of prevention strategies.This study synthesizes the existing evidence on the incidence and prevalence of injury and illness and summarizes reported injury or illness etiology and risk factors affecting short-course triathletes.Methods:This review followed the Preferred Reporting Items for S...     

Musculoskeletal injuries in professional modern dancers: a prospective cohort study of 15 years

We analysed work-related musculoskeletal injuries (WMSI) in two modern dance companies to determine whether injury rates decreased and patterns altered compared to previous 3-yr and 6-yr audits (0.48 and 0.25/1000-hrs exposure respectively). In this prospectively designed 15-yr cohort study, data were collected in 30-dancer Company-1 and 12-dancer Company-2. In-house physical therapists tracked WMSI and time-loss-injuries for 159 dancers (42 dancers/yr). 15-yrs were grouped into five 3-yr blocks for comparison with prior audits. Negative binomial logistic regression analyses were conducted with exposure-hrs converted to the natural log and used as the offset variable. Block and company were categorical predictors for dependent variables: WMSI, time-loss-injuries, trauma-injuries and overuse-injuries (p < 0.05). 69% of dancers reported WMSI; 45% sustained at least one time-loss-injury. Company-1, with greater annual exposure, was 1.6-times more likely to sustain time-loss-injuries (p = 0.016, CI = 1.095–2.422) and 5.6-times more likely to sustain time-loss overuse-injuries (p = 0.003, CI = 1.812–17.327). Compared to Block-1, WMSI and time-loss-injuries decreased in Blocks-2, 3, and 5 (p ≤ 0.027). The ratio of time-loss overuse to trauma-injuries was reversed, with trauma-injuries accounting for over 80% of injuries by Block 5. Time-loss-injuries averaged 0.16 injuries/1000-hrs, lower than rates in ballet and sports. Decreased injury rates and changed injury patterns demonstrate efficacious injury management and prevention programming.     

Incidence of injuries in professional snow sports: A systematic review and meta-analysis

Purpose:The study aimed to conduct a comprehensive systematic review and meta-analysis of injury incidence in professional skiers and snowboarders.Methods:We systematically searched PubMed,Web of Science,and MEDLINE for studies on injury incidence published from inception to April 2020.Injury data were extracted,alongside information on injury location,severity,type,cause,and sport discipline.Incidence of injuries was presented per 1000 athlete-days,with 95%confidence intervals(95%CIs).Results:The search identified 462 articles,and 22 were included in our review.The overall incidence of injuries among professional skiers and snowboarders was 3.49 per 1000 athlete-days(95%CI:2.97-4.01).Lower extremity had the highest injury incidence(1.54 per 1000 athletedays,95%CI:1.24-1.84).Incidence rates of slight,mild,moderate,and severe injuries were 0.26,0.31,0.57,and 0.59 per 1000 athlete-days,respectively.Contusion had the highest incidence rate(1.82 per 1000 athlete-days,95%CI:1.01-2.63).The most common cause of injury was contact trauma(3.20 per 1000 athlete-days,95%CI:1.32-5.08).Freestyle skiing had the highest incidence rate(6.83 per 1000 athlete-days,95%CI:4.00-9.66),and Nordic skiing had the lowest rate(2.70 per 1000 athlete-days,95%CI:1.94-3.46).Conclusion:Professional skiers and snowboarders have a substantial risk of sustaining injuries.Our findings can be used to inform the planning and provision of healthcare for elite participants in different snow sports.     

Prevalence and correlates of psychological distress among retired elite athletes: A systematic review

ABSTRACT

This article presents results of a systematic review of the literature (2000–2017) examining the prevalence and correlates of psychological distress among retired elite athletes. Forty articles were selected and included. Our review suggests the prevalence of psychological distress among retired athletes is similar to that found in the general population. However, subgroups reporting medical comorbidities, significant pain, a greater number of concussions, less social support, and adverse psychosocial factors were at greater risk for psychological distress. Additionally, athletes experiencing psychological distress in retirement often do not seek treatment for their distress. Based on the existing literature, there is a need for greater standardization and use of reliable measures, as well as use of diagnostic interviews in order to assess the most accurate prevalence of psychological distress among these athletes. Longitudinal designs, matched control groups, more heterogeneous samples, and use of multivariate analyses would also help to more accurately determine the prevalence and risk factors of psychological distress in this population. This review suggests a number of different clinical implications and highlights directions for future research to enhance our understanding of the long-term psychological health of former elite athletes.     

A comparison of the anthropometric, strength, endurance and flexibility characteristics of female elite and recreational climbers and non-climbers.

There is limited information on the anthropometry, strength, endurance and flexibility of female rock climbers. The aim of this study was to compare these characteristics in three groups of females: Group 1 comprised 10 elite climbers aged 31.3 +/- 5.0 years (mean +/- s) who had led to a standard of 'hard very severe'; Group 2 consisted of 10 recreational climbers aged 24.1 +/- 4.0 years who had led to a standard of 'severe'; and Group 3 comprised 10 physically active individuals aged 28.5 +/- 5.0 years who had not previously rock-climbed. The tests included finger strength (grip strength, finger strength measured on climbing-specific apparatus), flexibility, bent arm hang and pull-ups. Regression procedures (analysis of covariance) were used to examine the influence of body mass, leg length, height and age. For finger strength, the elite climbers recorded significantly higher values (P < 0.05) than the recreational climbers and non-climbers (four fingers, right hand: elite 321 +/- 18 N, recreational 251 +/- 14 N, non-climbers 256 +/- 15 N; four fingers, left hand: elite 307 +/- 14 N, recreational 248 +/- 12 N, non-climbers 243 +/- 11 N). For grip strength of the right hand, the elite climbers recorded significantly higher values than the recreational climbers only (elite 338 +/- 12 N, recreational 289 +/- 10 N, non-climbers 307 +/- 11 N). The results suggest that elite climbers have greater finger strength than recreational climbers and non-climbers.     

Risk factors for overuse injuries in short- and long-distance running: A systematic review

Purpose:The aim of this study was to review information about risk factors for lower extremity running injuries in both short-distance(mean running distance-20 km/week and-10 km/session)and long-distance runners(mean running distance>20 km/week and>10 km/session).Methods:Electronic databases were searched for articles published up to February 2019.Prospective cohort studies using multivariable analysis for the assessment of individual risk factors or risk models for the occurrence of lower extremity running injuries were included.Two reviewers independently selected studies for eligibility and assessed risk of bias with the Quality in Prognostic Studies Tool.The GRADE approach was used to assess the quality of the evidence.Results:A total of 29 studies were included:17 studies focused on short-distance runners,11 studies focused on long-distance runners,and 1 study focused on both types of runners.A previous running-related injury was the strongest risk factor for an injury for long-distance runners,with moderate-quality evidence.Previous injuries not attributed to running was the strongest risk factor for an injury for short-distance runners,with high-quality evidence.Higher body mass index,higher age,sex(male),having no previous running experience,and lower running volume were strong risk factors,with moderate quality evidence,for short-distance runners.Low-quality evidence was found for all risk models as predictors of runningrelated injuries among short-and long-distance runners.Conclusion:Several risk factors for lower extremity injuries have been identified among short-and long-distance runners,but the quality of evidence for these risk factors for running-related injuries is limited.Running injuries seem to have a multifactorial origin both in short-and long-distance runners.     

Injury rate,mechanism, and risk factors of hamstring strain injuries in sports: A review of the literature

Hamstring strains are one of most common sports injuries. The purpose of this literature review is to summarize studies on hamstring strain injury rate, mechanism, and risk factors in the last several decades with a focus on the prevention and rehabilitation of this injury. Hamstring injury commonly occurs in sporting events in which high speed sprinting and kicking are frequently performed, such as Australian football, English rugby, American football, and soccer. Basic science studies have demonstrated that a muscle strain injury occurs due to excessive strain in eccentric contraction instead of force, and that elongation speed and duration of activation before eccentric contraction affect the severity of the injury. Hamstring strain injury is likely to occur during the late swing phase and late stance phase of sprint running. Shortened optimum muscle length, lack of muscle flexibility, strength imbalance, insufficient warm-up, fatigue, lower back injury, poor lumbar posture, and increased muscle neural tension have been identified as modifiable risk factors while muscle compositions, age, race, and previous injuries are non-modifiable risk factors. The theoretical basis of some of these risk factors, however, is lacking, and the results of clinical studies on these risk factors are inconsistent. Future studies are needed to establish the cause-and-effect relationships between those proposed risk factors and the injury.     

Sex differences in injury rates in team-sport athletes: A systematic review and meta-regression analysis

Background:Team-sport players have a particularly high injury risk.Although female sex is considered a risk factor,it is still unknown whether female and male team-sport players,in fact,differ in their injury rates.We aimed to compare injury rates between female and male players by systematically reviewing and meta-analyzing injury surveillance studies of both sexes in order to evaluate sex-specific differences in team-sport injuries.Methods:Studies that prospectively collected injury data for high-level female and male players(age≥16 years)in basketball,field hockey,football(soccer),handball,rugby(union and sevens),and volleyball were included.Two reviewers(AZ and ALR)independently assessed study quality and extracted data for overall,match,training,and severe injuries(>28 days’time loss)as well as data regarding injury locations and types.Incidence rate ratios(IRRs)were pooled in a meta-analysis,and meta-regression analysis was performed when 10 or more studies were available.Results:Of 20 studies,9 studies reported injury data from football,3 studies from rugby,3 studies from handball,1 study from basketball,1 study from field hockey,2 studies from volleyball,and 1 study from basketball and field hockey.For overall injuries,the pooled IRR=0.86(95%confidence interval(95%CI):0.76-0.98)indicated significantly more injuries in male than in female players.For injury location,the pooled IRR showed higher injury rates in male athletes than in female athletes for upper extremity,hip/groin,thigh,ande foot injuries.Female players had a significantly higher rate of anterior cruciate ligament injuries(IRR=2.15,95%CI:1.27-3.62)than male players.No significant sex-specific differences in IRR were found for match,training,severe injuries,concussions,or ankle sprains.Conclusion:Our meta-analysis provides evidence for sex-specific differences in the injury rates in team sports.Further epidemiological studies including both sexes in sports other than football are needed in order to strengthen the evidence.     

Risk factors for musculoskeletal injuries in elite junior tennis players: a systematic review

The objective was to systematically review the literature on risk factors and prevention programs for musculoskeletal injuries among tennis players. PubmedMedline, Embase, CINAHL, Cochrane, SportDiscus were searched up to February 2017. Experts in clinical and epidemiological medicine were contacted to obtain additional studies.

For risk factors, prospective cohort studies (n > 20) with a statistical analysis for injured and non-injured players were included and studies with a RCT design for prevention programs. Downs&Black checklist was assessed for risk of bias for risk factors. From a total of 4067 articles, five articles met our inclusion criteria for risk factors. No studies on effectiveness of prevention programs were identified. Quality of studies included varied from fair to excellent.

Best evidence synthesis revealed moderate evidence for previous injury regardless of body location in general and fewer years of tennis experience for the occurrence of upper extremity injuries. Moderate evidence was found for lower back injuries, a previous back injury, playing >6hours/week and low lateral flexion of the neck for risk factors. Limited evidence was found for male gender as a risk factor.

The risk factors identified can assist clinicians in developing prevention-strategies. Further studies should focus on risk factor evaluation in recreational adult tennis players.     

Effect of a Marathon Run on Serum Lipoproteins,Creatine Kinase,and Lactate Dehydrogenase in Recreational Runners

Abstract

The objective of this study was to determine the effect of a marathon run on serum lipid and lipoprotein concentrations and serum muscle enzyme activities and follow their recovery after the run. These blood concentrations were measured before, immediately after, and serially after a marathon run in 15 male recreational runners. The triglyceride level was significantly elevated postrace, then fell 30% below baseline 1 day after the run, and returned to baseline after 1 week. Total cholesterol responded less dramatically but with a similar pattern. High-density lipoprotein cholesterol remained significantly elevated and low-density lipoprotein cholesterol was transiently reduced for 3 days after the run. The total cholesterol/high-density cholesterol ratio was significantly lowered for 3 days. Serum lactate dehydrogenase activity significantly doubled postrace and then declined but remained elevated for 2 weeks. Serum creatine kinase activity peaked 24 hr after the run, with a 15-fold rise, and returned to baseline after 1 week. The rise of these enzymes reflects mechanically damaged muscle cells leaking contents into the interstitial fluid. It is concluded that a prolonged strenuous exercise bout in recreational runners, such as a marathon, produces beneficial changes in lipid blood profiles that are significant for only 3 days. However, muscle damage is also evident for 1 week or more from the dramatic and longlasting effect on enzyme levels. Laboratory values for these runners were outside normal ranges for some days after the race.     

Validity of Wrist-Worn photoplethysmography devices to measure heart rate: A systematic review and meta-analysis

ABSTRACT

Heart rate (HR), when combined with accelerometry, can dramatically improve estimates of energy expenditure and sleep. Advancements in technology, via the development and introduction of small, low-cost photoplethysmography devices embedded within wrist-worn consumer wearables, have made the collection of heart rate (HR) under free-living conditions more feasible. This systematic review and meta-analysis compared the validity of wrist-worn HR estimates to a criterion measure of HR (electrocardiography ECG or chest strap). Searches of PubMed/Medline, Web of Science, EBSCOhost, PsycINFO, and EMBASE resulted in a total of 44 articles representing 738 effect sizes across 15 different brands. Multi-level random effects meta-analyses resulted in a small mean difference (beats per min, bpm) of ?0.40 bpm (95 confidence interval (CI) ?1.64 to 0.83) during sleep, ?0.01 bpm (?0.02 to 0.00) during rest, ?0.51 bpm (?1.60 to 0.58) during treadmill activities (walking to running), while the mean difference was larger during resistance training (?7.26 bpm, ?10.46 to ?4.07) and cycling (?4.55 bpm, ?7.24 to ?1.87). Mean difference increased by 3 bpm (2.5 to 3.5) per 10 bpm increase of HR for resistance training. Wrist-worn devices that measure HR demonstrate acceptable validity compared to a criterion measure of HR for most common activities.     

Lower leg and foot contributions to turnout in female pre-professional dancers: A 3D kinematic analysis

Turnout is a central element of classical ballet which involves sustained external rotation of the lower limbs during dance movements. Lower leg and foot compensation mechanisms which are often used to increase turnout have been attributed to the high incidence of lower limb injury in dancers. Evaluation of dancers’ leg posture is needed to provide insight into the lower limb kinematic strategies used to achieve turnout. The primary purpose of this study was to use 3D kinematic analyses to determine the lower leg and foot compensations that are incorporated by female university dancers to accentuate their turnout. Active and passive external tibiofemoral rotation (TFR) was also measured. A moderate-strong negative relationship was observed between hip external rotation (HER) and foot abduction in the three first position conditions. A moderate negative relationship was found between passive TFR and foot abduction in all first position conditions. Our findings suggest dancers are more likely to pronate, than rotate the knee to compensate for limited HER. Dancers with a limited capacity to pronate may force additional rotation via the knee. Ongoing research would benefit from more in-depth analyses of the foot/ankle complex using a multi-segment foot model.     

The role of ultrasonography in the diagnosis of anterior cruciate ligament injury: A systematic review and meta-analysis

To evaluate the value of ultrasonography in the diagnosis of anterior cruciate ligament injury (ACL injury) by conducting a systematic review and meta-analysis. A literature search was carried out in the Cochrane Library, Embase, Pubmed databases and included studies prior to April 2017. Based on inclusion and exclusion criteria, studies evaluating ultrasound to diagnose ACL injury were selected. MRI, arthroscopy and clinical-follow were considered the reference standards. The diagnostic accuracy of ultrasound was assessed using a combination of sensitivity, specificity, likelihood ratio (LR), post-test probability, diagnostic odds ratio (DOR) and by summarizing the area under the receiver operating characteristic (SROC) curve. A total of 4 studies involving 246 patients were eventually included in the analysis. In these four studies, the combined sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, post-test probability and DOR were 90.0% (95% CI: 77–96), 97% (95% CI: 90–99), 31.08 (95% CI: 8.75–110.41), 0.11 (95% CI: 0.05–0.24), 89% (3%) and 288.81 (95% CI: 78.51–1062.48), respectively. The area under the SROC curve was 0.98 (95% CI: 0.97–0.99). Our meta-analysis showed that ultrasound can play an important role in the diagnosis of ACL injury. Because of its high sensitivity, high specificity and high diagnostic ability, ultrasound should be a part of the standard diagnostic work-up of an ACL injury.