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

J Athl Train. 2015 Jun;50(6):589-95. doi: 10.4085/1062-6050-50.1.10. Epub 2015 Mar 26.


Context: Identifying neuromuscular screening factors for anterior cruciate ligament (ACL) injury is a critical step toward large-scale deployment of effective ACL injury-prevention programs. The Landing Error Scoring System (LESS) is a valid and reliable clinical assessment of jump-landing biomechanics.

Objective: To investigate the ability of the LESS to identify individuals at risk for ACL injury in an elite-youth soccer population.

Design: Cohort study.

Setting: Field-based functional movement screening performed at soccer practice facilities.

Patients or other participants: A total of 829 elite-youth soccer athletes (348 boys, 481 girls; age = 13.9 ± 1.8 years, age range = 11 to 18 years), of whom 25% (n = 207) were less than 13 years of age.

Intervention(s): Baseline preseason testing for all participants consisted of a jump-landing task (3 trials). Participants were followed prospectively throughout their soccer seasons for diagnosis of ACL injuries (1217 athlete-seasons of follow-up).

Main outcome measure(s): Landings were scored for "errors" in technique using the LESS. We used receiver operator characteristic curves to determine a cutpoint on the LESS. Sensitivity and specificity of the LESS in predicting ACL injury were assessed.

Results: Seven participants sustained ACL injuries during the follow-up period; the mechanism of injury was noncontact or indirect contact for all injuries. Uninjured participants had lower LESS scores (4.43 ± 1.71) than injured participants (6.24 ± 1.75; t1215 = -2.784, P = .005). The receiver operator characteristic curve analyses suggested that 5 was the optimal cutpoint for the LESS, generating a sensitivity of 86% and a specificity of 64%.

Conclusions: Despite sample-size limitations, the LESS showed potential as a screening tool to determine ACL injury risk in elite-youth soccer athletes.

Keywords: biomechanics; children; knee; movement patterns.

Publication types

  • Evaluation Study
  • Multicenter Study

MeSH terms

  • Adolescent
  • Anterior Cruciate Ligament Injuries*
  • Athletes
  • Athletic Injuries / prevention & control
  • Biomechanical Phenomena / physiology
  • Case-Control Studies
  • Child
  • Early Diagnosis
  • Female
  • Humans
  • Knee Injuries / prevention & control
  • Male
  • Movement / physiology
  • Prospective Studies
  • Risk Factors
  • Soccer / injuries*
  • Sports Medicine / methods*
  • Video Recording