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Understanding injury mechanisms: a key component of preventing injuries in sport
Open accessAbstract
Anterior cruciate ligament (ACL) injuries are a growing cause of concern, as these injuries can have serious consequences for the athlete with a greatly increased risk of early osteoarthrosis. Using specific training programmes, it may be possible to reduce the incidence of knee and ankle injuries. However, it is not known which programme components are the key to preventing knee and ankle injuries or how the exercises work to reduce injury risk. Our ability to design specific prevention programmes, whether through training or other preventive measures, is currently limited by an incomplete understanding of the causes of injuries. A multifactorial approach should be used to account for all the factors involved-that is, the internal and external risk factors as well as the inciting event (the injury mechanism). Although such models have been presented previously, we emphasise the need to use a comprehensive model, which accounts for the events leading to the injury situation (playing situation, player and opponent behaviour), as well as to include a description of whole body and joint biomechanics at the time of injury.
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“Although creatine supplementations do not appear to affect training-related plasma lactate levels, which have been correlated with muscle damage in the acute phase, little is known about the effect of an artificial increase in muscle mass on joint mechanics and core stability.44,45”
From Creatine supplementation in the pediatric and adolescent athlete-- A literature review (2023) · cites this paper as [44]
In the citing paper
“little is known about the effect of an artificial increase in muscle mass on joint mechanics and core stability.44,45”
From Creatine supplementation in the pediatric and adolescent athlete-- A literature review (2023) · cites this paper as [44]
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“Furthermore, a multifactorial approach is required to account for all the factors involved, that is, the inciting event and also the global and local injury mechanisms.(5) 6 A systematic video analysis of injuries provides valuable information on the playing situation and athlete movement patterns, which can be used t…”
BackgroundResultInfluentialA systematic video analysis of 69 injury cases in World Cup alpine skiing
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BackgroundSelf-citationPsychosocial stress as a predictor of injury in elite junior soccer: a latent growth curve analysis.
Ivarsson, A., Johnson, U., Lindwall, M., Gustafsson, H., & Altemyr, M. (2014) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2013.10.242 · Cited by 75
“An injury was defined as a condition meeting the following wo criteria: (1) it occurred as a result of participation in an soccer ractice or game, and (2) it led to the restriction of the athlete’s articipation for three days or more beyond the day of injury.”
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ter Stege, M. H. P., Dallinga, J. M., Benjaminse, A., & LEMMINK, K. A. P. M. (2014) · Sports Medicine · doi:10.1007/s40279-014-0216-4 · Cited by 69
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BackgroundEpidemiology of injuries in young volleyball athletes: a systematic review
Silva, A. D. A. S., Sassi, L. B., Martins, T. B., de Menezes, F. S., Migliorini, F., Maffulli, N., & Okubo, R. (2023) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-023-04224-3 · Cited by 69
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Gokeler, A., Benjaminse, A., Villa, F. D., Tosarelli, F., Verhagen, E. A. L. M., & Baumeister, J. (2021) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2021-001091 · Cited by 79
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Steffen, K., Andersen, T., Krosshaug, T., van Mechelen, W., Myklebust, G., Verhagen, E., & Bahr, R. (2010) · European Journal of Sport Science · doi:10.1080/17461390903585173 · Cited by 64
“In addition, a precise description of the inciting event – the injury mechanism – is necessary (Bahr & Krosshaug, 2005 ).”
BackgroundSelf-citationHayen, A. D., Dennis, R. J., & Finch, C. F. (2006) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2006.09.002 · Cited by 61
Prevalence and incidence of low back pain among runners: a systematic review
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BackgroundFrisch, A., Urhausen, A., Seil, R., Croisier, J., Windal, T., & Theisen, D. (2011) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/j.1600-0838.2011.01369.x · Cited by 61
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BackgroundMethodWarming-up before sporting activity improves knee position sense.
Magalhães, T., Ribeiro, F., Pinheiro, A., & Oliveira, J. (2010) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2010.06.001 · Cited by 61
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BackgroundDistribution of injury mechanisms and related factors in ACL-injured female carving skiers
Ruedl, G., Linortner, I., Schranz, A., Fink, C., Schindelwig, K., Nachbauer, W., & Burtscher, M. (2009) · Knee Surgery, Sports Traumatology, Arthroscopy · doi:10.1007/s00167-009-0860-7 · Cited by 60
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BackgroundBurger, N., Lambert, M., Viljoen, W., Brown, J., Readhead, C., den Hollander, S., & Hendricks, S. (2017) · American Journal of Sports Medicine · doi:10.1177/0363546516677548 · Cited by 59
Injury Risk Management Plan for Volleyball Athletes
James, L. P., Kelly, V. G., & Beckman, E. M. (2014) · Sports Medicine · doi:10.1007/s40279-014-0203-9 · Cited by 61
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BackgroundEdouard, P., Depiesse, F., Branco, P., & Alonso, J.-M. (2014) · Clinical Journal of Sport Medicine · doi:10.1097/jsm.0000000000000052 · Cited by 58
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BackgroundRøtterud, J., Sivertsen, E., Forssblad, M., Engebretsen, L., & Årøen, A. (2011) · American Journal of Sports Medicine · doi:10.1177/0363546510397813 · Cited by 58
“This knowledge will be important in the development of prevention programs for these combined serious knee injuries.(3) A study by Takeda et al(26) showed that damage to the articular cartilage was one of the most important negative predictors on the rate of return to sports after ACL reconstruction, underlining the i…”
BackgroundFinch, C., White, P., Twomey, D., & Ullah, S. (2011) · British Journal of Sports Medicine · doi:10.1136/bjsm.2010.081406 · Cited by 58
Kannan, P., Chapple, C., Miller, D. L., Claydon-Mueller, L., & Baxter, G. D. (2019) · Contemporary Clinical Trials · doi:10.1016/j.cct.2019.05.004 · Cited by 57
Yan, A. F., Sinclair, P., Hiller, C., Wegener, C., & Smith, R. (2013) · Gait & Posture · doi:10.1016/j.gaitpost.2012.11.017 · Cited by 57
“Weight-bearing activities have a risk of injury to the lower limb through repetitive impact and inadequate recovery [1].”
BackgroundCharles, D., White, R., Reyes, C., & Palmer, D. A. (2020) · International Journal of Sports Physical Therapy · doi:10.26603/ijspt20200882 · Cited by 56
Cherni, Y., Jlid, M. C., Hammami, M., Shephard, R. J., Paillard, T., Chelly, M. S., & Hermassi, S. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.00726 · Cited by 53
“Furthermore, female basketball players are particularly vulnerable, with injury rates 2–4 times higher than in male players (Malinzak et al., 2001; Bahr and Krosshaug, 2005; Taylor et al., 2015).”
BackgroundMeyers, M. (2013) · American Journal of Sports Medicine · doi:10.1177/0363546513498994 · Cited by 56
“Coupled with this is the psychological trauma and setbacks in training and the potential for long-term degenerative changes typically experienced by athletes after a significant injury.(2,34,58) As such, efforts to address ways to minimize the predisposition to injury are warranted.”
BackgroundMethodResultInfluentialDifferent strategies for sports injury prevention in an America's Cup yachting crew.
Hadała, M., & Barrios, C. (2009) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31819c0de7 · Cited by 56
Meeting the Global Demand of Sports Safety
Timpka, T., Finch, C., Goulet, C., Noakes, T., & Yammine, K. (2008) · Sports Medicine · doi:10.2165/00007256-200838100-00001 · Cited by 56
“Traditionally focused sports injury preventionresearchhascontributed to thebuilding of an evidence base about the magnitude of the injury problem, identification of risk factors and efficacyof interventions.([56,57])Unfortunately, such approaches only indirectly impact on policy change, and from a global prevention pe…”
BackgroundEnglander, Z. A., Baldwin, E. L., Smith, W. A. R., Garrett, W. E. J., Spritzer, C. E., & DeFrate, L. E. (2019) · The American Journal of Sports Medicine · doi:10.1177/0363546519876074 · Cited by 57
“Each radiograph had a resolution of 1152 3 1152 pixels.(2) First, the positions of the sources and intensifiers were adjusted to ensure that the single-legged jumping motion could be captured in the field of view without the contralateral leg obscuring the field of view.”
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Artificial intelligence. A tool for sports trauma prediction.
Kakavas, G., Malliaropoulos, N., Pruna, R., & Maffulli, N. (2020) · Injury · doi:10.1016/j.injury.2019.08.033 · Cited by 54
Genetic Variants and Anterior Cruciate Ligament Rupture: A Systematic Review
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“Therefore, multifactorial and comprehensive models are designed to predict the risk of ACL rupture [62].”
BackgroundUsing video analysis for concussion surveillance in Australian football.
Makdissi, M., & Davis, G. (2016) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2016.02.014 · Cited by 54
Paterno, M. (2015) · Journal of athletic training · doi:10.4085/1062-6050-50.10.07 · Cited by 54
Impact of environmental factors on knee injuries in male and female recreational skiers
Ruedl, G., Fink, C., Schranz, A., Sommersacher, R., Nachbauer, W., & Burtscher, M. (2012) · Scandinavian Journal of Medicine & Science in Sports · doi:10.1111/j.1600-0838.2011.01286.x · Cited by 54
“In general, sport-related injuries are caused by a complex interaction of intrinsic and extrinsic (e.g. environment) risk factors (Bahr & Krosshaug, 2005).”
BackgroundEl modelo global psicológico de las lesiones deportivas
Zafra, A. O., & García-Mas, A. (2009) · Acción Psicológica · doi:10.5944/ap.6.2.223 · Cited by 54
The Effect of Tackler Technique on Head Injury Assessment Risk in Elite Rugby Union
Tierney, G. J., Denvir, K., Farrell, G., & Simms, C. (2017) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000001461 · Cited by 53
“However, they focussed on general injury for tackles in a youth-level rugby union competition, although the mechanism of injury in terms of the inciting event may not be the same for all types of injury (26).”
BackgroundInjury Patterns and Injury Rates in the Circus Arts
Shrier, I., Meeuwisse, W., Matheson, G., Wingfield, K., Steele, R., Prince, F., Hanley, J., & Montanaro, M. (2009) · American Journal of Sports Medicine · doi:10.1177/0363546508331138 · Cited by 53
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“Athletes with poor neuromuscular control, core strength, or muscular imbalances are more susceptible to these types of injuries because of the repetitive loads imposed on top of these dysfunctional movement patterns (1).”
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“Such information could be used to guide implementation of a specific intervention that is designed to improve the individual’s capacity to prevent an injury by either avoiding or tolerating the transfer of energy from the external environment to body tissues.(11,12) A prospective cohort study design provides the only…”
BackgroundThe common mechanisms of anterior cruciate ligament injuries in judo: a retrospective analysis
Koshida, S., Deguchi, T., Miyashita, K., Iwai, K., & Urabe, Y. (2008) · British Journal of Sports Medicine · doi:10.1136/bjsm.2008.051425 · Cited by 52
“It is necessary to understand the mechanism of ACL injury in specific sports to establish preventive strategies.”
BackgroundUtility of FMS to understand injury incidence in sports: current perspectives
Warren, M., Lininger, M. R., Chimera, N. J., & Smith, C. (2018) · Open Access Journal of Sports Medicine · doi:10.2147/oajsm.s149139 · Cited by 63
Attitude and behaviour of junior rugby union players towards tackling during training and match play
Hendricks, S., Jordaan, E., & Lambert, M. (2012) · Safety Science · doi:10.1016/j.ssci.2011.08.061 · Cited by 51
“Conceptual sport injury prevention models and frameworks teach sport scientists and sports clinicians to look beyond injurymechanisms and injury biomechanics as a means of understanding injury (Bahr and Krosshaug, 2005; Gissane et al., 2001; McIntosh, 2005a;Meeuwisse, 1994; vanMechelen et al., 1992).”
BackgroundInfluentialInjury risk-workload associations in NCAA American college football.
Sampson, J., Murray, A., Williams, S., Halseth, T., Hanisch, J., Golden, G., & Fullagar, H. (2018) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2018.05.019 · Cited by 50
Injury rate and injury pattern among elite World Cup snowboarders: a 6-year cohort study
Major, D., Steenstrup, S., Bere, T., Bahr, R., & Nordsletten, L. (2013) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-092573 · Cited by 50
Self-citationKlein, C., Luig, P., Henke, T., Bloch, H., & Platen, P. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2019-101344 · Cited by 49
Finch, C., Gabbe, B., Lloyd, D., Cook, J., Young, W., Nicholson, M., Seward, H., Donaldson, A., & Doyle, T. (2011) · Injury Prevention · doi:10.1136/ip.2010.031385 · Cited by 49
Effects of Physical Efforts on Injury in Elite Soccer
Carling, C., Gall, F., & Reilly, T. (2009) · International Journal of Sports Medicine · doi:10.1055/s-0029-1241212 · Cited by 49
Anterior Cruciate Ligament Biology and Its Relationship to Injury Forces
Slauterbeck, J. R., Hickox, J. R., Beynnon, B. D., & Hardy, D. M. (2006) · Orthopedic Clinics of North America · doi:10.1016/j.ocl.2006.09.001 · Cited by 43
Knee ligament mechanical properties are not influenced by estrogen or its receptors
Warden, S. J., Saxon, L., Castillo, A. B., & Turner, C. H. (2005) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00367.2005 · Cited by 45
“The risk of knee ligament injury is multifactorial and results from a combination of extrinsic and intrinsic factors (4).”
BackgroundGeurkink, Y., Boone, J., Verstockt, S., & Bourgois, J. (2021) · Applied Sciences · doi:10.3390/app11052378 · Cited by 48
“Given that game performance [49], training load [50] and injury [51] are all multidimensional, the application of machine learning can be useful since it is particularly helpful when dealing with many input variables.”
Baseball pitching biomechanics in relation to pain, injury, and surgery: A systematic review.
Bullock, G., Menon, G., Nicholson, K., Butler, R., Arden, N., & Filbay, S. (2020) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2020.06.015 · Cited by 48
Luig, P., Krutsch, W., Henke, T., Klein, C., Bloch, H., Platen, P., & Achenbach, L. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2018-100250 · Cited by 48
Mechanisms of injuries in World Cup Snowboard Cross: a systematic video analysis of 19 cases
Bakken, A., Bere, T., Bahr, R., Kristianslund, E., & Nordsletten, L. (2011) · British Journal of Sports Medicine · doi:10.1136/bjsports-2011-090527 · Cited by 48
Self-citationAchenbach, L., Bloch, H., Klein, C., Damm, T., Obinger, M., Rudert, M., Krutsch, W., & Szymski, D. (2024) · British Journal of Sports Medicine · doi:10.1136/bjsports-2023-107113 · Cited by 47
Dos'santos, T., Thomas, C. M., McBurnie, A. J., Donelon, T., Herrington, L., & Jones, P. (2021) · Biomechanics · doi:10.3390/biomechanics1010007 · Cited by 47
Alanen, A.-M., Räisänen, A. M., Benson, L., & Pasanen, K. (2021) · International Journal of Sports Science & Coaching · doi:10.1177/17479541211003064 · Cited by 61
Divided attention during cutting influences lower extremity mechanics in female athletes
Almonroeder, T. G., Kernozek, T. W., Cobb, S. C., Slavens, B. A., Wang, J., & Huddleston, W. E. (2017) · Sports Biomechanics · doi:10.1080/14763141.2017.1391327 · Cited by 47
“Achievement of this goal is dependent on an in-depth understanding of how both intrinsic (e.g., strength, range of motion) and extrinsic (e.g., the playing situation, player and opponent behaviour) factors influence ACL injury risk (Bahr & Krosshaug, 2005).”
BackgroundPsychosocial factors and sport injuries: prediction, prevention and future research directions
Johnson, U., & Ivarsson, A. (2017) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2017.04.023 · Cited by 49
“, [27]), no studies have, to our knowledge, tested a prevention program based on a combination of physiological (training monitoring and modification) and psychological interventions.”
BackgroundShoulder injuries in elite rugby union football matches: Epidemiology and mechanisms.
Usman, J., McIntosh, A., Quarrie, K., & Targett, S. (2015) · Journal of Science and Medicine in Sport · doi:10.1016/j.jsams.2014.07.020 · Cited by 47
Injury prevention in paediatric sport-related injuries: a scientific approach
Emery, C. (2009) · British Journal of Sports Medicine · doi:10.1136/bjsm.2009.068353 · Cited by 47
“19 Bahr and Krosshaug 20 built on this model to highlight the mechanism of injury including biomechanical components, the playing situation and player/ opponent behaviour.”
BackgroundCollins, J. D., Almonroeder, T., Ebersole, K., & O'Connor, K. (2016) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2016.04.004 · Cited by 46
Cammarata, M. L., & Dhaher, Y. Y. (2008) · Clinical Biomechanics · doi:10.1016/j.clinbiomech.2008.03.071 · Cited by 46
“vers in sports knee varus/valgus loading often occurs with the knee in a flexed position (Bahr and Krosshaug, 2005; Hewett et al., 2005).”
BackgroundInjury-Inciting Activities in Male and Female Football Players: A Systematic Review
Aiello, F., Impellizzeri, F., Brown, S. J., Serner, A., & McCall, A. (2022) · Sports Medicine · doi:10.1007/s40279-022-01753-5 · Cited by 45
“1 Terminology Sport-specific activities performed before and at the time of injury are often described as injury mechanisms [11, 12].”
BackgroundGram, M., Clarsen, B., & Bø, K. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2020-102315 · Cited by 45
“40 41 To our knowledge, this is the first study within RG to find an association between age and lack of menarche and injuries.”
The epidemiology of injury in adventure and extreme sports.
Caine, D. (2012) · Medicine and Sport Science · doi:10.1159/000338558 · Cited by 45
Abraham, T., Fong, G., & Scott, A. (2011) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-12-26 · Cited by 45
“There is increasing recognition of the need to detect early signs of tendon injury so that appropriate prevention strategies can be implemented, as the pathology is frequently career- or activity-limiting [6].”
Mizuno, K., Andrish, J., van den Bogert, A. J., & Mclean, S. (2009) · Knee (Oxford) · doi:10.1016/j.knee.2009.04.008 · Cited by 45
“Current research geared towards ACL injury prevention remains focused primarily on gender-based neuromechanical differences elicited during high-risk sports postures, as such factors are modifiable, and hence, amenable to targeted interventions [6–8].”
BackgroundFältström, A., Kvist, J., Bittencourt, N., Mendonça, L., & Hägglund, M. (2021) · American Journal of Sports Medicine · doi:10.1177/0363546521999109 · Cited by 44
“Many different factors, such as age, sex, functional performance, psychological, factors, social-contextual factors, and surgical factors probably affect the outcome.(5) To uncover this complex nature of risk factors, a complex systems approach is necessary.”
BackgroundRisk Factors for Upper Limb Injury in Tennis Players: A Systematic Review
Kekelekis, A., Nikolaidis, P., Moore, I., Rosemann, T., & Knechtle, B. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17082744 · Cited by 44
“Previous injury has been clearly documented as one of the commonest intrinsic factors for musculoskeletal injury in sports [45].”
BackgroundKerin, F., Farrell, G., Tierney, P., Persson, U. M., Devito, G., & Delahunt, E. (2022) · British Journal of Sports Medicine · doi:10.1136/bjsports-2021-104171 · Cited by 43
An ecological dynamics approach to ACL injury risk research: a current opinion
Bolt, R., Heuvelmans, P., Benjaminse, A., Robinson, M. A., & Gokeler, A. (2021) · Sports Biomechanics · doi:10.1080/14763141.2021.1960419 · Cited by 57
“In 2005, Bahr & Krosshaug (2005) proposed a conceptual model describing the factors that contribute to the inciting event of an injury.”
Verstappen, S., van Rijn, R. V., Cost, R., & Stubbe, J. (2021) · Sports Medicine - Open · doi:10.1186/s40798-020-00296-1 · Cited by 43
“that highlighted the importance of accounting for all factors involved, such as the internal and external risk factors as well as the inciting event [35, 36].”
BackgroundFarley, J. B., Barrett, L. M., Keogh, J., Woods, C., & Milne, N. (2020) · Sports Medicine - Open · doi:10.1186/s40798-020-00264-9 · Cited by 43
Biomechanical considerations in the design of equipment to prevent sports injury
McIntosh, A. (2012) · Proceedings of the Institution of Mechanical Engineers Part P Journal of Sports Engineering and Technology · doi:10.1177/1754337111431024 · Cited by 43
“Impacts cause many injuries, but there are other loading mechanisms, such as in non-contact knee and ankle ligament injuries, for example, that can be exacerbated or controlled by equipment and the playing surface.(3,19) The National Collegiate Athletic Association data on fifteen sports showed that, in games, 58% of…”
BackgroundTosarelli, F., Buckthorpe, M., Paolo, S. D., Grassi, A., Rodas, G., Zaffagnini, S., Nanni, G., & Villa, F. D. (2024) · Orthopaedic Journal of Sports Medicine · doi:10.1177/23259671241234880 · Cited by 42
“3,35 Our work suggests that improving neuromuscular control/kinematics during single-leg landing and cutting actions, in response to either mechanical or neurocognitive perturbation, may be important to reduce the ACL injury risk.”
Background
Metadata
- Authors
- Bahr, R., & Krosshaug, T.
- Affiliations
- Oslo Sports Trauma Research Center (NO)
- Corresponding author
- Bahr, R
- ORCID
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2005-05-23
- Volume
- 39
- Issue
- 6
- Pages
- 324-329
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- PMC
- PMC1725226
- OpenAlex
- W2077950187
- Cited by
- 1,255
- References
- 0
- Citations by year
- 2026: 80 · 2025: 87 · 2024: 78 · 2023: 73 · 2022: 86 · 2021: 104 · 2020: 87 · 2019: 68 · 2018: 68 · 2017: 60 · 2016: 83 · 2015: 64 · 2014: 54 · 2013: 53 · 2012: 34
- FWCI
- 3.74
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
- Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
- Keywords
- injury mechanisms, sports injury prevention, anterior cruciate ligament injury, knee injury, ankle injuries, injury risk factors, injury prevention programs, joint biomechanics, osteoarthritis risk
- MeSH terms
- Anterior Cruciate Ligament Injuries, Athletic Injuries, Biomechanical Phenomena, Female, Humans, Knee Injuries, Male, Physical Education and Training, Risk Factors, Sports, Ankle Injuries
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