Landing Biomechanics In Adolescent Female Athletes With Concussion History Who Sustain Subsequent Lower Extremity Musculoskeletal Injury

PURPOSE: Sport-related concussion (SRC) increases the risk for future lower extremity injury (LE-I). Risky landing biomechanics may underlie the elevated incidence of LE-I following SRC. It is unknown whether females who sustain LE-I with no history of SRC display altered landing biomechanics. To evaluate if female adolescent athletes with and without a history of SRC who experienced a subsequent LE-I demonstrate aberrant landing biomechanics compared to females who did not sustain a subsequent LE-I. METHODS: Female athletes were recruited prior to the competitive season and completed a SRC history questionnaire (history of SRC group: CONC, N = 29; control group: CTRL, N = 48). LE-Is were recorded during a single season. Athletes completed drop vertical jump (DVJ) trials from a 30 cm box and virtual reality (VR)-immersed sport-specific scenario landings. Ankle, knee, and hip peak external joint moments (Nm*kg-1*m-1) for both tasks were analyzed via 2 (Group; CONC, CTRL) x 2 (Injury; Yes, No) between-subjects ANOVAs in R. Statistical significance was set a priori at p < .05. RESULTS: 3 CTRL and 7 CONC recorded an LE-I. The only significant Group x Injury interaction for DVJ was left hip flexion peak moment (p = .02). CONC with LE-I landed with lower hip flexion moment than CTRL LE-I (d = 2.53). In VR, Group x Injury interactions were observed for right hip flexion peak moment (p < 0.001) and right hip internal rotation peak moment (p = 0.01). CONC LE-I landed with lower hip flexion (d = 0.93) and internal rotation moments (d = 4.54) than CTRL LE-I. There were no other significant Group x Injury interactions for other ankle, knee, or hip angle/moments during the DVJ or VR tasks. CONCLUSIONS: Female adolescent athletes with a history of SRC who suffered a LE-I demonstrated robustly similar laboratory and VR-based landing biomechanics to CTRL athletes who sustained a LE-I. These findings indicate that athletes with a history of SRC who experience subsequent LE-I may not exhibit notable biomechanical deficiencies relative to athletes with an SRC who do not go on to future injury. Future work should consider supplementing landing tasks with added cognitive load and/or alternative measures of motor stability to isolate neuromuscular control deficits that may underlie subsequent LE-I in athletes with a history of SRC. U01AR067997, R01AR077248, R01AR076153, and T32NS7453-20