Jump-Landing Mechanics After Anterior Cruciate Ligament Reconstruction: A Landing Error Scoring System Study

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Abstract
Context: The Landing Error Scoring System (LESS) is a clinical evaluation of jump-landing mechanics and may provide useful information in assisting with return-to-sport decisions in patients after anterior cruciate ligament reconstruction (ACLR). However, it is currently unknown how patients with ACLR perform on the LESS compared with healthy controls. Objective: To determine if the total LESS score differed between individuals with ACLR and healthy controls and to determine the types of errors that differ between groups. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: A total of 27 individuals with unilateral ACLR (age = 19.8 ± 1.8 years, height = 170 ± 5.5 cm, mass = 68.8 ± 11.9 kg) and 27 controls (age = 20.5 ± 1.7 years, height = 169 ± 8.4 cm, mass = 66.6 ± 9.0 kg) with no history of ACLR. Intervention(s): Each participant completed 3 trials of a standardized jump-landing task. Main Outcome Measure(s): Each jump landing was assessed for specific postures using standardized LESS criteria by a blinded evaluator. Individual LESS items were summed to create a total LESS score. The dominant limb was assessed in the control group, and the reconstructed limb was assessed in the ACLR group. Results: The ACLR group had higher LESS scores compared with controls (ACLR: 6.7 ± 2.1 errors, control: 5.6 ± 1.5 errors, P = .04). Additionally, the ACLR group was more likely to err when landing with lateral trunk flexion (Fisher exact test, P = .002). Conclusions: Individuals with ACLR had worse landing mechanics as measured by the LESS. Lateral trunk deviation may be related to quadriceps avoidance in the reconstructed limb or poor trunk neuromuscular control. The LESS is useful for evaluating landing errors in patients with ACLR and may help to identify areas of focus during rehabilitation and before return to sport.

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