This study aimed to examine the relationship between eccentric hamstring strength and biomechanical energy absorption parameters during the landing phase of a vertical jump, and the impact of a pre-season preparation period on these variables in professional soccer players. Thirty-one professional male soccer players (n=31, age: 24.81±5.23 years) participated in the study. Eccentric hamstring strength was measured using the NordBord system, and countermovement jump (CMJ) landing kinetics were assessed via ForceDecks dual force plates before and after the pre-season camp. The landing phase was analyzed through Peak Landing Force, Landing Impulse, and Landing Rate of Force Development (RFD). After the preparation period, a significant decrease in Peak Landing Force (5429.89±1865.7N vs. 4939.13±1449.8N; p=0.012) and a significant increase in Landing Impulse (98.2±18.19 Ns vs. 106.54±24.67 Ns; p=0.029) were observed. Furthermore, a statistically significant reduction of 11.6% was found in Landing RFD (p=0.047). A statistically significant increase of 7.4% was observed in normalized Nordic hamstring strength (p=0.021). The pre-season training period enabled soccer players to develop a "softer" and more controlled landing strategy by enhancing the eccentric braking capacity of the hamstrings. The reduction in impact forces and the increase in impulse indicate more effective absorption of loads on the knee joint. Integrating eccentric hamstring exercises and landing mechanics drills into training programs is recommended to reduce injury risk.
Adolescent female soccer players exhibit a disproportionately high risk of non-contact anterior cruciate ligament (ACL) injuries, with dynamic knee valgus (DKV) representing one of the major modifiable biomechanical risk factors, particularly under conditions of functional fatigue. The FIFA 11+ injury prevention program has demonstrated efficacy in reducing lower extremity injury risk, yet its impact on landing mechanics under fatigued conditions in this population remains underexplored. This study aimed to investigate the effects of an 8-week FIFA 11+ program on Landing Error Scoring System (LESS) scores following a functional fatigue protocol in adolescent female soccer players with DKV. This parallel-group randomized controlled trial included 21 adolescent female soccer players (aged 13-17 years) exhibiting DKV, allocated to an intervention group (n = 11) receiving the FIFA 11+ program or a control group (n = 10) maintaining standard warm-up routines. LESS assessments were conducted before and after a validated youth soccer fatigue simulation protocol (YoSFS⁵) at baseline and after 8 weeks. A 2 × 2 × 2 mixed-design ANOVA examined the effects of group, time, and fatigue on LESS scores. Significant main effects were observed for time (F1,19= 4.90,p = 0.039, partial η² = 0.205) and fatigue (F1,19= 73.49, p < 0.001, partial η² = 0.795). Critically, significant interactions emerged for time × group (F1,19= 13.51,p = 0.002, partial η² = 0.416), time × fatigue (F1,19= 15.95,p < 0.001, partial η² = 0.456), and time × fatigue × group (F1,19= 4.62, p = 0.045, partial η² = 0.196). The intervention group demonstrated substantial reductions in LESS scores post-intervention, particularly under fatigued conditions (-34.2% vs. +3.1% in controls). The 8-week FIFA 11+ program significantly improved landing mechanics and attenuated fatigue-induced deteriorations in adolescent female soccer players with DKV. These findings highlight the program's potential to improve the maintenance of landing mechanics during high-risk fatigued states, with potential implications for improving biomechanical factors associated with ACL injury risk during fatigue. Iranian Registry of Clinical Trials (IRCT), IRCT20250818066901N1, registered 24/09/2025.
Background: Non-contact anterior cruciate ligament (ACL) injury is common and disabling, often requiring reconstruction and predisposing individuals to early post-traumatic osteoarthritis, making scalable, exercise-based prevention a clinical and public health priority. Excessive peak vertical ground reaction force (vGRF) during landing is a modifiable biomechanical risk marker for ACL injury, although whether reducing it lowers injury incidence is unproven. We evaluated the effect of movement retraining on peak vGRF during landing in pivot-sport athletes and general athletic populations. Methods: MEDLINE (PubMed), Embase, and the Cochrane Central Register of Controlled Trials were searched from inception through to 25 May 2026. Two reviewers independently screened records and extracted data. Random-effects meta-analyses (DerSimonian-Laird) used Hedges' g; risk of bias was assessed with RoB 2 and certainty with GRADE. The protocol was registered in PROSPERO (CRD42025116119). Results: Nine comparisons from eight randomised controlled trials (292 participants) were included. Movement retraining significantly reduced peak vGRF (Hedges' g = -0.94, 95% CI -1.34 to -0.54; I2 = 63%), with larger effects in general athletic populations (g = -1.50) than in pivot-sport athletes (g = -0.66; subgroup difference p = 0.005). Knee flexion angle at initial contact showed a non-significant increasing trend (g = 0.48; p = 0.18). Certainty of evidence (GRADE) was low. Conclusions: Movement retraining was associated with a reduction in peak vGRF during landing, a surrogate biomechanical marker for ACL injury, on the basis of low-certainty evidence with substantial heterogeneity (I2 = 63%). A subgroup difference favouring general over pivot-sport athletes was observed but is exploratory, resting on only three general-athletic comparisons. Because no included trial measured injury incidence, whether these biomechanical changes reduce ACL injury is unknown, and the findings should be regarded as hypothesis-generating.
This study investigated the effects of static quadriceps angle (Q-angle) and body composition on dynamic landing mechanics in young female athletes. Twenty-four right-limb dominant female athletes (age: 17.04 ± 0.36 years, BMI: 20.65 ± 2.62) participated. Body composition was assessed via bioelectrical impedance. Static Q-angle, frontal plane projection angle (FPPA), and Landing Error Scoring System (LESS) scores during a drop vertical jump were analyzed using 120 fps cameras and Kinovea software. Correlation analysis revealed significant negative relationships between right Q-angle and both right FPPA (rho = -0.440, p = .031) and left FPPA (rho = -0.490, p = .015). A significant positive correlation was found between body fat percentage and LESS scores (r = .521, p = .009). The regression model explained 22.6% of variance in right FPPA, showing a near-significant exploratory trend for right Q-angle (beta = -0.394, p = .060). ROC analysis suggested a potential, exploratory threshold value of 15.00 degrees for right Q-angle to detect high-risk landing mechanics (LESS > 6), yielding 78.6% sensitivity and 60.0% specificity, although the model did not reach formal statistical significance (p = .143). While the static Q-angle demonstrates a preliminary correlation with dynamic knee valgus tendencies in the dominant limb, non-significant predictive models prevent its use as a definitive standalone screening tool at this stage. Conversely, an elevated body fat percentage independently impairs overall movement quality rather than altering specific frontal plane joint angles. Not applicable.
Landing from a jump presents distinct challenges that require accurate prediction of both ground contact timing and the characteristics of the forthcoming impact forces to generate anticipatory kinematic adjustments to efficiently dissipate energy. This study quantified these adjustments under simulated microgravity to characterize their temporal and magnitude features. Nine participants performed countermovement jumps (CMJ) and drop-landings (DL) under simulated microgravity during parabolic flights, using a subject loading system to apply downward force in weightlessness (0g). Ground reaction forces and sagittal-plane kinematics were recorded to compute hip, knee and ankle joint angles, angular velocities, and joint flexion onsets. Loading rate, peak vertical ground reactions forces and extra work were computed to quantify the effect of anticipatory adjustments. A linear mixed-effects model examined the effect of energy to be dissipated at touchdown (ETD), task (CMJ or DL) and their interaction on onsets of joint flexion, joint angles and angular velocities at touchdown (TD). Joint flexion onsets occurred later relative to TD with increased ETD, to reach smaller joint flexion angles at TD. When expressed relative to the instant of downward fall initiation, latency of joint flexion also varied with ETD, indicating that adjustments do not rely on fixed timing reference. Joint angular velocities at touchdown increased with ETD in CMJ, suggesting a combined modulation of onset timing and angular acceleration to achieve the required velocity at TD. During DL, angular velocities at TD were lower, leading to reduced extra work and greater loading rates. Overall, these findings highlighted the critical role of anticipatory kinematic adjustments and the importance of fall initiation in energy dissipation during landing.
The landing error scoring system (LESS) is a critical tool for evaluating jump-landing biomechanics in athletes, particularly for identifying movement patterns that may increase the risk of non‑contact injuries such as anterior cruciate ligament (ACL) injuries. This systematic review aimed to examine the effects of various exercise interventions on improving LESS scores among athletes. Comprehensive searches of PubMed, Web of Science, Scopus, and Embase were performed from database inception through June 2025. Two independent reviewers screened for studies reporting the effects of exercise interventions on LESS. We extracted data on each study's design, athletic discipline, exercise modality, intervention parameters (duration and session frequency), and participants' demographic characteristics. Study quality was assessed using the Downs & Black checklist. Meta-analyses were conducted in RevMan 5.4 using a random-effects model to calculate mean differences (MD) with 95% confidence intervals (CI) and generate forest plots, and overall evidence certainty was graded via GRADE. Twenty-four trials (total n = 1,153; mean age 15 years; 51.8% female) met inclusion criteria. Intervention categories comprised integrated neuromuscular training (12 studies), SportsMetrics™ training (4 studies), FIFA 11+ (3 studies), TRX-based training (2 studies), and four studies evaluating other exercise interventions. Integrated neuromuscular training yielded significantly lower LESS scores (MD = 2.40; 95% CI 1.17-3.63; P < 0.001; I² = 51%), as did SportsMetrics™ (MD = 2.99; 95% CI 2.07-3.91; P < 0.001; I² = 0%). The results of FIFA 11 + interventions were heterogeneous. Structured multimodal neuromuscular interventions, particularly those incorporating progressive plyometric training, appear effective for improving LESS scores and landing mechanics in athletes. However, the current evidence supports improvements in biomechanical risk markers rather than direct reductions in ACL injury incidence. Future studies should determine whether improvements in LESS scores translate into meaningful reductions in ACL injury risk.
This paper proposes an adaptive predefined-time fault-tolerant control scheme for carrier-based aircraft landing under actuator faults, airwake disturbances, and input saturation. Based on predefined-time stability theory, a generalized parameterized Lyapunov condition is established and rigorously proven. The carrier landing controller is designed incorporating predefined-time command filters with dynamic error compensation to avoid complexity explosion, an adaptive mechanism with projection operators to address actuator faults, and anti-saturation auxiliary systems. Lyapunov analysis proves that the closed-loop system converges within a predefined time. Comparative simulations verify practical predefined-time stability (PPTS) in actuator fault scenarios, along with faster convergence and superior fault tolerance compared to other methods.
Efficient preparation, isolation, and soft-landing deposition of stable clusters with atomic precision are important for developing new catalysts. However, small metal clusters are often highly susceptible to oxidation and prone to structural deformation on supports, which poses substantial challenges to experimental catalysis and theoretical calculations. In this study, we prepared pure Agn+ and Cun+ clusters and screened out superatomic clusters Ag9+ and Cu9+ by gas-phase reactions of sufficient collisions. We then deposited the two clusters onto different substrates using soft landing techniques. Characterization by X-ray photoelectron spectroscopy verified successful deposition and revealed that these superatomic clusters preserve unoxidized states at exposure to air, highlighting their unique stability rooted in superatomic eight-electron shell closure. We tested the catalysis of Ag9+ and Cu9+ clusters for acetylene hydrogenation and related hydrogen-deuterium exchange reactions. The results revealed that the Cu9+ clusters on TiO2 exhibit superior catalytic activity, which is associated with the enhanced cluster-support interactions and favorable H2 activation behavior. This study validates the applicability of superatom clusters for designing new catalysts, with enhanced stability and tailorable active sites.
Electric vertical takeoff and landing (eVTOL) vehicles represent a rapidly expanding field in aerospace engineering, driven by the pursuit of sustainable, efficient, and low-noise air mobility solutions. Among the key aeroacoustic challenges associated with Lift+Cruise configurations, understanding the effects of rotor-wing interaction has become increasingly relevant for supporting ongoing efforts toward noise-mitigation and future certification frameworks. The diversity of architectures and propulsion concepts, combined with stringent safety regulations, presents significant challenges to system reliability and performance assessment. Comprehensive aeroacoustic analyses integrating experimental, analytical, and numerical methods are essential for advancing design maturity. However, traditional development processes are often costly and time-intensive. Medium-fidelity simulation frameworks have emerged as efficient alternatives for predicting aerodynamic loads and acoustic behavior. This paper investigates noise-generation mechanisms and performs aeroacoustic predictions for Lift+Cruise eVTOL configurations through a hybrid approach that integrates open-source tools, including OpenCOPTER and PSU-WOPWOP, with anechoic wind tunnel measurements. The proposed framework provides estimates of aerodynamic loads, rotor-wing interaction effects, and the associated noise radiation across different flight conditions. Results demonstrate agreement between predicted and experimental data, validating the methodology's capability to capture dominant noise sources, contributing to the advancement of quieter and more efficient eVTOL designs.
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Jumping is a primary contributor to mechanical loading in collegiate dance training, yet objective, style-specific indicators of training load remain poorly defined. This study examined how jump-related external and internal training loads behave during real-world dance classes by evaluating repeated measures of jump landing impact, jump height, and perceived exertion. Eighteen female collegiate dancers completed three standardized ballet and modern dance classes while wearing waist-mounted inertial measurement units (IMUs). Jump landing impact and jump height were recorded across eleven ballet and eight modern jump types, and session rating of perceived exertion (sRPE) was collected after each dance style segment. Jump landing impact and jump height demonstrated good-to-excellent within-session reliability (ICC = 0.75-0.98), supporting their use as indicators of external mechanical training load for repeated monitoring. Across classes, most jump types exhibited stable landing impacts and jump heights, while select jumps (e.g., sautés, prances, tuck jumps) exhibited day-to-day differences under natural training conditions. Contrary to expectations, variation in jump metrics was not significantly associated with sRPE, indicating a dissociation between external mechanical and internal perceptual training loads. Modern dance elicited significantly higher landing impacts, jump heights, and sRPE than ballet, demonstrating clear style-specific differences in training load. These findings highlight the value of jump-specific, style-specific mechanical metrics for monitoring external training load in collegiate dance and suggest that perceived exertion alone may not reflect jump-related mechanical demands. Wearable IMUs enable practical, movement-specific assessment of training load during real-world dance classes and provide a foundation for longitudinal workload monitoring in collegiate dance programs, informing training management and injury risk reduction strategies.
To investigate the effect of peripheral scleral lens landing zone modifications upon short-term regional variations in corneal oedema. Nine healthy participants wore different scleral lens designs ((1) spherical landing zone, (2) toric landing zone, (3) peripheral notches, and (4) peripheral channels) in a randomised order on four separate days for 100 min. Stromal oedema was quantified using high-resolution optical coherence tomography across the central, mid-peripheral, and peripheral cornea with the lens in situ. Eye Surface Profiler (ESP) images were also captured following the application of 10 μL of 2% sodium fluorescein, over a period of 100 min. Central and peripheral fluorescent intensity data were extracted from the ESP images and analysed using customised software to quantify tear exchange. The channel lens design displayed less central oedema compared to the toric design (1.57 ± 0.45% less oedema, p = 0.04). In the corneal periphery, the magnitude of oedema was less for both the toric lens (2.66 ± 0.66% less oedema, p = 0.02) and the channel design (3.39 ± 0.97% less oedema, p = 0.04) in comparison to the spherical lens design. A highly significant correlation was observed between the magnitude of peripheral tear exchange after 90 min of lens wear and the magnitude of peripheral oedema (r = -0.61, p < 0.001). Scleral lenses with either a toric landing zone or peripheral channels exhibited less peripheral corneal oedema than a spherical landing zone design, due to enhanced peripheral tear exchange.
Lateral ankle sprains (LAS) are prevalent among adolescent athletes and can lead to persistent sensorimotor impairment. Although altered postural control is a known consequence, the impact of recurrent LAS on time-resolved landing dynamics, while accounting for maturational and anthropometric confounding factors, remains unclear in adolescent athletes. We categorized 238 ankles from 156 adolescent basketball players into three LAS history groups: control, one-time, and multiple-time. Non-weight-bearing (non-WB) and weight-bearing (WB) ankle range of motion (RoM) were measured. The center of pressure (CoP) trajectory length during a single-legged landing (SLL) task was calculated across six time windows (20 ms to 5 s post-landing). Linear mixed-effects models accounted for within-participant dependence and were adjusted for covariates including age, height, body weight, and basketball experience. LAS history was not independently associated with CoP trajectory length in any time window. Non-WB dorsiflexion RoM was significantly and positively associated with the CoP trajectory length during the 200 ms to 1 s, 1 to 2 s, and 4 to 5 s intervals. The multiple-time group demonstrated significantly greater plantarflexion RoM than the control group. Time-resolved CoP trajectory length during SLL was more closely related to dorsiflexion RoM than to a history of LAS alone. The observed relationship between the non-WB dorsiflexion RoM and CoP trajectory length suggests that limited dorsiflexion mobility may constrain the magnitude of CoP modulation during post-landing stabilization. Assessing dorsiflexion mobility may help characterize inter-individual differences in dynamic balance behavior among adolescent basketball players. Basic Science; Biomechanics.
Elevated uric acid (UA) has been linked to impaired nervous system and skeletal muscle function. This study aimed to investigate the relationship between UA and digital gait characteristics in older adults. We enrolled 651 older adults (≥ 60 years) who completed a wearable device-based walking test and blood sample detection. Multidimensional sensors were used to measure 15 gait parameters. Asymmetry index (AI) and coefficient of variation (CV) were calculated for each parameter. Multiple linear regression analyses were employed to examine the associations between UA and gait characteristics. The mean age of all participants was 70.45 ± 6.12 years, with a mean UA concentration of 298.60 ± 92.39 μmol/L. After full adjustment for demographic characteristics and multiple health indicators, per 1-SD increase in UA was positively associated with swing time (β = 6.953, P = 0.007). Conversely, UA was negatively associated with thigh swing work (β = - 0.023, P = 0.003), foot landing control force (β = - 0.134, P < 0.001), stride frequency (β = - 1.074, P = 0.049) and stride length (β = - 0.014, P = 0.012). After false discovery rate (FDR) correction for multiple comparisons, all these associations remained statistically significant except for stride frequency. Higher UA levels were associated with higher AIs of thigh acceleration (β = 0.034, P = 0.013), ground reaction force (β = 0.033, P = 0.002), foot landing control force (β = 0.048, P < 0.001) and toe-off angle (β = 0.061, P = 0.001). UA was positively associated with CVs of swing time (β = 0.032, P < 0.001), ground reaction force (β = 0.015, P = 0.001), foot landing control force (β = 0.018, P = 0.001) and toe-off angle (β = 0.035, P = 0.002). All these associations with gait symmetry and stability indices remained statistically significant after FDR correction. Exploratory analyses identified high-sensitivity C-reactive protein, interleukin-6, superoxide dismutase, and glutathione reductase as potential biomarkers linking the association between UA and gait performance. Higher UA levels are associated with poorer gait performance in terms of vigor, symmetry, and stability. The underlying inflammatory and oxidative stress mechanisms need to be elucidated in future experimental studies. Not applicable.
STRAIGHT-IN is a genome engineering platform that enables precise integration of DNA payloads into mammalian genomes, including hiPSCs. In this study, we generated three hiPSC acceptor lines containing either one (single) or two (dual) landing pads. These landing pads support efficient, seamless integration of DNA cargos with single-copy control and a near-scarless genomic footprint. All landing pads were targeted to the CLYBL genomic safe harbor locus in the male hiPSC line iPS11. The resulting acceptor lines offer a versatile resource for the controlled genomic integration of diverse transgenes, making them broadly applicable to a wide range of applications.
Fatal paragliding accidents are complex medicolegal events in which accident dynamics and fatal injury mechanisms must be reconstructed through integration of scene findings, witness statements, technical records, and autopsy findings. This study evaluated fatal paragliding accidents using an autopsy-based forensic reconstruction approach, focusing on flight phase, injury patterns, impact biomechanics, and cause-of-death assessment. This retrospective study included 33 fatal paragliding cases in Muğla, Türkiye, from 2012 to 2025. Data were collected from autopsy reports, scene investigation records, law enforcement documents, toxicological analyses, and clinical records. Evaluated variables included flight phase, accident mechanism, crash location, equipment information, rescue data, injury distribution, and cause of death. Phase-related patterns were summarized descriptively due to the small sample size and sparse subgroups. Fatal events occurred during takeoff in 7 cases, en-route flight in 3 cases, and landing in 23 cases. Wing collapse and line entanglement were common initiating events. Thoracic traumatic lesions were observed in all cases. Head and neck injuries were identified in 25 cases, and abdominal or pelvic injuries were detected in 23 cases. Spinal injuries and extremity fractures were each identified in 18 cases. Intracranial findings were observed in 11 cases; hyoid bone and/or thyroid cartilage fractures were also observed in 11 cases. The autopsy conclusions in 23 cases described death due to the combined effects of severe multisystem blunt-force trauma, predominantly among landing-phase fatalities. Takeoff and en-route deaths more often showed localized fatal pathways, including massive intrathoracic hemorrhage, fatal abdominal hemorrhage due to organ rupture, cardiac tamponade, and drowning/asphyxia. Fatal paragliding trauma should be interpreted using an integrated forensic reconstruction model, not merely a list of injuries. This study identifies recurring autopsy-based injury patterns, notably a thoraco-cranio-cervical pattern in landing-phase fatalities. These findings support standardized documentation of body position, harness configuration, equipment interaction, and impact context in future investigations.
Dynamic bipedal jumping is highly sensitive to takeoff momentum and landing configuration, making the direct execution of purely offline-optimized trajectories unreliable on full-sized humanoid robots in the presence of modeling inaccuracies and execution uncertainties. A key challenge is the gap between dynamic feasibility predicted offline using simplified models and executability on physical hardware, because such models cannot fully capture full-body dynamics, actuator behavior, contact transitions, and execution uncertainty. This paper proposes an offline-to-online planning and whole-body control framework for robust in-place jumping of full-sized humanoid robots. The framework integrates phase-consistent offline trajectory optimization, lightweight online reference reshaping, constraint-aware whole-body control, and actuator-level command mapping to improve execution robustness without online re-optimization. In the offline stage, centroidal-dynamics-based trajectory optimization generates jumping references subject to kinematic-consistency and contact-feasibility constraints. During execution, these references are adapted online using real-time state estimates to compensate for takeoff deviations and regulate the landing state; a weighted quadratic-programming whole-body controller then tracks the adapted references. Hardware experiments on a 79.5 kg humanoid robot demonstrate repeatable in-place vertical jumps with a height of approximately 30 cm and stable landings. The results show that robust jumping on a full-sized humanoid robot can be achieved by combining offline nominal trajectory generation with online execution adaptation rather than relying on exact reproduction of the offline trajectories.
Female reproductive hormones are attributed to the higher rate of musculoskeletal (MSK) injuries among female athletes compared with male athletes. To evaluate association between exposure to hormonal contraceptives (HCs), joint laxity, and number of injuries in female athletes over a 1-year period. Cohort study. Level 3. Professional and Division I collegiate female athletes were recruited into 2 groups based on HC status (HC vs non-HC). Serum relaxin, estrogen and progesterone levels, knee laxity, generalized hypermobility, and lower extremity kinematics during a single-legged jump were examined during preseason in the luteal phase of each athlete's menstrual cycle. Injuries were tracked for 1 year after testing. Circulating levels of progesterone (non-HC, 38.9 ± 15.0 pg/mg vs HC, 28.6 ± 11.4 pg/mg; P < 0.01), estrogen (non-HC, 2.80 ± 3.0 pg/mg vs HC, 2.0 ± 3.0 pg/mg; P = 0.01), and relaxin (non-HC, 0.26 ± 0.08 pg/mg vs HC, 0.22 ± 0.03 pg/mg; P = 0.04) were lower in HC (n = 32) than in non-HC (n = 40) athletes during the luteal phase of the cycle. Non-HC athletes demonstrated significantly greater hip flexion at initial contact (non-HC, 29.42°± 7.64° vs HC, 25.25°± 7.13°; P = 0.02), and greater knee adduction (valgus) at maximum knee flexion (non-HC, -1.90°± 3.25° vs HC, -0.25° ± 3.40°; P = 0.02) during a single-legged drop. Average (±SD) injury count for non-HC athletes was 0.71 (±1.3) compared with 0.35 (±0.70) in the HC group (P = 0.25). Injury count was correlated significantly to circulating levels of relaxin (r = 0.32; P < 0.01). A potential relationship between increased circulating relaxin levels and the risk of injury was established. Athletes taking HCs demonstrated significantly reduced peak knee adduction angles when landing from a jump. The results advance knowledge of relationships between specific hormones and injury risk, and the potential role of HCs on kinematic patterns when landing from a jump. Future research will determine HC formulations that may protect against MSK injury, and inform broader strategies to reduce sport-related injury risk in female athletes.
Noncontact anterior cruciate ligament (ACL) injuries are common and carry long-term consequences for the athlete. Altered foot and ankle biomechanics, landing patterns, and prior ankle injury have been implicated in ACL injury risk and may inform prevention strategies. To identify key biomechanical risk factors associated with the foot and ankle that may contribute to ACL injury risk. Systematic review; Level of evidence, 4. A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. PubMed, Cochrane, and SPORTDiscus databases were searched for English-language studies (2010-2025) evaluating ACL injuries and reporting on the foot or ankle. Screening was performed using Rayyan, followed by full-text review. Data were extracted, and then risk of bias was assessed using the methodological index for non-randomized studies (MINORS). Out of 1772 studies evaluated, a total of 48 (2.7%) studies met inclusion criteria. Overall, 33 studies (68.8%) identified variables associated with increased ACL injury risk, while 11 (22.9%) reported decreased risk and 9 (18.8%) found no association. Foot and ankle biomechanics were examined in 32 studies (66.7%), foot strike pattern in 8 (16.7%), toe direction in 7 (14.6%), and prior ankle injury history in 5 (10.4%). Statistically supported findings were present in 81% of studies. Greater dynamic rearfoot motion (eversion/inversion), increased dorsiflexion, and medial arch collapse (eg, navicular drop) were commonly associated with increased risk. Forefoot landings were protective, while rearfoot and flatfoot strikes, as well as toe-in or toe-out positions, were consistently linked to higher injury risk. Sex-specific analysis showed that female athletes demonstrated more high-risk biomechanical patterns than their male counterparts. Sport-specific analysis revealed basketball (n = 14), soccer (n = 8), and handball (n = 6) as the most studied sports, with >75% of these studies identifying ≥1 foot- or ankle-related ACL injury risk factor. Study quality was generally low, with predominantly noncomparative designs and modest MINORS. Foot and ankle factors, including prior injury, alignment, foot strike patterns, and toe progression, contribute meaningfully to ACL injury risk, yet their precise influence on knee stabilization remains unclear. The foot and ankle are understudied, with few investigations addressing their role in dynamic tasks that challenge knee stability. High-quality comparative research that accounts for sex and sport differences is needed to inform targeted prevention and improve risk stratification.
This study aimed to develop an end-to-end intelligent decision support system, NeurAneuNet, to automate the selection of Pipeline Embolization Device (PED) size and landing zones for intracranial aneurysm treatment, thereby reducing reliance on operator experience and improving planning consistency. NeurAneuNet integrates multimodal deep learning with knowledge enhancement. The system processes three-dimensional rotational angiography (3DRA) images using a dual-path attention U-Net++ for aneurysm segmentation, extracts knowledge-augmented geometric and clinical features, fuses five feature modalities via tensor decomposition, and predicts optimal PED sizing and landing zones with a high-order Kolmogorov-Arnold Network (KAN). A dataset of 600 aneurysms (including 210 PED-treated cases) was used for model development and validation, with an independent clinical cohort of 21 cases employed to assess real-world utility. NeurAneuNet achieved a Dice coefficient of 0.874 ± 0.03 for aneurysm segmentation, a PED size classification accuracy of 91.8%, and a diameter prediction error of 0.24 ± 0.10 mm. In the independent test, its primary recommendation agreed with the expert consensus in 95.2% of cases. When assisting clinicians, the system reduced planning time by 44.8% and significantly lowered subjective cognitive workload, as assessed by the National Aeronautics and Space Administration Task Load Index (NASA-TLX) score (from 33 ± 8 to 21 ± 5). NeurAneuNet demonstrates clinically relevant accuracy and efficiency in automating PED treatment planning, providing robust, intelligent support for intracranial aneurysm interventions. The system provides a promising foundation for developing a generalizable AI-driven decision support framework in complex medical scenarios.