{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:03:51Z","timestamp":1790741031199,"version":"4.1.0"},"reference-count":54,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T00:00:00Z","timestamp":1618444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100009752","name":"futurum - akademin f\u00f6r h\u00e4lsa och v\u00e5rd, region j\u00f6nk\u00f6pings l\u00e4ns","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009752","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010805","name":"forskningsr\u00e5det i syd\u00f6stra sverige","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010805","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003945","name":"link\u00f6pings universitet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003945","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005350","name":"centrum f\u00f6r idrottsforskning","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005350","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Dr. Karola Messner Foundation"},{"name":"Swedish Football Association"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The risk of a second anterior cruciate ligament (ACL) injury when participating in pivoting sports after ACL reconstruction is high. Risk factors associated with a second ACL injury are complex.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To investigate the combinations of various clinical risk factors associated with second ACL injury in female soccer players with a primary unilateral ACL reconstruction, using Classification and Regression Tree (CART) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 117 active female soccer players (mean \u00b1 SD age, 20 \u00b1 2 years) were included. Athletes were enrolled 19 \u00b1 9 months after ACL reconstruction and were prospectively followed for 2 years. At baseline, all players underwent assessment of knee and ankle joint range of motion (ROM), participated in functional tests (postural control, hop performance, and movement asymmetries in the lower limbs and trunk), and answered questionnaires (patient-reported knee function, knee-related quality of life, psychological and personality factors). A clinical prediction model using CART was developed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 28 players (24%) sustained a second ACL injury (21 ipsilateral and 7 contralateral ruptures) while playing soccer. CART analysis selected 9 of 19 independent variables associated with second ACL injury: the 5-jump test, knee collapse on the non\u2013ACL reconstructed leg in a drop vertical jump, tuck jump, limb symmetry index on side hop and the single hop for distance, side difference in ankle dorsiflexion ROM, and scores for the questionnaires ACL-Return to Sport After Injury and the Swedish Universities Scales of Personality subscales of Stress Susceptibility and Adventure Seeking. The accuracy of the model was 89%, with 100% sensitivity and 76% specificity. CART analysis indicated that the interaction of longer jumps in the 5-jump test (&gt;916 cm) with more side difference in ankle dorsiflexion ROM (&gt;\u20132.5\u00b0) and more knee valgus collapse in the nonreconstructed knee (&gt;\u22121.4 cm) (relative risk, 4.03; 95% CI, 2.21-7.36) best predicted an increased likelihood of a second ACL injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The risk profiles selected by CART could accurately identify female soccer players at high risk for a second ACL injury. There was an interaction between functional performance, clinical assessment, and psychological factors, and it is reasonable to include these factors in return-to-sport decisions and in athlete screening after ACL injury.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0363546521999109","type":"journal-article","created":{"date-parts":[[2021,4,15]],"date-time":"2021-04-15T18:57:35Z","timestamp":1618513055000},"page":"1421-1430","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":49,"title":["Clinical Risk Profile for a Second Anterior Cruciate Ligament Injury in Female Soccer Players After Anterior Cruciate Ligament Reconstruction"],"prefix":"10.1177","volume":"49","author":[{"given":"Anne","family":"F\u00e4ltstr\u00f6m","sequence":"first","affiliation":[{"name":"Region J\u00f6nk\u00f6ping County, Rehabilitation Centre, Ryhov County Hospital, J\u00f6nk\u00f6ping, Sweden"},{"name":"Unit of Physiotherapy, 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