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Is the Landing Error Scoring System Reliable and Valid? A Systematic Review

Context: The Landing Error Scoring System (LESS) is a clinical tool often used in research and practice to identify athletes presenting high injury-risk biomechanical patterns during a jump-landing task. Objective: To systematically review the literature addressing the psychometric properties of the LESS. Data Sources: Three electronic databases (PubMed, Web of Science, and Scopus) were searched on March 28, 2018, using the term “Landing Error Scoring System.” Study Selection: All studies using the LESS as main outcome measure and addressing its reliability, validity against motion capture system, and predictive validity were included. Original English-language studies published in peer-reviewed journals were reviewed. Studies using modified versions of the LESS were excluded. Study Design: Systematic literature review. Level of Evidence: Level 4. Data Extraction: Study design, population, LESS testing procedures, LESS scores, statistical analysis, and main results were extracted from studies using a standardized template. Results: Ten studies met inclusion criteria and were appraised using Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. The overall LESS score demonstrated good-to-excellent intrarater (intraclass correlation coefficient [ICC], 0.82-0.99), interrater (ICC, 0.83-0.92), and intersession reliability (ICC, 0.81). The validity of the overall LESS score against 3-dimensional jump-landing biomechanics was good when individuals were divided into 4 quartiles based on LESS scores. The validity of individual LESS items versus 3-dimensional motion capture data was moderate-to-excellent for most of the items addressing key risk factors for anterior cruciate ligament (ACL) injury. The predictive value of the LESS for ACL and other noncontact lower-extremity injuries remains uncertain based on the current scientific evidence. Conclusion: The LESS is a reliable screening tool. However, further work is needed to improve the LESS validity against motion capture system and confirm its predictive validity for ACL and other noncontact lower-extremity injuries.
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