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Article: Handgrip Strength and Anthropometry in Parkinson's Disease at Diagnosis.

Håglin, Lena / Törnkvist, Birgitta / Edström, Mona / Håglin, Sofia / Bäckman, Lennart

2022 Volume 2022, Page(s) 1516807

Abstract: Objectives: To investigate how age, malnutrition, and the level of plasma cortisol and phosphate in patients with Parkinson's disease (PD) at time of diagnosis are associated with body composition and handgrip strength in males and females compared to ... ...

Abstract	Objectives: To investigate how age, malnutrition, and the level of plasma cortisol and phosphate in patients with Parkinson's disease (PD) at time of diagnosis are associated with body composition and handgrip strength in males and females compared to controls. Results: Low fat-free mass index (FFMI), MNA score, and a high Unified Parkinson's Disease Rating Scale (UPDRS-total and UPDRS-III) were associated with high daytime levels of P-cortisol in total PD population but not in controls. Partial correlations reveal that high fat mass percent (FM (%)) and low FFMI were associated with older age in males with PD but not females with PD. Risk of malnutrition was associated with P-cortisol in males but not in females with PD ( Conclusions: Age- and disease-associated risk factors that decrease muscle mass and HGS and increase FM (%) in patients with PD differ between males and females by an association with levels of cortisol and phosphate.
Language	English
Publishing date	2022-07-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2573854-9
ISSN	2042-0080 ; 2090-8083
ISSN (online)	2042-0080
ISSN	2090-8083
DOI	10.1155/2022/1516807
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Article ; Online: Using phosphate supplementation to reverse hypophosphatemia and phosphate depletion in neurological disease and disturbance.

Håglin, Lena

Nutritional neuroscience

2016 Volume 19, Issue 5, Page(s) 213–223

Abstract: Hypophosphatemia (HP) with or without intracellular depletion of inorganic phosphate (Pi) and adenosine triphosphate has been associated with central and peripheral nervous system complications and can be observed in various diseases and conditions ... ...

Abstract	Hypophosphatemia (HP) with or without intracellular depletion of inorganic phosphate (Pi) and adenosine triphosphate has been associated with central and peripheral nervous system complications and can be observed in various diseases and conditions related to respiratory alkalosis, alcoholism (alcohol withdrawal), diabetic ketoacidosis, malnutrition, obesity, and parenteral and enteral nutrition. In addition, HP may explain serious muscular, neurological, and haematological disorders and may cause peripheral neuropathy with paresthesias and metabolic encephalopathy, resulting in confusion and seizures. The neuropathy may be improved quickly after proper phosphate replacement. Phosphate depletion has been corrected using potassium-phosphate infusion, a treatment that can restore consciousness. In severe ataxia and tetra paresis, complete recovery can occur after adequate replacement of phosphate. Patients with multiple risk factors, often with a chronic disease and severe HP that contribute to phosphate depletion, are at risk for neurologic alterations. To predict both risk and optimal phosphate replenishment requires assessing the nutritional status and risk for re-feeding hypophosphatemia. The strategy for correcting HP depends on the severity of the underlying disease and the goal for re-establishing a phosphate balance to limit the consequences of phosphate depletion.
MeSH term(s)	Animals ; Deficiency Diseases/diagnosis ; Deficiency Diseases/diet therapy ; Deficiency Diseases/etiology ; Deficiency Diseases/therapy ; Dietary Supplements/adverse effects ; Humans ; Hypophosphatemia/diagnosis ; Hypophosphatemia/diet therapy ; Hypophosphatemia/physiopathology ; Hypophosphatemia/therapy ; Infusions, Intravenous ; Nervous System Diseases/blood ; Nervous System Diseases/etiology ; Nervous System Diseases/physiopathology ; Nutritional Status ; Phosphates/administration & dosage ; Phosphates/adverse effects ; Phosphates/deficiency ; Phosphates/therapeutic use ; Phosphorus/blood ; Practice Guidelines as Topic ; Refeeding Syndrome/blood ; Refeeding Syndrome/etiology ; Refeeding Syndrome/physiopathology ; Refeeding Syndrome/prevention & control ; Severity of Illness Index
Chemical Substances	Phosphates ; Phosphorus (27YLU75U4W)
Language	English
Publishing date	2016-06
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1447449-9
ISSN	1476-8305 ; 1028-415X
ISSN (online)	1476-8305
ISSN	1028-415X
DOI	10.1179/1476830515Y.0000000024
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Article ; Online: High serum phosphate concentration as the result of smoking might underlie the lower risk of Parkinson's disease.

Håglin, L

Medical hypotheses

2015 Volume 85, Issue 3, Page(s) 287–290

Abstract: Epidemiological studies have found a negative association between cigarette smoking and Parkinson's disease (PD): PD patients are approximately 50% less likely to have smoked cigarettes than age- and sex-matched controls. In both women and men, the PD ... ...

Abstract	Epidemiological studies have found a negative association between cigarette smoking and Parkinson's disease (PD): PD patients are approximately 50% less likely to have smoked cigarettes than age- and sex-matched controls. In both women and men, the PD protection effect of smoking may be explained by higher levels of phosphate in serum (S-P) and triglycerides (S-TG) in smokers compared to non-smokers. That is, the protecting effect from smoking could be mediated by either a high S-P or high S-TG levels. I suggest that higher S-P as the result of smoking may be associated with intracellular depletion of Pi in skeletal muscle and that this depletion of Pi is associated with increased availability of phosphate for the brain. This increased phosphate availability would protect against PD, as oxidative phosphorylation in the mitochondria is a central and persistent phenomenon in the pathogenesis cascade of PD. Phosphate is necessary for energy production in the form of creatine phosphate (CP) and adenosine-tri-phosphate (ATP) in the brain and skeletal muscle. As such, hypophosphatemia increases risk of cell death. In some clinical instances, this energy depletion may pre-dispose to dopamine neuron death. Mitochondrial dysfunction is associated with the generation of oxidative stress and mediates the induction of apoptosis. Studies with NMR spectroscopy reveal that an energy deficit in brain cells is a strong mark for PD although this differed for men and women. Compared to women, men had lower serum phosphate and ATP levels in the brain (about 15% lower). In addition to sex differences, age, stress, and malnutrition may cause low serum phosphate levels, a situation that could contribute to the lack of energy available to the brain and the risk of PD. As hypophosphatemia is present in overnutrition and has an inverse relation with a high BMI, both obesity and malnutrition are considered to be presumptive risk factor for PD.
MeSH term(s)	Female ; Humans ; Male ; Parkinson Disease/blood ; Parkinson Disease/epidemiology ; Phosphates/blood ; Risk Factors ; Smoking/blood
Chemical Substances	Phosphates
Language	English
Publishing date	2015-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	193145-3
ISSN	1532-2777 ; 0306-9877
ISSN (online)	1532-2777
ISSN	0306-9877
DOI	10.1016/j.mehy.2015.05.017
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Article ; Online: APOE ɛ4, but not polygenic Alzheimer's disease risk, is related to longitudinal decrease in hippocampal brain activity in non-demented individuals.

Håglin, Sofia / Koch, Elise / Schäfer Hackenhaar, Fernanda / Nyberg, Lars / Kauppi, Karolina

Scientific reports

2023 Volume 13, Issue 1, Page(s) 8433

Abstract: The hippocampus is affected early in Alzheimer's disease (AD) and altered hippocampal functioning influences normal cognitive aging. Here, we used task-based functional MRI to assess if the APOE ɛ4 allele or a polygenic risk score (PRS) for AD was linked ...

Abstract	The hippocampus is affected early in Alzheimer's disease (AD) and altered hippocampal functioning influences normal cognitive aging. Here, we used task-based functional MRI to assess if the APOE ɛ4 allele or a polygenic risk score (PRS) for AD was linked to longitudinal changes in memory-related hippocampal activation in normal aging (baseline age 50-95, n = 292; n = 182 at 4 years follow-up, subsequently non-demented for at least 2 years). Mixed-models were used to predict level and change in hippocampal activation by APOE ɛ4 status and PRS based on gene variants previously linked to AD at p ≤ 1, p < 0.05, or p < 5e-8 (excluding APOE). APOE ɛ4 and PRS
MeSH term(s)	Humans ; Middle Aged ; Aged ; Aged, 80 and over ; Alzheimer Disease/genetics ; Aging ; Alleles ; Hippocampus ; Apolipoproteins E
Chemical Substances	Apolipoproteins E
Language	English
Publishing date	2023-05-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-023-35316-z
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Article ; Online: Low plasma thiamine and phosphate in male patients with Parkinson's disease is associated with mild cognitive impairment.

Håglin, L / Domellöf, M / Bäckman, L / Forsgren, L

Clinical nutrition ESPEN

2020 Volume 37, Page(s) 93–99

Abstract: Objectives: Thiamine deficiency (TD) and phosphate depletion increase the risk for cognitive disturbances. This study investigates whether plasma levels of thiamine (P-THIAM), thiamine-monophosphate (P-TMP), and phosphate (P-PHOS) are associated with ... ...

Abstract	Objectives: Thiamine deficiency (TD) and phosphate depletion increase the risk for cognitive disturbances. This study investigates whether plasma levels of thiamine (P-THIAM), thiamine-monophosphate (P-TMP), and phosphate (P-PHOS) are associated with mild cognitive decline (MCI) in patients with Parkinson's disease (PD). Design and study population: This case-control study includes baseline data from a cohort of newly diagnosed patients identified in the New Parkinsonism in Umeå study (NYPUM) (N = 75) and an age and sex matched control group (n = 24). Measurements: Mini Nutritional Assessment (MNA-score) and concentrations of P-THIAM, P-TMP, and P-PHOS at baseline were compared between PD patients with mild cognitive impairment (PD-MCI) and PD patients with normal cognition (PD-NC). Neuropsychological assessments of MCI were performed at time of diagnosis. Results: Compared to patients with NC, patients with MCI had lower levels of P-THIAM and P-TMP as well as lower scores on both the Mini Mental State Examination (MMSE) and MNA-screening test. In addition, patients with MCI were older and had more motor problems. The multiple logistic regressions adjusted for age and sex revealed that higher levels of P-THIAM and the MNA-total score were associated with a lower risk of having MCI. Higher MNA-total score and higher P-THIAM and P-PHOS concentrations decreased the risk of MCI in male patients, but not in female patients. The decreased risk of MCI with higher P-TMP levels was lost after adding age and sex to the model. Bivariate correlations between P-PHOS and P-TMP were shown for the total PD population and controls as well as for males with MCI (r = 0.533; n = 22; p = 0.011), but not for males with NC (r = 0.314; n = 19; p = 0.204). An inverse partial correlation (adjusted for age, sex and UPDRS III) was shown for P-THIAM and MNA-total (r = -0.315,p = 0.009) and -final (part II) (r = -0.395,p = 0.001) score for the PD population (n = 75). Conclusions: Higher P-THIAM and P-PHOS concentrations and higher MNA-total score were associated with a lower risk of MCI in male PD patients, findings that indicate that nutritional factors may influence cognitive function in males in the early phase of PD.
MeSH term(s)	Case-Control Studies ; Cognitive Dysfunction/diagnosis ; Female ; Humans ; Male ; Parkinson Disease/diagnosis ; Phosphates ; Thiamine
Chemical Substances	Phosphates ; Thiamine (X66NSO3N35)
Language	English
Publishing date	2020-04-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2405-4577
ISSN (online)	2405-4577
DOI	10.1016/j.clnesp.2020.03.012
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Article ; Online: Obesity, smoking habits, and serum phosphate levels predicts mortality after life-style intervention.

Håglin, Lena / Törnkvist, Birgitta / Bäckman, Lennart

PloS one

2020 Volume 15, Issue 1, Page(s) e0227692

Abstract: ... diabetes mellitus (T2DM), high serum calcium (S-Ca), mmol/L and high systolic blood pressure (SBP, mmHg) were ...

Abstract	Background: Life-style interventions, including smoking cessation and weight control are of importance for managing future escalating prevalence of obesity. Smoking habits and obesity have jointly great impact on mortality, however mechanisms behind the effect and variables involved in the obesity paradox is still unknown. Objectives: This study examines risk factors for all-cause, cardiovascular, and cancer mortality in males and females with high cardiovascular risk, mediated by smoking habits, body mass index (BMI, kg/m2), and serum phosphate (S-P) levels. Methods: Patients were admitted to the Vindeln Patient Education Center in groups of 30 for a four-week residential comprehensive program (114 hours) focusing on smoking cessation, stress reduction, food preferences and selections, and physical exercise. The follow-up, in years from 1984 to 2014 corresponds to 30 years. This study included 2,504 patients (1,408 females and 1,096 males). Cox regression analysis was used to assess mortality risk associated with smoking habits, low and high BMI, and low and high S-P levels. Results: High BMI (>34,2 kg/m2), current smoking, type 2 diabetes mellitus (T2DM), high serum calcium (S-Ca), mmol/L and high systolic blood pressure (SBP, mmHg) were associated with all-cause mortality irrespective of sex. Former and current smoking females had a high all-cause mortality (adjusted hazard ratio [HR] 1.581; 95% CI 1.108-2.256, adjusted hazard ratio [HR] 1.935; 95% CI 1.461-2.562, respectively) while current smoking and high BMI increased risk for cardiovascular mortality (adjusted hazard ratio [HR] 3.505; 95% CI 2.140-5.740 and [HR] 1.536; 95% CI 1.058-2.231, respectively). Neither low nor high levels of S-P predicted all-cause, cardiovascular disease (CVD) and cancer mortality in males or females while low levels of S-P predicted all-cause mortality in smokers (adjusted hazard ratio [HR] 1.713; 95% CI 1.211-2.424). In non-smokers, low BMI (<27.6 kg/m2) was protecting and high BMI a risk for all-cause mortality. In males, ischemic heart disease (IHD), and low serum albumin (S-Alb) were associated with all-cause mortality. In females, an interaction between high BMI and smoking (HbmiSM) decreased the cardiovascular mortality (adjusted hazard ratio [HR] 0.410; 95% CI 0.179-0.937, respectively). Conclusions: High BMI and current smoking were associated with all-cause mortality in both males and females in the present high cardiovascular-risk cohort. In current smokers and non-smokers, T2DM and high S-Ca were associated with an increase in all-cause mortality, while low S-P was associated with all-cause mortality in smokers. Interaction between high BMI and smoking contribute to the obesity paradox by being protective for cardiovascular mortality in females.
MeSH term(s)	Adult ; Body Mass Index ; Cohort Studies ; Female ; Health Promotion/methods ; Healthy Lifestyle ; Humans ; Male ; Middle Aged ; Obesity/blood ; Obesity/mortality ; Obesity/therapy ; Phosphates/blood ; Risk Factors ; Smoking/blood ; Smoking/mortality ; Smoking/therapy ; Smoking Cessation ; Sweden/epidemiology ; Weight Reduction Programs
Chemical Substances	Phosphates
Language	English
Publishing date	2020-01-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0227692
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Article ; Online: Covariation between plasma phosphate and daytime cortisol in early Parkinson's disease.

Håglin, Lena / Bäckman, Lennart

Brain and behavior

2016 Volume 6, Issue 12, Page(s) e00556

Abstract: Background: Disturbed phosphate homeostasis in early Parkinson's disease (PD) may originate from a stress-related condition and nutritional status among other risk factors, age, and gender.: Methods: Risk of malnutrition using Mini-nutritional ... ...

Abstract	Background: Disturbed phosphate homeostasis in early Parkinson's disease (PD) may originate from a stress-related condition and nutritional status among other risk factors, age, and gender. Methods: Risk of malnutrition using Mini-nutritional assessment (MNA score) and plasma levels of protein markers and daytime cortisol at the time of diagnosis in PD ( Results: The patients with PD had significantly lower MNA score than controls which correlated with plasma phosphate levels. The logistic regression revealed that increasing MNA protected from low plasma phosphate, final score (OR = 0.399; 95% CI = 0.196-0.816; Conclusion: This study highlights the importance of phosphate for optimal nutritional status by association with MNA score and albumin in plasma. An inverse relationship between phosphate and cortisol indicate, in addition, that low phosphate levels may affect cognition and motor function in PD.
MeSH term(s)	Aged ; Aged, 80 and over ; Antiparkinson Agents/therapeutic use ; Case-Control Studies ; Circadian Rhythm ; Cognition/physiology ; Female ; Humans ; Hydrocortisone/blood ; Levodopa/therapeutic use ; Logistic Models ; Male ; Malnutrition/blood ; Middle Aged ; Nutrition Assessment ; Parkinson Disease/blood ; Parkinson Disease/drug therapy ; Parkinson Disease/psychology ; Phosphates/blood ; Serum Albumin/metabolism ; Transferrin/metabolism
Chemical Substances	Antiparkinson Agents ; Phosphates ; Serum Albumin ; Transferrin ; Levodopa (46627O600J) ; Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2016-10-03
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2623587-0
ISSN	2162-3279 ; 2162-3279
ISSN (online)	2162-3279
ISSN	2162-3279
DOI	10.1002/brb3.556
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Article ; Online: Intake of vitamin B before onset of Parkinson's disease and atypical parkinsonism and olfactory function at the time of diagnosis.

Håglin, L / Johansson, I / Forsgren, L / Bäckman, L

European journal of clinical nutrition

2017 Volume 71, Issue 1, Page(s) 97–102

Abstract: Background/objectives: To investigate whether vitamin-B density in the diet 2-8 years before diagnosis is associated with olfactory function at the time of diagnosis.: Subjects/methods: This prospective nested case-control study included patients ... ...

Abstract	Background/objectives: To investigate whether vitamin-B density in the diet 2-8 years before diagnosis is associated with olfactory function at the time of diagnosis. Subjects/methods: This prospective nested case-control study included patients with Parkinson's disease (PD), multiple system atrophy and progressive supranuclear paralysis identified between 2004 and 2009 in the county of Västerbotten in northern Sweden. The case database (NYPUM study; Newly Diagnosed Parkinson in Umeå; n=147) was cross-linked to the Northern Sweden Health and Disease Study (NSHDS). Identified patients (n=96) and controls (n=375) were matched for sex, age, year of health survey, sub-cohort and geographical area. Dietary intake was assessed by a food frequency questionnaire, and the brief smell identification test (B-SIT) was used to measure olfactory function at the time of diagnosis. Results: There was no difference in vitamin-B or any other macro- or micro-nutrient densities, energy intake or body mass index (kg/m Conclusions: A low thiamin and folate density in the reported diet, 2-8 years before PD diagnosis, was significantly associated with olfactory dysfunction at the time of PD diagnosis.
Language	English
Publishing date	2017-01
Publishing country	England
Document type	Journal Article
ZDB-ID	639358-5
ISSN	1476-5640 ; 0954-3007
ISSN (online)	1476-5640
ISSN	0954-3007
DOI	10.1038/ejcn.2016.181
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Article ; Online: Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population.

Gill, Vikram S / Sullivan, Georgia / Stearns, Hunter / Tummala, Sailesh V / Haglin, Jack M / Economopoulos, Kostas J / Marks, Lisa / Chauhan, Mohit

Sports medicine (Auckland, N.Z.)

2024

Abstract: Background and objective: Previous systematic reviews on mental health in athletes have found athletes to be at a potentially increased risk for mental health diagnoses compared to the public. Multiple cross-sectional studies have examined suicide ... ...

Abstract	Background and objective: Previous systematic reviews on mental health in athletes have found athletes to be at a potentially increased risk for mental health diagnoses compared to the public. Multiple cross-sectional studies have examined suicide behaviour within different athlete populations, but there is a need for a comprehensive review to synthesize and identify risk factors and epidemiology regarding suicide behaviour in the elite athlete population, especially as it compares to the general population. Methods: A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science from 1990 to January 2023. Inclusion criteria included original peer-reviewed research articles examining suicidal ideation, suicide attempt, or suicide completion within elite athlete populations. Exclusion criteria included athletes participating in high-school or Paralympic level sports, studies that did not report results regarding elite athletes and non-athletes separately, and non-peer reviewed work. All studies were screened for inclusion by two independent reviewers. The primary outcome variables extracted from included studies included rates, risk factors, and protective factors for suicide behaviour. The study quality and risk of bias was evaluated for each study using the Joanna-Briggs Institute (JBI) critical appraisal tools. Results: Of the 875 unique studies identified, 22 studies, all of which were cross-sectional in nature, met the inclusion criteria. Seven studies evaluated previous athletes, 13 studies evaluated current athletes, and two studies included a combination of previous and current athletes. Seven studies involved varsity college athletes, nine involved professional athletes of various sports, and six focused on international or Olympic level athletes. The rate of suicidal ideation in professional athletes ranged from 6.9 to 18% across four studies, while the rate in collegiate athletes ranged from 3.7 to 6.5% across three studies. Ten studies compared athletes to the general population, the majority of which found athletes to be at reduced risk of suicidal ideation, suicide attempt, and suicide completion. Only one study found athletes to have increased rates of suicide compared to matched non-athletes. Risk factors for suicide behaviour identified across multiple studies included male sex, non-white race, older age, and depression. Player position, athletic level, sport played, and injuries showed trends of having limited effect on suicide behaviour risk. Conclusion: This review suggests that elite athletes generally demonstrate reduced risk of suicidal ideation, suicide attempt, and suicide completion compared to the general population. Coaches should remain aware of specific factors, such as male sex, non-white race, and higher athletic level, in order to better identify at-risk athletes. Limitations of this review include the heterogeneity in the methodology and athlete populations across the included studies. Therefore, future targeted research is essential to compare suicide behaviour between sports and identify sport-specific suicide risk factors. Trial registration: PROSPERO Registration: CRD42023395990.
Language	English
Publishing date	2024-02-26
Publishing country	New Zealand
Document type	Systematic Review
ZDB-ID	605911-9
ISSN	1179-2035 ; 0112-1642
ISSN (online)	1179-2035
ISSN	0112-1642
DOI	10.1007/s40279-024-01998-2
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Article ; Online: Functional Return-to-Sport Testing Demonstrates Inconsistency in Predicting Short-Term Outcomes Following Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Gill, Vikram S / Tummala, Sailesh V / Sullivan, Georgia / Han, Will / Haglin, Jack M / Marks, Lisa / Tokish, John M

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association

2024

Abstract: Purpose: To systematically review the relationship between functional testing at the time of return to sport (RTS) and short-term outcomes, such as second anterior cruciate ligament (ACL) tear and return to a preinjury level of sport, among athletes who ...

Abstract	Purpose: To systematically review the relationship between functional testing at the time of return to sport (RTS) and short-term outcomes, such as second anterior cruciate ligament (ACL) tear and return to a preinjury level of sport, among athletes who underwent anterior cruciate ligament reconstruction (ACLR). Methods: A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science to identify studies examining athletes who underwent functional RTS testing and were followed for at least 12 months following ACLR. Studies were screened by 2 reviewers. A standardized template was used to extract information regarding study characteristics, ACLR information, functional test results, and risk factors associated with retear or reduced RTS. Results: Of the 937 studies identified, 22 met the inclusion criteria. The average time between ACLR and RTS testing was 8.5 months. Single leg hop for distance performance had no association with retear risk in any study and no association with RTS rates in most studies. Quadriceps strength had conflicting results in relation to retear risk, whereas it had no relationship with RTS rates. Rates of reinjury and RTS were similar between patients who passed and did not pass combined hop and strength batteries. Asymmetric knee extension and hip moments, along with increased knee valgus and knee flexion angles, demonstrated increased risk of retear. Conclusions: Individual hop and strength tests that are often used in RTS protocols following ACLR may have limited and inconsistent value in predicting ACL reinjury and reduced RTS when used in isolation. Combined hop and strength test batteries also demonstrate low sensitivity and negative predictive value, highlighting conflicting evidence to suggest RTS testing algorithm superiority. Biomechanical assessment is promising for stratifying ACL reinjury risk, but further research is necessary. Level of evidence: Level IV, systematic review of Level I-IV studies.
Language	English
Publishing date	2024-01-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	632528-2
ISSN	1526-3231 ; 0749-8063
ISSN (online)	1526-3231
ISSN	0749-8063
DOI	10.1016/j.arthro.2023.12.032
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