Criterion-related validity of 2-Dimensional measures of hip, knee and ankle kinematics during bilateral drop-jump landings


  • Iñaki Ruiz-Pérez Department of Sport Science, Sport Research Centre, Miguel Hernandez University of Elche, Elche (Alicante), Spain.
  • José LL Elvira Department of Sport Science, Sport Research Centre, Miguel Hernandez University of Elche, Elche (Alicante), Spain.
  • Gregory D Myer The SPORT Center, Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States.
  • Mark De Ste Croix School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom of Great Britain and Northern Ireland.
  • Francisco Ayala Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, (Murcia, Spain).



Dynamic knee valgus, injury, screening, motion analysis


Three-dimensional (3D) motion capture systems have been used to identify athletes in high risk of injury, but due to their cost, lack of portability and qualified technicians, an alternative is needed, such as two-dimensional (2D) systems. The purpose of this study was to examine the criterion-related validity of three measures of frontal plane knee alignment (Frontal plane projection angle [FPPA], knee-to-ankle separation ratio [KASR] and knee medial displacement [KMD]) and two sagittal plane measures (hip and knee flexion ranges of motion [ROMs]), recorded simultaneously using a 2D video analysis procedure and a 3D motion analysis system. Twenty-nine male futsal players had frontal and sagittal plane kinematics assessed while performing bilateral drop vertical jumps (DVJ). The criterion-related validity of the frontal and sagittal plane kinematic measures obtained using the 2D video analysis procedure and 3D motion system was determined through the estimation equation, typical error of the estimate (TEEST) and validity correlation (r). Kappa correlations were also calculated to determine the agreement between the 2D and 3D kinematic approaches. The results showed poor validity for the FPPA measure (standardized TEEST = 1.34 [large], r = 0.60) and moderate validity for KASR (standardized TEEST = 0.88 [moderate], r = 0.77), KMD (standardized TEEST = 0.53 [small], r = 0.88), hip flexion ROM (standardized TEEST = 0.62 [moderate], r = 0.85) and knee flexion ROM (standardized TEEST = 0.56 [small], r = 0.87) measures. However, only the KMD and knee flexion ROM measures showed high levels of agreement (kappa > 0.7). Therefore, the KMD and knee flexion ROM measures calculated during a bilateral DVJ and using a 2D video analysis procedure might be considered as valid and feasible alternatives to their respective 3D criterion to quantify knee kinematics and to detect futsal players who demonstrated aberrant movement patterns in the frontal and sagittal planes, respectively.


Download data is not yet available.


Metrics Loading ...


Agel, J., Arendt, E., & Bershadsky, B. (2005). Anterior Cruciate Ligament Injury in National Collegiate Athletic Association Basketball and Soccer: A 13-Year Review. American Journal of Sports Medicine, 33(4), 524–531.

Ardern, C. L., Webster, K. E., Taylor, N. F., & Feller, J. a. (2011). Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery. The American Journal of Sports Medicine, 39(3), 538–543.

Baudet, A., Morisset, C., D’Athis, P., Maillefert, J.-F., Casillas, J.-M., Ornetti, P., & Laroche, D. (2014). Cross-Talk Correction Method for Knee Kinematics in Gait Analysis Using Principal Component Analysis (PCA): A New Proposal. PLoS ONE, 9(7), e102098.

Bittencourt, N. F. N., Meeuwisse, W. H., Mendonça, L. D., Nettel-Aguirre, A., Ocarino, J. M., & Fonseca, S. T. (2016). Complex systems approach for sports injuries: moving from risk factor identification to injury pattern recognition—narrative review and new concept. British Journal of Sports Medicine, 50(21), 1309–1314.

Boden, B. P., Griffin, L. Y., & Garrett, W. E. (2000). Etiology and prevention of noncontact ACL injury. Physician and Sportsmedicine, 28(4), 53–60.

Chung, P. Y. M., & Ng, G. Y. F. (2012). Comparison between an accelerometer and a three-dimensional motion analysis system for the detection of movement. Physiotherapy (United Kingdom), 98(3), 256–259.

Cohen, J. (1988). Statistical power analysis for the behavioural sciences (2.a ed. Ac).

Dai, B., Mao, D., Garrett, W. E., & Yu, B. (2014). Anterior cruciate ligament injuries in soccer: Loading mechanisms, risk factors, and prevention programs. Journal of Sport and Health Science, 3(4), 299–306.

Della Villa, F., Buckthorpe, M., Grassi, A., Nabiuzzi, A., Tosarelli, F., Zaffagnini, S., & Della Villa, S. (2020). Systematic video analysis of ACL injuries in professional male football (soccer): injury mechanisms, situational patterns and biomechanics study on 134 consecutive cases. British Journal of Sports Medicine, bjsports-2019-101247.

Eltoukhy, M., Asfour, S., Thompson, C., & Latta, L. (2012). Evaluation of the Performance of Digital Video Analysis of Human Motion: Dartfish Tracking System. International Journal of …, 3(3), 1–6.

Fong, C. M., Blackburn, J. T., Norcross, M. F., McGrath, M., & Padua, D. A. (2011). Ankle-dorsiflexion range of motion and landing biomechanics. Journal of Athletic Training, 46(1), 5–10.

France, L., & Nester, C. (2001). Effect of errors in the identification of anatomical landmarks on the accuracy of Q angle values. Clinical Biomechanics, 16(8), 710–713.

Groen, B. E., Geurts, M., Nienhuis, B., & Duysens, J. (2012). Sensitivity of the OLGA and VCM models to erroneous marker placement: Effects on 3D-gait kinematics. Gait and Posture, 35(3), 517–521.

Gwynne, C. R., & Curran, S. A. (2014). Quantifying frontal plane knee motion during single limb squats: reliability and validity of 2-dimensional measures. International Journal of Sports Physical Therapy, 9(7), 898–906.

Herrington, L., Alenezi, F., Alzhrani, M., Alrayani, H., & Jones, R. (2017). The reliability and criterion validity of 2D video assessment of single leg squat and hop landing. Journal of Electromyography and Kinesiology, 34, 80–85.

Hewett, T. E., Myer, G. D., & Ford, K. R. (2006). Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. American Journal of Sports Medicine, 34(2), 299–311.

Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., van den Bogert, A. J., Paterno, M. V., & Succop, P. (2005). Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: A Prospective Study. The American Journal of Sports Medicine, 33(4), 492–501.

Hopkins, W. G. (2000). Measures of reliability in sports medicine and science. Sports Medicine (Auckland, N.Z.), 30(1), 1–15.

Howe, L. P., Bampouras, T. M., North, J., & Waldron, M. (2019). Ankle dorsiflexion range of motion is associated with kinematic but not kinetic variables related to bilateral drop-landing performance at various drop heights. Human Movement Science, 64(January), 320–328.

Hughes, G., Watkins, J., & Owen, N. (2008). Gender differences in lower limb frontal plane kinematics during landing. Sports Biomechanics, 7(3), 333–341.

Ireland, M. L. (1999). Anterior Cruciate Ligament Injury in Female Athletes: Epidemiology. Journal of Athletic Training, 34(2), 150–154.

J.M.Bland, D.G.Altman, Bland, J. M., Altman, D. G., J.M.Bland, & D.G.Altman. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. The Lancet, 1(8476), 307–310.

Janssen, K. W., Orchard, J. W., Driscoll, T. R., & van Mechelen, W. (2012). High incidence and costs for anterior cruciate ligament reconstructions performed in Australia from 2003-2004 to 2007-2008: Time for an anterior cruciate ligament register by Scandinavian model? Scandinavian Journal of Medicine and Science in Sports, 22(4), 495–501.

Junge, A., & Dvorak, J. (2010). Injury risk of playing football in Futsal World Cups. British Journal of Sports Medicine, 44(15), 1089–1092.

Kadaba, M. P., Ramakrishnan, H. K., & Wootten, M. E. (1990). Measurement of lower extremity kinematics during level walking. Journal of Orthopaedic Research, 8(3), 383–392.

Koga, H., Nakamae, A., Shima, Y., Bahr, R., & Krosshaug, T. (2018). Hip and Ankle Kinematics in Noncontact Anterior Cruciate Ligament Injury Situations: Video Analysis Using Model-Based Image Matching. The American Journal of Sports Medicine, 46(2), 333–340.

Krosshaug, T., Nakamae, A., Boden, B. P., Engebretsen, L., Smith, G., Slauterbeck, J. R., Hewett, T. E., & Bahr, R. (2007). Mechanisms of anterior cruciate ligament injury in basketball: Video analysis of 39 cases. American Journal of Sports Medicine, 35(3), 359–367.

Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174.

Leporace, G., Tannure, M., Zeitoune, G., Metsavaht, L., Marocolo, M., & Souto Maior, A. (2020). Association between knee-to-hip flexion ratio during single-leg vertical landings, and strength and range of motion in professional soccer players. Sports Biomechanics, 19(3), 411–420.

Leppänen, M., Pasanen, K., Krosshaug, T., Kannus, P., Vasankari, T., Kujala, U. M., Bahr, R., Perttunen, J., & Parkkari, J. (2017). Sagittal Plane Hip, Knee, and Ankle Biomechanics and the Risk of Anterior Cruciate Ligament Injury: A Prospective Study. Orthopaedic Journal of Sports Medicine, 5(12), 232596711774548.

Leppänen, M., Pasanen, K., Kujala, U. M., Vasankari, T., Kannus, P., Äyrämö, S., Krosshaug, T., Bahr, R., Avela, J., Perttunen, J., & Parkkari, J. (2017). Stiff Landings Are Associated With Increased ACL Injury Risk in Young Female Basketball and Floorball Players. The American Journal of Sports Medicine, 45(2), 386–393.

Maykut, J. N., Taylor-Haas, J. A., Paterno, M. V, DiCesare, C. A., & Ford, K. R. (2015). Concurrent validity and reliability of 2d kinematic analysis of frontal plane motion during running. International Journal of Sports Physical Therapy, 10(2), 136–146.

McLean, S. G., Walker, K., Ford, K. R., Myer, G. D., Hewett, T. E., & Van Den Bogert, A. J. (2005). Evaluation of a two dimensional analysis method as a screening and evaluation tool for anterior cruciate ligament injury. British Journal of Sports Medicine, 39(6), 355–362.

McMahon, J. J., Jones, P. A., & Comfort, P. (2016). A Correction Equation for Jump Height Measured Using the Just Jump System. International Journal of Sports Physiology and Performance, 11(4), 555–557.

Mizner, R. L., Chmielewski, T. L., Toepke, J. J., & Tofte, K. B. (2012). Comparison of 2-Dimensional Measurement Techniques for Predicting Knee Angle and Moment During a Drop Vertical Jump. Clinical Journal of Sport Medicine, 22(3), 221–227.

Montgomery, C., Blackburn, J., Withers, D., Tierney, G., Moran, C., & Simms, C. (2018). Mechanisms of ACL injury in professional rugby union: A systematic video analysis of 36 cases. British Journal of Sports Medicine, 52(15), 994–1001.

Munro, B., Visintainer, M., & Page, E. (1986). Statistical methods for health care research. Lippincott.

Myer, G. D., Ford, K. R., Brent, J. L., & Hewett, T. E. (2012). An Integrated Approach to Change the Outcome Part I. Journal of Strength and Conditioning Research, 26(8), 2265–2271.

Myer, G. D., Ford, K. R., Di Stasi, S. L., Foss, K. D. B., Micheli, L. J., & Hewett, T. E. (2015). High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury? British Journal of Sports Medicine, 49(2), 118–122.

Myer, G. D., Ford, K. R., Khoury, J., Succop, P., & Hewett, T. E. (2010). Development and Validation of a Clinic-Based Prediction Tool to Identify Female Athletes at High Risk for Anterior Cruciate Ligament Injury. The American Journal of Sports Medicine, 38(10), 2025–2033.

Norris, B. S., & Olson, S. L. (2011). Concurrent validity and reliability of two-dimensional video analysis of hip and knee joint motion during mechanical lifting. Physiotherapy Theory and Practice, 27(7), 521–530.

Olsen, O.-E., Myklebust, G., Engebretsen, L., & Bahr, R. (2004). Injury Mechanisms for Anterior Cruciate Ligament Injuries in Team Handball. The American Journal of Sports Medicine, 32(4), 1002–1012.

Onate, J., Cortes, N., Welch, C., & Van Lunen, B. (2010). Expert versus Novice Interrater Reliability and Criterion Validity of the Landing Error Scoring System. Journal of Sport Rehabilitation, 19(1), 41–56.

Ortiz, A., Rosario-Canales, M., Rodríguez, A., Seda, A., Figueroa, C., & Venegas-Ríos, H. (2016). Reliability and concurrent validity between two-dimensional and three-dimensional evaluations of knee valgus during drop jumps. Open Access Journal of Sports Medicine, 65.

Paterno, M. V., Schmitt, L. C., Ford, K. R., Rauh, M. J., Myer, G. D., Huang, B., & Hewett, T. E. (2010). Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. American Journal of Sports Medicine, 38(10), 1968–1978.

Powers, C. M. (2010). The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. Journal of Orthopaedic & Sports Physical Therapy, 40(2), 42–51.

Sell, T. C., Hufnagel, M., Heebner, N., & Lephart, S. M. (2019). Reliability, discriminant validity and sex comparisons of dynamic postural stability during a landing task designed to challenge transverse plane knee stability. Sports Biomechanics, 00(00), 1–13.

Shultz, S. J., Schmitz, R. J., Benjaminse, A., Collins, M., Ford, K., & Kulas, A. S. (2015). ACL research retreat VII: An update on anterior cruciate ligament injury risk factor identification, screening, and prevention March 19-21, 2015; Greensboro, nc. Journal of Athletic Training, 50(10), 1076–1093.

Sorenson, B., Kernozek, T. W., Willson, J. D., Ragan, R., & Hove, J. (2015). Two- and Three-Dimensional Relationships Between Knee and Hip Kinematic Motion Analysis: Single-Leg Drop-Jump Landings. Journal of Sport Rehabilitation, 24(4), 363–372.

Starkey, C. (2000). Injuries and Illnesses in the National Basketball Association: A 10-Year Perspective. Journal of Athletic Training, 35(2), 161–167.

Sutherland, D. H. (2002). The evolution of clinical gait analysis: Part II kinematics. Gait and Posture, 16(2), 159–179.

Taylor, K.-L. L., Sheppard, J. M., Lee, H., & Plummer, N. (2009). Negative effect of static stretching restored when combined with a sport specific warm-up component. Journal of Science and Medicine in Sport, 12(6), 657–661.

Waldén, M., Hägglund, M., Werner, J., & Ekstrand, J. (2011). The epidemiology of anterior cruciate ligament injury in football (soccer): a review of the literature from a gender-related perspective. Knee Surgery, Sports Traumatology, Arthroscopy, 19(1), 3–10.

Waldén, M., Krosshaug, T., Bjørneboe, J., Andersen, T. E., Faul, O., & Hägglund, M. (2015). Three distinct mechanisms predominate in noncontact anterior cruciate ligament injuries in male professional football players: A systematic video analysis of 39 cases. British Journal of Sports Medicine, 49(22), 1452–1460.

Willson, J. D., & Davis, I. S. (2008). Utility of the Frontal Plane Projection Angle in Females With Patellofemoral Pain. Journal of Orthopaedic & Sports Physical Therapy, 38(10), 606–615.





Original Research

Most read articles by the same author(s)