Automated Quantification of the Landing Error Scoring System With a Markerless Motion-Capture System

Context: The Landing Error Scoring System (LESS) can be used to identify individuals with an elevated risk of lower extremity injury. The limitation of the LESS is that raters identify movement errors from video replay, which is time-consuming and, therefore, may limit its use by clinicians. A markerless motion-capture system may be capable of automating LESS scoring, thereby removing this obstacle. Objective: To determine the reliability of an automated markerless motion-capture system for scoring the LESS. Design: Cross-sectional study. Setting: United States Military Academy. Patients or Other Participants: A total of 57 healthy, physically active individuals (47 men, 10 women; age = 18.6 +/- 0.6 years, height = 174.5 +/- 6.7 cm, mass = 75.9 +/- 9.2 kg). Main Outcome Measure(s): Participants completed 3 jump-landing trials that were recorded by standard video cameras and a depth camera. Their movement quality was evaluated by expert LESS raters (standard video recording) using the LESS rubric and by software that automates LESS scoring (depth-camera data). We recorded an error for a LESS item if it was present on at least 2 of 3 jump-landing trials. We calculated kappa statistics, prevalence-and bias-adjusted kappa (PABAK) statistics, and percentage agreement for each LESS item. Interrater reliability was evaluated between the 2 expert rater scores and between a consensus expert score and the markerless motion-capture system score. Results: We observed reliability between the 2 expert LESS raters (average kappa = 0.45 +/- 0.35, average PABAK = 0.67 +/- 0.34; percentage agreement = 0.83 +/- 0.17). The markerless motion-capture system had similar reliability with consensus expert scores (average kappa = 0.48 +/- 0.40, average PABAK = 0.71 +/- 0.27; percentage agreement = 0.85 +/- 0.14). However, reliability was poor for 5 LESS items in both LESS score comparisons. Conclusions: A markerless motion-capture system had the same level of reliability as expert LESS raters, suggesting that an automated system can accurately assess movement. Therefore, clinicians can use the markerless motion-capture system to reliably score the LESS without being limited by the time requirements of manual LESS scoring.