Patrick Mai

• Norder, Thomas; Mai, Patrick; Gruettner, Maximilian; Healey, Laura & Rice, Hannah (2026). How Does Manipulation of Advanced Running Shoe Midsole Compliance Influence Frontal Plane Kinematics and Kinetics? Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 36(7). doi: 10.1111/sms.70331. Full text in Research Archive
• Mai, Patrick; Willwacher, Steffen; Rahlf, Lina; Hoenig, Tim; Braun, Luca & Diecken, Carlo von [Show all 12 contributors for this article] (2026). Situations Leading to Anterior Cruciate Ligament Injury in Sports: A Systematic Review with Meta-analysis. Sports Medicine. ISSN 0112-1642. doi: 10.1007/s40279-026-02436-1. Full text in Research Archive Show summary

  Background Anterior cruciate ligament (ACL) injuries are common in many sports and impose substantial performance and long-term health burdens. A quantitative synthesis of real-world, video-identified game situations can inform sport-specific prevention methods. Objective The aim of the study was to identify game situations and movement patterns leading to ACL injury in different sports. Design Systematic review with meta-analysis. Data Sources PubMed, Google Scholar, Web of Science, and Scopus were searched for studies analyzing video recordings of ACL injuries sustained by athletes of any sex during training or competition. Random effects meta-analyses of prevalence and moderator analyses (sport as a factor) were performed. Results In total, 39 articles (1551 video-verified ACL injuries) of on-average moderate quality (Quality Appraisal for Sports Injury Video Analysis Studies [QA-SIVAS]) scale mean 66%) were included. Noncontact ( n  = 745), indirect contact ( n  = 533), and direct contact ( n  = 273) mechanisms were reported, with notable sport-specific differences. Across all injuries, the most frequent contexts were ball action (45.7%), pressing/tackling (40.9%), and cutting (36.6%). Within noncontact cases, cutting (53.8%), pressing/tackling (50.2%), decelerating (38.9%), and landing (30.1%) were the most prevalent actions, whereas being tackled was most frequent in indirect contact cases (56.1%). For direct contact injuries, pooled action-specific estimates were available for being tackled (23.9%) and pressing/tackling (24.2%). Injuries typically occurred at high horizontal speed (53.8%; noncontact 70.7%), were more frequent during ball possession (67.5%) and offensive play (55.4%), and happened more early in time within the first 25% of the game in football (37.5%) and netball (37.8%). Conclusions The identified patterns support the use of mechanism-specific, sport-tailored prevention strategies (e.g., technique/strength, neurocognitive functioning for noncontact, perturbation-based drills for indirect contact, and rules/choice of equipment for knee-directed contact). Methodological improvements, such as harmonized and more detailed injury reporting, are needed to refine risk estimates.

• Müller-Kühnle, Julian; Bill, Kevin; Thun, Patrik; Mai, Patrick; Bagehorn, Timo & Kamatsuki, Yusuke [Show all 18 contributors for this article] (2025). A Novel Cutting Technique and Resistance Training Intervention to Improve Movement Patterns in Youth Female Handball Players. Journal of Orthopaedic & Sports Physical Therapy Open (JOSPT Open). 3(4), p. 473–482. doi: 10.2519/josptopen.2025.0144. Full text in Research Archive Show summary

  OBJECTIVE: To assess whether a 9-week intervention combining cutting technique retraining and hip/calf resistance exercises reduced knee abduction moment (KAM) in young female handball players. STUDY DESIGN: Controlled laboratory study. METHODS: Forty female players (aged 15-18 years) were assigned to an intervention group (IG; n = 20) or control group (CG; n = 20). KAM during sidestep cutting and isometric strength were assessed preintervention and postintervention. The IG completed a twice-weekly program integrated into team practice. RESULTS: Group × time interaction was not significant for KAM ( P = .366) or foot strike angle (FSA; P = .171). Both groups reduced KAM ( P = .002; IG: 0.68 ± 0.16 to 0.59 ± 0.21 Nm/kg*m; CG: 0.68 ± 0.31 to 0.53 ± 0.22 Nm/kg*m) and increased FSA ( P = .040). Knee valgus angle showed no significant interaction ( P = .462) or main effects ( P = .148, P = .080). There was no interaction for hip external rotation, hip abduction, or ankle plantarflexion strength ( P≥.05). Hip abduction strength increased over time ( P = .046) without group differences. CONCLUSION: The intervention did not significantly improve KAM or strength versus standard training, though trends suggest possible effects on cutting mechanics. JOSPT Open 2025;3(4):473-482. Epub 20 August 2025. doi:10.2519/josptopen.2025.0144

• Bill, Kevin; Bartsch, Julia; Willwacher, Steffen; Eriksrud, Ola; Mausehund, Lasse & Kersting, Uwe [Show all 8 contributors for this article] (2025). Same Same but Different: Why Both Sport-Specific Cutting Tasks and Generic Change-of-Direction Tasks Might Need to Be Considered to Prevent ACL Injury. Journal of Orthopaedic & Sports Physical Therapy Open (JOSPT Open). 3(2), p. 162–170. doi: 10.2519/josptopen.2024.0076. Full text in Research Archive Show summary

  OBJECTIVES: To compare knee abduction moment (KAM) magnitudes between a generic 180° pivot turn (modified 505 change-of-direction test [m505]) and a handball-specific sidestep cut, to assess ranking consistency, and to examine the resultant ground reaction force (GRF) and its frontal plane moment arm to the knee to comprehend their contributions to KAM. STUDY DESIGN: Observational laboratory study. METHODS: High-level female handball players (n = 45) performed the m505 and the handball-specific sidestep cut. The resultant GRF and its frontal plane moment arm to the knee as well as KAM were obtained and subsequently compared between tasks. Rank correlation coefficients were employed to assess if the variables of both tasks were related. RESULTS: Peak KAM was similar for the m505 and the sidestep cut (median [range], 1.79 [0.95-3.53] Nm/kg vs 1.64 [0.34-3.60] Nm/kg; r b = .25; P = .14). The ranking of the players’ peak KAM differed substantially ( r s = .26; P = .084), suggesting that different tasks could classify the same player with different injury risk. The m505 generated lower resultant GRFs (24 ± 4 N/kg, 95% CI [23, 24] vs 33 ± 9 N/kg, 95% CI [31, 35]; d = 1.30; P<.001) but longer frontal plane moment arms (7.8 ± 1.8 cm, 95% CI [7.3, 8.4] vs 5.4 ± 1.5 cm, 95% CI [5.0, 5.8]; d = 1.36; P<.001) compared to those generated by the sidestep cut. CONCLUSION: A difference in individual anterior cruciate ligament injury risk assessment depending on movement type was revealed. While KAM magnitudes were similar across direction-change tasks, player rankings differed. The contributions of resultant GRF and frontal plane moment arms to peak KAM varied between tasks, underscoring the importance of task-specific and individualized injury prevention. JOSPT Open 2025;3(2):162-170. Epub 4 December 2024. doi:10.2519/josptopen.2024.0076

• Braun, Luca; Mai, Patrick; Hipper, Markus; Denis, Yannick; Helwig, Janina & Anedda, Bastian [Show all 9 contributors for this article] (2025). Managing lower extremity loading in distance running by altering sagittal plane trunk leaning. Journal of Sport and Health Science. ISSN 2095-2546. 14. doi: 10.1016/j.jshs.2024.100985. Full text in Research Archive Show summary

  Background Trunk lean angle is an underrepresented biomechanical variable for modulating and redistributing lower extremity joint loading and potentially reducing the risk of running-related overuse injuries. The purpose of this study was to systematically alter the trunk lean angle in distance running using an auditory real-time feedback approach and to derive dose–response relationships between sagittal plane trunk lean angle and lower extremity (cumulative) joint loading to guide overuse load management in clinical practice. Methods Thirty recreational runners (15 males and 15 females) ran at a constant speed of 2.5 m/s at 5 systematically varied trunk lean conditions on a force-instrumented treadmill while kinematic and kinetic data were captured. Results A change in trunk lean angle from –2° (extension) to 28° (flexion) resulted in a systematic increase in stance phase angular impulse, cumulative impulse, and peak moment at the hip joint in the sagittal and transversal plane. In contrast, a systematic decrease in these parameters at the knee joint in the sagittal plane and the hip joint in the frontal plane was found (p < 0.001). Linear fitting revealed that with every degree of anterior trunk leaning, the cumulative hip joint extension loading increases by 3.26 Nm·s/kg/1000 m, while simultaneously decreasing knee joint extension loading by 1.08 Nm·s/kg/1000 m. Conclusion Trunk leaning can reduce knee joint loading and hip joint abduction loading, at the cost of hip joint loading in the sagittal and transversal planes during distance running. Modulating lower extremity joint loading by altering trunk lean angle is an effective strategy to redistribute joint load between/within the knee and hip joints. When implementing anterior trunk leaning in clinical practice, the increased demands on the hip musculature, dynamic stability, and the potential trade-off with running economy should be considered.

• Bill, Kevin; Mai, Patrick; Kersting, Uwe G. & Krosshaug, Tron (2025). Is the knee joint more vulnerable to injury in unplanned cutting tasks? An EMG vector field analysis of high-level female athletes. Knee (Oxford). ISSN 0968-0160. 55, p. 62–69. doi: 10.1016/j.knee.2025.04.002. Full text in Research Archive
• Bill, Kevin; Mai, Patrick; Mausehund, Lasse; Solbakken, Sigurd; Krosshaug, Tron & Kersting, Uwe G. (2024). Individualized Technique Feedback for Instant Technique Improvements and Knee Abduction Moment Reductions – A New Approach for ‘Sidestepping’ ACL Injuries? International Journal of Sports Physical Therapy. 19(5), p. 535–547. doi: 10.26603/001c.116274. Full text in Research Archive Show summary

  Background: Sidestep cutting technique is highly individual and has been shown to influence knee joint loading. However, studies assessing whether individualized technique feedback improves technique and ACL injury-relevant knee joint loads instantly in a sport-specific task are lacking. Purpose: To determine the instant effects of individualized augmented technique feedback and instructions on technique and the peak external knee abduction moment (pKAM) in a handball-specific sidestep cut. Additionally, to determine the effects of technique modifications on the resultant ground reaction force and its frontal plane moment arm to the knee joint center. Study Design: Controlled laboratory cohort study Methods: Three-dimensional biomechanics of 48 adolescent female handball players were recorded during a handball-specific sidestep cut. Following baseline cuts to each side, leg-specific visual and verbal technique feedback on foot strike angle, knee valgus motion, or vertical impact velocity using a hierarchically organized structure accounting for the variables’ association with performance was provided. Subsequently, sidestep cuts were performed again while verbal instructions were provided to guide technique modifications. Combined effects of feedback and instructions on technique and pKAM as well as on the resultant ground reaction force and its frontal plane moment arm to the knee joint center were assessed. Results: On average, each targeted technique variable improved following feedback and instructions, leading to instant reductions in pKAM of 13.4% to 17.1%. High inter-individual differences in response to feedback-instruction combinations were observed. These differences were evident in both the adherence to instructions and the impact on pKAM and its components. Conclusion: Most players were able to instantly adapt their technique and decrease ACL injury-relevant knee joint loads through individualized augmented technique feedback, thereby potentially reducing the risk of injury. More research is needed to assess the retention of these adaptations and move towards on-field technique assessments using low-cost equipment. Level of Evidence: Level 3

• Bagehorn, Timo; Bill, Kevin; Mai, Patrick; Krosshaug, Tron & Kersting, Uwe G. (2024). A biomechanical report of an acute lateral ankle sprain during a handball-specific cutting movement. Sports Biomechanics. ISSN 1476-3141. doi: 10.1080/14763141.2024.2319134. Full text in Research Archive Show summary

  Biomechanical measurements of accidental ankle sprain injuries are rare but make important contributions to a more detailed understanding of the injury mechanism. In this case study, we present the kinematics and kinetics of a lateral ankle sprain of a female athlete performing handball-specific fake-and-cut manoeuvres. Three-dimensional kinematics and kinetics were recorded and six previously performed trials were used as reference. Plantarflexion, inversion, and internal rotation angles were substantially larger than the reference trials and peaked between 190 and 200 ms after initial ground contact. We observed a highly increased inversion and internal rotation moment. However, compared to the non-injury trials the data also revealed a reduction in the second dorsiflexion moment peak. Ground reaction forces were lower throughout the injury trial. Other parameters at initial ground contact including ankle and hip position, step length, and the traction coefficient indicate that a preparatory maladjustment occurred. This study adds valuable contributions to the understanding of lateral ankle sprains by building upon previously published reports and considering the shoe-surface interaction as an important factor for injury.

• Utku, Burkay; Bähr, Gloria; Knoke, Hannah; Mai, Patrick; Paganini, Francesca & Hipper, Markus [Show all 10 contributors for this article] (2024). The effect of fresh and used ankle taping on lower limb biomechanics in sports specific movements. Journal of Science and Medicine in Sport. ISSN 1440-2440. 27(11), p. 772–778. doi: 10.1016/j.jsams.2024.07.002. Full text in Research Archive Show summary

  Objectives: We aimed to investigate the effects of ankle taping on lower extremity biomechanics related to injury development and how these effects change after sports-specific use. Design: Randomized, repeated measures design with three conditions: Barefoot, tape applied fresh, and tape after sports-specific use (between-subject factor: sex). Methods: Twenty-five healthy participants (ten female) performed sports-specific movements, including running, drop jumping, and 180° change of direction, under the three conditions. Kinetic and kinematic data were collected using 3D motion capturing and force platforms. Results: Tape applied fresh and tape after sports-specific use significantly reduced peak ankle inversion. Biomechanical risk factors for anterior cruciate ligament or running overuse injuries were either unchanged or decreased with tape applied fresh, except for the peak loading rate of the resultant ground reaction force, which increased between 4% and 18% between movement types. After 15 minutes of sports-specific use of the tape, the alterations induced by tape applied fresh remained for some biomechanical risk factors while they became closer to barefoot again for others, indicating a differential response to prolonged use of taping for different biomechanical variables. Conclusions: Ankle taping protects the ankle joint by reducing biomechanical risk factors associated with ankle sprains, and most biomechanical risk factors for anterior cruciate ligament or running overuse injuries are not increased. Further research is needed to explore the duration of protective effects, variations across sports, and its impact on patients with chronic ankle instability, contributing to a more comprehensive understanding of ankle taping's influence on lower extremity biomechanics.

• Bagehorn, Timo; Mai, Patrick; Bill, Kevin; Herbaut, Alexis; Zee, Mark de & Kersting, Uwe G. (2024). Effect of increased shoe longitudinal bending stiffness on ankle and foot biomechanics in jump-cut movements of low and high degrees. Footwear Science. ISSN 1942-4280. 16(2), p. 135–146. doi: 10.1080/19424280.2024.2328289. Full text in Research Archive Show summary

  Lateral ankle sprains are the most common injuries in indoor and court sports, with ankle inversion being a primary injury driver. Stabilising the ankle during multidirectional changes is crucial for injury prevention. Conversely, increased shoe stiffness has been hypothesised to influence the magnitude of ankle inversion and may raise the risk for ankle injuries. Therefore, the purpose of this study was to investigate the influence of shoe longitudinal bending stiffness on ankle biomechanics during indoor and court sport-specific cutting movements. Biomechanical data from 19 participants were collected using a motion capture system and force plate. A jump-cut protocol with two different cutting directions after landing was performed in indoor shoes with and without carbon plate inserts of varying stiffness. Ankle kinematics and kinetics were analysed with statistical parametric mapping and repeated measures analysis of variance. A significant increase in ankle inversion during the 180° cut and a reduction in forefoot inversion (foot torsion) for stiffer footwear conditions during both the 45° and 180° cut were observed. While dorsiflexion moments differed during the last 10% of ground contact, ankle inversion moments did not significantly diverge between shoe conditions. Furthermore, a noteworthy correlation between footwear longitudinal bending stiffness and torsional stiffness was identified. In conclusion, increased bending stiffness significantly affected ankle and foot kinematics. The ankle compensated for restricted mobility and higher demands during high-degree jump-cuts, while foot torsion played a more prominent role in low-degree cuts. The heightened ankle inversion during high-degree cuts may induce an elevated risk for lateral ankle sprains. Further longitudinal studies are necessary to comprehensively understand injury incidence and the role of shoe stiffness in injury prevention.

• Mai, Celine; Mai, Patrick; Hinz, Maximilian; Saenger, Rebecca; Seil, Romain & Tischer, Thomas [Show all 7 contributors for this article] (2024). Females show worse functional outcome and quality of life compared to males 2 years after meniscus surgery: Data analysis from the German Arthroscopy Registry. Knee Surgery, Sports Traumatology, Arthroscopy. ISSN 0942-2056. 32(10), p. 2644–2654. doi: 10.1002/ksa.12131. Full text in Research Archive Show summary

  Purpose: The purpose of this study was to investigate the impact of sex on knee function, activity and quality of life following meniscus surgery using data from the German Arthroscopy Registry. Methods: This is a retrospective cohort study with data collected between 2017 and 2022. Patient-reported outcome measures (PROMs), namely Knee Injury and Osteoarthritis Outcome Score (KOOS), EuroQol Visual Analogue Scale (EQ Scale), and Marx Activity Rating Scale (MARS), were collected preoperatively and at 6, 12 and 24 months postoperatively. Data were analysed to examine differences between male and female patients regarding PROMs, pre-existing conditions, meniscus lesion types and surgical treatments. Results: A total of 1106 female (36.6%) and 1945 male patients (63.7%) were included. Males were significantly younger than females and had a higher body mass index. Overall, there were four times more medial meniscus lesions (MMLs) (77.5%) than lateral meniscus lesions (LMLs) (27.9%). Degenerative LMLs were more frequent in females, while traumatic LMLs were more common in males. Frequencies of traumatic and degenerative MMLs were similar among males and females. Males had higher absolute KOOS irrespective of treatment or meniscus lesion type. Meniscus repair resulted in similar improvements in ΔKOOS for both sexes, while meniscus resection exhibited higher absolute KOOS for males at each time point. Males generally had higher EQ Scale and MARS than females. Conclusion: Greater improvements in knee function, activity and quality of life were observed in males. While MMLs appear to be comparable among sexes, the nature of LML differed significantly. These results may help surgeons to refine patient selection for specific treatments to improve overall clinical outcomes.

• Mai, Patrick; Robertz, Leon; Robbin, Johanna; Bill, Kevin; Weir, Gillian & Kurz, Markus [Show all 10 contributors for this article] (2023). Towards functionally individualised designed footwear recommendation for overuse injury prevention: a scoping review. BMC sports science, medicine and rehabilitation. 15(1). doi: 10.1186/s13102-023-00760-x. Full text in Research Archive Show summary

  Injury prevention is essential in running due to the risk of overuse injury development. Tailoring running shoes to individual needs may be a promising strategy to reduce this risk. Novel manufacturing processes allow the production of individualised running shoes that incorporate features that meet individual biomechanical and experiential needs. However, specific ways to individualise footwear to reduce injury risk are poorly understood. Therefore, this scoping review provides an overview of (1) footwear design features that have the potential for individualisation; and (2) the literature on the differential responses to footwear design features between selected groups of individuals. These purposes focus exclusively on reducing the risk of overuse injuries. We included studies in the English language on adults that analysed: (1) potential interaction effects between footwear design features and subgroups of runners or covariates (e.g., age, sex) for running-related biomechanical risk factors or injury incidences; (2) footwear comfort perception for a systematically modified footwear design feature. Most of the included articles (n = 107) analysed male runners. Female runners may be more susceptible to footwear-induced changes and overuse injury development; future research should target more heterogonous sampling. Several footwear design features (e.g., midsole characteristics, upper, outsole profile) show potential for individualisation. However, the literature addressing individualised footwear solutions and the potential to reduce biomechanical risk factors is limited. Future studies should leverage more extensive data collections considering relevant covariates and subgroups while systematically modifying isolated footwear design features to inform footwear individualisation.

• Hoenig, Tim; Rahlf, Lina; Wilke, Jan; Krauß, Inga; Dalos, Dimitris & Willwacher, Steffen [Show all 11 contributors for this article] (2023). Appraising the Methodological Quality of Sports Injury Video Analysis Studies: The QA-SIVAS Scale. Sports Medicine. ISSN 0112-1642. 54(1), p. 203–211. doi: 10.1007/s40279-023-01907-z. Full text in Research Archive Show summary

  Background: Video analysis (VA) is commonly used in the assessment of sports injuries and has received considerable research interest. Until now, no tool has been available for the assessment of study quality. Therefore, the objective of this study was to develop and evaluate a valid instrument that reliably assesses the methodological quality of VA studies. Methods: The Quality Appraisal for Sports Injury Video Analysis Studies (QA-SIVAS) scale was developed using a modified Delphi approach including expert consensus and pilot testing. Reliability was examined through intraclass correlation coefficient (ICC3,1) and free-marginal kappa statistics by three independent raters. Construct validity was investigated by comparing QA-SIVAS with expert ratings by using Kendall’s tau analysis. Rating time was studied by applying the scale to 21 studies and computing the mean time for rating per study article. Results: The QA-SIVAS scale consists of an 18-item checklist addressing the study design, data source, conduct, report, and discussion of VA studies in sports injury research. Inter- and intra-rater reliability were excellent with ICCs > 0.97. Expert ratings revealed a high construct validity (0.71; p < 0.001). Mean rating time was 10 ± 2 min per article. Conclusion: QA-SIVAS is a reliable and valid instrument that can be easily applied to sports injury research. Future studies in the field of VA should adhere to standardized methodological criteria and strict quality guidelines.

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• Mausehund, Lasse; Schild, Simon; Carlsen, Emil; Wiedemann, Lea; Sollman, Britt & Fischbacher, Linda [Show all 10 contributors for this article] (2025). Sex differences in cutting biomechanics among handball players with and without previous ACL injury. Full text in Research Archive
• Bill, Kevin; Mai, Patrick; Krosshaug, Tron & Kersting, Uwe G. (2024). The foot strike angle predicts three-dimensional knee joint moments in preplanned and unplanned sidestep cuts. Full text in Research Archive
• Bagehorn, Timo; Bill, Kevin; Mai, Patrick; Krosshaug, Tron & Kersting, Uwe G. (2024). Impact of footwear bending stiffness and torsional stiffness on ankle biomechanics during handball specific fake-and-cut manoeuvres. Full text in Research Archive
• Eriksrud, Ola; Krosshaug, Tron; Mai, Patrick; Glørsen, Øyvind & Westheim, Frederic (2024). Deceleration demands in change of direction tests: insights from measurements using a motorized resistance device. Full text in Research Archive
• Bill, Kevin; Mai, Patrick; Krosshaug, Tron; Mausehund, Lasse & Kersting, Uwe (2024). Individualized Sidestep Cutting Technique Feedback in Handball Under Consideration of Performance - Best of Both Worlds for ACL Injury Prevention? Full text in Research Archive
• Mai, Patrick; Bill, Kevin; Kersting, Uwe; Willwacher, Steffen; Eriksrud, Ola & Krosshaug, Tron (2024). A nine-week ACL injury prevention program for female handball players: Effect on knee joint loading and cutting technique during a handball-specific fake-cut. Full text in Research Archive

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