About

Chris Kuenze is an Associate Professor at the UVA School of Education and Human Development and the co-director of the Exercise & Sport Injury Lab. His research interests include the impact of anterior cruciate ligament (ACL) injury and surgical reconstruction (ACLR) on physical activity participation and lower extremity biomechanics. His research aims to reduce ACL re-injury risk and promote positive long-term joint health and well-being. Kuenze has authored or co-authored more than 75 peer-reviewed journal articles and has presented at various national and international meetings. His educational background includes a Ph.D. from the University of Virginia, obtained in 2013, and he is associated with the Department of Kinesiology, where he contributes to research on movement and physical health.

Research topics

• Medicine
• Physical therapy
• Surgery
• Physical medicine and rehabilitation
• Clinical psychology
• Anatomy
• Developmental psychology
• Medical emergency
• Psychology
• Pathology

Selected publications

• Knee Effusion-Synovitis Is Not Associated With Self-Reported Knee Pain in Division I Female Athletes.

  UNC Libraries · 2026-04-29

  articleOpen access

  BACKGROUND: Recent research indicates a potential link between effusion-synovitis and knee pain in athletes. This study investigates the association of knee effusion-synovitis with self-reported knee pain in elite female athletes, leveraging ultrasound imaging for effusion-synovitis assessment. HYPOTHESIS: Presence of knee effusion-synovitis is associated with increased self-reported knee pain in Division I female athletes. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 53 NCAA Division I female athletes underwent bilateral knee ultrasound to identify effusion-synovitis. The Knee Injury and Osteoarthritis Outcome Survey (KOOS) Pain subscale assessed knee pain. A 1-way analysis of variance compared KOOS pain, symptoms, activities during daily living (ADL), and quality of life (QoL) scores across groups with no, unilateral, and bilateral effusion-synovitis. RESULTS: Among the athletes, 49.1% showed no effusion-synovitis, 26.4% had unilateral, and 24.5% had bilateral effusion-synovitis. There were no differences in self-reported pain scores (<em>F</em> = 0.027; <em>P</em> = 0.97), ADL (<em>F</em> = 0.256; <em>P</em> = 0.78), or QoL (<em>F</em> = 0.120; <em>P</em> = 0.88) between any groups. In addition, the frequency of effusion-synovitis was as follows: for the right limb, Grade 0 = 35 (66%), Grade 1 = 15 (28%), Grade 2 = 1 (2%), and Grade 3 = 2 (4%); for the left limb, Grade 0 = 31 (58%), Grade 1 = 19 (36%), Grade 2 = 3 (6%), and Grade 3 = 0 (0%). CONCLUSION: The presence of effusion-synovitis, irrespective of being unilateral or bilateral, was not associated with self-reported knee pain in elite female athletes. This suggests that lower grades of effusion-synovitis may not significantly impact knee pain. CLINICAL RELEVANCE: The findings of this study challenge existing assumptions about the impact of effusion-synovitis on knee pain in athletes, contributing to the nuanced understanding of knee joint health in sports medicine.

  PublisherDOI

• Assessment of Quadriceps Muscle Characteristics in Female Division I Athletes: A Validation Study of Wireless Probes Against Standard Ultrasound Units.

  UNC Libraries · 2026-03-18

  articleOpen access

  OBJECTIVE: Wireless ultrasound probes offer a quicker, more affordable option for muscle quality assessment compared with standard cart units, yet their effectiveness for evaluating larger muscles such as the rectus femoris in terms of cross-sectional area (CSA) and echo-intensity (EI) is unclear due to limited field of view. This study evaluates whether rectus femoris thickness and EI measured with a wireless probe correlate with CSA and EI obtained from a standard cart ultrasound. METHODS: A cross-sectional, convenience sample of 29 division I college female athletes (age: 20.1 [1.1]&nbsp;y, height: 169.7 [7.4]&nbsp;cm, mass: 69.7 [10.0]&nbsp;kg) were recruited. Panoramic thigh ultrasound images were acquired with a standard ultrasound cart to assess the rectus femoris CSA and EI at 50% of the thigh length. A wireless ultrasound probe was used to acquire stationary images with the knee in the same position to assess rectus femoris thickness and EI. A Pearson product-moment correlation was used to determine the association between the muscle outcomes obtained with the standard cart ultrasound and wireless ultrasound probe. RESULTS: Standard ultrasound CSA (10.1 [2.0] cm2) and wireless ultrasound thickness (2.0 [0.3]&nbsp;cm) were strongly associated (r = .71, P &lt; .001). Standard ultrasound EI (56.2 [5.1]&nbsp;arbitrary units) and wireless ultrasound EI (62.0 [6.3]&nbsp;arbitrary units) were moderately associated (r = .49, P = .007). CONCLUSION: Wireless ultrasound offers a fast and accessible method for assessing muscle thickness in female division I athletes when compared with similar muscle size and quality metrics measured on panoramic images acquired with a standard ultrasound cart. The echogenicity indices from wireless and standard ultrasound are significantly associated between units; however, wireless ultrasound systematically overestimates echogenicity compared with the standard.

  PublisherDOI

• Age and Sex Differences in Anterior Cruciate Ligament–Return to Sport after Injury Subscale Scores of Emotion, Risk Appraisal, and Confidence After ACL Reconstruction

  Orthopaedic Journal of Sports Medicine · 2025-07-01

  articleOpen access

  Background: The Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI) scale is widely used after anterior cruciate ligament reconstruction (ACLR), but its 3 subscale domains of emotion, risk appraisal, and confidence are rarely considered when assessing readiness to return to sport (RTS). Current guidelines for ACL-RSI scores at time of RTS are derived from adult-only studies, and there is a need for age- and sex-specific data to guide RTS decision-making. Purpose/Hypothesis: The purpose of this study was to investigate differences in ACL-RSI subscale scores by age and sex. It was hypothesized that males and teens would report higher scores on emotion, confidence, and risk appraisal subscales compared with females and adults. Study Design: Cohort study; Level of evidence, 3. Methods: ACL-RSI data were obtained from a multisite clinical outcome registry. Participants were included if they were between 6 and 12 months after primary, unilateral ACLR. Sex subgroups (female, male) and age subgroups (teen: 14-18 years; adult: 19-30 years) were established and compared to identify potential sex- and age-related differences in the ACL-RSI scale (total, subscales, and item scores). Descriptive statistics were computed and multiple 2-way analyses of variance were used to determine main effects and interactions between sex and age group. The significance level (α) was set to .05. Results: A total of 154 participants (mean age, 20.2 ± 3.8 years; 53.9% female; mean time after ACLR, 8.7 ± 2.1 months) were included. The mean ACL-RSI total score across the cohort was 67.92 ± 24.65. A significant main effect of age group on ACL-RSI total score was found as teens exhibited significantly greater psychological readiness compared with adults (mean difference, 10.91 points). A significant main effect of age group on the confidence subscale score was found, with teens reporting significantly higher confidence in returning to sport compared with adults (mean difference, 14.05 points). The main effect of sex on ACL-RSI total score was not significant ( P = .337). Conclusion: Teens demonstrated significantly higher total scores and confidence on the ACL-RSI scale compared with adults. Therefore, when assessing a teen athlete's psychological preparedness to RTS, target scores determined from adult data may not be appropriate. Sex was not found to influence ACL-RSI scores. Future work should strive to create age- and sex-specific ACL-RSI cutoff scores for successful RTS after ACLR in teen athletes.

  PublisherDOI

• The Effect Of Home Rehabilitation Exercises And Minimalist Shoes On Impact Forces And Pain

  Medicine & Science in Sports & Exercise · 2025-09-16

  article

  Plantar fasciopathy (PF) occurs when the plantar fascia is mechanically overloaded due to increased weight or activity, leading to foot pain while weight-bearing. Impact forces (IF) at initial contact while walking are decreased in individuals with PF compared to healthy individuals, likely due to pain. Interventions to strengthen the foot such as rehabilitation or wearing minimalist shoes (MS) have been prescribed for PF, but it is unknown how they affect gait and whether pain plays a role. PURPOSE: To investigate the effects of 8 weeks of exercise and wearing minimalist shoes on IF at initial contact while walking in individuals with PF, and to determine if the changes are influenced by pain. METHODS: Twelve individuals (n = 9 female) with unilateral PF who underload the injured limb (1.05 N ± 0.09) compared to the healthy limb (1.18 N ± 0.07) volunteered for this study (age: 46.1 ± 10.4, height: 166 ± 9.15, weight: 74.7 ± 8.86). Participants recorded their average first-step pain over the past week using a 100 mm visual analog scale. Participants walked on a treadmill at a self-selected pace with force-sensing insoles in their conventional shoes of choice at both baseline and follow-up. Peak IF were measured and normalized to body weight (% BW). Participants wore MS with progressing daily wear time during the intervention, and were instructed in home rehabilitation exercises including massage ball myofascial release, toes elevated calf-raises, calf and foot stretches. Changes in pain and IF symmetry over time were assessed using t-tests. Linear regression was used to evaluate the association between changes in pain and IF symmetry from baseline to follow-up. RESULTS: From baseline to follow-up there were no significant changes in IF symmetry (p = 0.46, baseline: 88.80% ± 6.06, follow-up: 90.63% ± 9.89). Decrease in pain was significant (p < 0.001, baseline: 49.30 mm ± 15.40, follow-up: 23.50 mm ± 16.80) and significantly predicted change in symmetry (p < 0.001, adjusted R2 = 0.77, B = -0.49), showing that every 1 unit decrease in pain led to a 0.49% increase in peak IF symmetry. CONCLUSION: Individuals with PF did not experience significant changes in symmetry of IF, after 8 weeks of exercise and minimalist shoes. However, increases in symmetry and decreases in pain levels were highly related. Supported by: Xero Shoes' Minimal Footwear Research Grant

  PublisherDOI

• Knee Effusion-Synovitis Is Not Associated With Self-Reported Knee Pain in Division I Female Athletes

  Sports Health A Multidisciplinary Approach · 2025-03-27 · 1 citations

  articleOpen access

  BACKGROUND: Recent research indicates a potential link between effusion-synovitis and knee pain in athletes. This study investigates the association of knee effusion-synovitis with self-reported knee pain in elite female athletes, leveraging ultrasound imaging for effusion-synovitis assessment. HYPOTHESIS: Presence of knee effusion-synovitis is associated with increased self-reported knee pain in Division I female athletes. STUDY DESIGN: Cross-sectional study. LEVEL OF EVIDENCE: Level 3. METHODS: A total of 53 NCAA Division I female athletes underwent bilateral knee ultrasound to identify effusion-synovitis. The Knee Injury and Osteoarthritis Outcome Survey (KOOS) Pain subscale assessed knee pain. A 1-way analysis of variance compared KOOS pain, symptoms, activities during daily living (ADL), and quality of life (QoL) scores across groups with no, unilateral, and bilateral effusion-synovitis. RESULTS: = 0.88) between any groups. In addition, the frequency of effusion-synovitis was as follows: for the right limb, Grade 0 = 35 (66%), Grade 1 = 15 (28%), Grade 2 = 1 (2%), and Grade 3 = 2 (4%); for the left limb, Grade 0 = 31 (58%), Grade 1 = 19 (36%), Grade 2 = 3 (6%), and Grade 3 = 0 (0%). CONCLUSION: The presence of effusion-synovitis, irrespective of being unilateral or bilateral, was not associated with self-reported knee pain in elite female athletes. This suggests that lower grades of effusion-synovitis may not significantly impact knee pain. CLINICAL RELEVANCE: The findings of this study challenge existing assumptions about the impact of effusion-synovitis on knee pain in athletes, contributing to the nuanced understanding of knee joint health in sports medicine.

  PublisherOA PDFDOI

• Posterior Tibial Slope and High-Severity Meniscal Tears With Anterior Cruciate Ligament Injury

  Orthopaedic Journal of Sports Medicine · 2025-11-01

  articleOpen access

  Background: Increased posterior tibial slope (PTS) is a known risk factor for anterior cruciate ligament (ACL) injury and incidence of concomitant meniscal tears. However, the effect of PTS on the severity of concomitant meniscal injury has not been investigated. Purposes: To characterize the association between PTS and concomitant meniscal injury severity among patients with ACL injury and identify risk factors for high-severity meniscal tears. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively identified patients who underwent primary ACL reconstruction (ACLR) at a single institution from 2015 to 2021. Patients were excluded if they had a multiligament injury, underwent magnetic resonance imaging (MRI) &gt;12 weeks before surgery, or had &gt;1 year between the injury and surgery. We collected patient demographics, preoperative course, surgical details, and measured medial and lateral PTS. The primary outcome was the presence of a high-severity meniscal tear identified at the time of arthroscopy, defined as a medial or lateral complex, bucket-handle, root, or Zone 3 radial tear. We determined the association between PTS and high-severity meniscal tears using both univariate and logistic regression analyses. Results: We included 219 patients—47% women, aged 25.3 ± 10.3 years, with a body mass index (BMI) of 25.6 ± 4.5 kg/m 2 — in the analysis. A total of 41 patients (18.7%) underwent a medial meniscal procedure, 68 patients (31.1%) underwent a lateral meniscal procedure, 42 patients had both medial and lateral meniscal procedures (19.2%), and 68 patients had no meniscal tear (31.1%). The mean medial PTS was 4.3°± 2.8°, and the mean lateral PTS was 5°± 3.1°. The rate of any high-severity meniscal tear was 11.4% or 11% for a high-severity medial or lateral meniscal tear, respectively. BMI was positively associated with medial or lateral high-severity meniscal tears (odds ratio, 1.12 [95% CI, 1.04-1.21]; P = .003). Neither medial nor lateral PTS was associated with high-severity meniscal tears (all, P &gt; .05). Conclusion: Our study shows that neither medial nor lateral PTS was associated with high-severity meniscal tears in patients undergoing ACLR within 1 year of injury, given the available numbers in this study. While BMI was an independent factor associated with meniscal tear severity, delays in surgery did not increase the odds of severe meniscal tear incidence when taking into account PTS. Our study does not support the use of PTS to alter the timing or indications for ACLR out of concern for an increase in the severity of encountered meniscal tears.

  PublisherDOI

• Biointegrative Fixation for Tibial Tubercle Osteotomy Is Effective and May Lower Removal Rate

  Arthroscopy Sports Medicine and Rehabilitation · 2025-09-23

  articleOpen access

  Purpose To report the safety and efficacy of biointegrative fiber‐reinforced implants for tibial tubercle osteotomy (TTO) and perform a cost‐benefit analysis. Methods Patients treated with TTO for all indications by a single surgeon from May 2017 to July 2024 were retrospectively reviewed. There were no exclusion criteria. In 2023, the surgeon switched TTO fixation from two 4.5‐mm metal compression screws to 2 biointegrative, partially threaded 4.0‐mm headless compression screws, made of continuous mineral fibers comprised of elements found in natural bone (SiO 2 , Na 2 O, CaO, MgO, B 2 O 3 , and P 2 O 5 ), and bound together by PLDLA [poly (L‐lactide‐co‐D,L‐lactide)] (70:30 L:DL) in 50% weight by weight ratio. Postoperative protocols were consistent across fixation types, with full weight‐bearing as tolerated in full extension for 6 weeks and range of motion from 0 to 90° allowed immediately. Patients were followed longitudinally for osseous union, recurrent instability, and return to the operating room. Results Sixty‐two TTOs were analyzed (44 metal, 18 biointegrative); 61.3% of patients were female, and the median age was 23.3 years (interquartile range 22.5). One patient with biointegrative implants underwent irrigation and debridement with implant retention at 9 days postoperatively. Mean follow‐up for biointegrative fixation was 1.3 ± 0.4 years (range: 0.5‐1.8) and for metal fixation was 3.5 ± 1.8 years (range: 0.4‐6.7), P &lt; .001. All patients achieved clinical union by 6 months without differences in time to clinical union ( P = .159). Hardware removal rates differed between metal versus biointegrative groups (29.5 vs 0%, P = .009) but otherwise did not differ for rates of superficial infection (2.3 vs 0%, P = .519) or deep infection (2.3 vs 5.6%, P = .507). Conclusions Biointegrative screws are a safe and effective alternative to metal screws for TTO in short‐term follow‐up. The use of biointegrative fixation may reduce the need for secondary hardware removal procedures commonly reported with 4.5‐mm metal screws, albeit at a potentially increased cost to the health system. Level of Evidence Level III, retrospective comparative study.

  PublisherOA PDFDOI

• Preventing osteoarthritis after anterior cruciate ligament injury: The case for targeting pre-osteoarthritis illness

  Osteoarthritis and Cartilage · 2025-12-12

  articleOpen access
  PublisherOA PDFDOI

• Changes In Psychological Readiness And Quadriceps Strength From Early To Late Rehabilitation Following Acl Reconstruction

  Medicine & Science in Sports & Exercise · 2025-09-16

  articleSenior author

  Psychological readiness for return to sport has previously been associated with quadriceps strength during late-stage anterior cruciate ligament reconstruction (ACLR) rehabilitation. However, it is unclear if improvements in quadriceps strength are associated with improvements in psychological readiness from early to late rehabilitation. PURPOSE: The purpose of this study was to examine the relationship between longitudinal changes in psychological readiness for sport and isokinetic thigh muscle strength from early (3-5 mo.) to late (7-9 mo.) rehabilitation after ACLR. METHODS: Thirty-two individuals with primary, unilateral ACLR (11 females, age = 20.8 ± 4.9 years) were included. Participants completed testing 3-5 months (4.0 ± 0.3 mo.) and 7-9 months (8.3 ± 0.8 mo.) after ACLR. Participants completed the ACL return to sport after injury survey (ACL-RSI) to assess psychological readiness for sport and bilateral isokinetic knee extension strength assessments at 60 deg/s. Peak knee extension torque (PT) was normalized to body mass and a limb symmetry index (LSI) was calculated. RESULTS: Repeated measures ANOVAs indicated that, after controlling for sex and age, there was a significant overall model indicating that both ACL-RSI scores (p = 0.003, R2 = 0.216) and LSI ( p < 0.001, R2 = 0.407) improved over time. Pearson’s correlation revealed that absolute change over time in ACL-RSI was related to change in PT LSI (p = 0.050, R2 = 0.126). However, the percent change in ACL-RSI was not related to the percent change in PT LSI (p = 0.575, R2 = 0.011). CONCLUSION: The findings suggest that there is a weak relationship between the absolute change in psychological readiness to return to sport and knee extension torque symmetry between early and late stages of rehabilitation. Therefore, it may be beneficial for clinicians to assess psychological readiness independently from isokinetic quadriceps strength when considering patient progress in rehabilitation.

  PublisherDOI

• Plantar Fasciopathy Pain Correlates With Time Between Peaks Symmetry But Not Intrinsic Foot Muscle Strength

  Medicine & Science in Sports & Exercise · 2025-09-16

  article
  PublisherDOI

Frequent coauthors

• Matthew S. Harkey

  Michigan United

  65 shared

• Caroline Lisee

  University of Georgia

  63 shared

• Joseph M. Hart

  43 shared

• Moataz Eltoukhy

  University of Miami

  37 shared

• Jeffrey B. Driban

  Massachusetts Academy of Math and Science

  35 shared

• Ashley Triplett

  Michigan State University

  29 shared

• Joseph F. Signorile

  29 shared

• Matt Salzler

  Tufts Medical Center

  26 shared

Labs

• Exercise and Sport Injury LaboratoryPI

Education

• Ph.D., Kinesiology

  University of Virginia

  2013