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Two-dimensional motion analysis of dynamic knee valgus identifies female high school athletes at risk of non-contact anterior cruciate ligament injury

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Female athletes are at greater risk of non-contact ACL injury. Three-dimensional kinematic analyses have shown that at-risk female athletes have a greater knee valgus angle during drop jumping. The purpose of this study was to evaluate the relationship between knee valgus angle and non-contact ACL injury in young female athletes using coronal-plane two-dimensional (2D) kinematic analyses of single-leg landing.

Methods

Two hundred ninety-one female high school athletes newly enrolled in basketball and handball clubs were assessed. Dynamic knee valgus was analysed during single-leg drop jumps using 2D coronal images at hallux–ground contact and at maximal knee valgus. All subjects were followed up for 3 years for ACL injury. Twenty-eight (9.6%) of 291 athletes had ACL rupture, including 27 non-contact ACL injuries. The injured group of 27 knees with non-contact ACL injury was compared with a control group of 27 randomly selected uninjured knees. The relationship between initial 2D movement analysis results and subsequent ACL injury was investigated.

Results

Dynamic knee valgus was significantly greater in the injured group compared to the control group at hallux–ground contact (2.1 ± 2.4 vs. 0.4 ± 2.2 cm, P = 0.006) and at maximal knee valgus (8.3 ± 4.3 vs. 5.1 ± 4.1 cm, P = 0.007).

Conclusion

The results of this study confirm that dynamic knee valgus is a potential risk factor for non-contact ACL injury in female high school athletes. Fully understanding the risk factors that increase dynamic knee valgus will help in designing more appropriate training and interventional strategies to prevent injuries in at-risk athletes.

Level of evidence

Prognostic studies, Level II.

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Acknowledgements

The authors thank Mr. Tsuyoshi Kimura and Kentaro Sasaki of Kinjyo University for their skilful technical assistance. Editorial support, in the form of medical writing based on the authors’ detailed directions, collating author comments, copyediting, fact checking, and referencing, was provided by Cactus Communications.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Hitoaki Numata, Junsuke Nakase, Takeshi Oshima, Yasushi Takata, Kengo Shimozaki & Hiroyuki Tsuchiya

  2. Department of Orthopaedic Surgery, Kijima Hospital, Kanazawa, Ishikawa, 920-0011, Japan

    Katsuhiko Kitaoka

  3. Department of Orthopaedic Surgery, KKR Hokuriku Hospital, Kanazawa, Ishikawa, 921-8035, Japan

    Yosuke Shima

Authors
  1. Hitoaki Numata
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  2. Junsuke Nakase
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  3. Katsuhiko Kitaoka
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  4. Yosuke Shima
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  5. Takeshi Oshima
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  6. Yasushi Takata
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  7. Kengo Shimozaki
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  8. Hiroyuki Tsuchiya
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Contributions

JN conceived the study, participated in its design, and helped to draft the manuscript. KK, YS, and HT provided guidance about the study design. JN, TO, YT, and KS carried out the assessments and analysed the results.

Corresponding author

Correspondence to Junsuke Nakase.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This study received no funding.

Ethical approval

The study design was approved by the Ethical Committee of Graduate School of Medical Sciences, Kanazawa University (approval #1050).

Consent to publish

Participant provided written consent for publication of images.

Informed consent

Written informed consent was obtained from all the participants and their parental guardians. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Numata, H., Nakase, J., Kitaoka, K. et al. Two-dimensional motion analysis of dynamic knee valgus identifies female high school athletes at risk of non-contact anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 26, 442–447 (2018). https://doi.org/10.1007/s00167-017-4681-9

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  • DOI: https://doi.org/10.1007/s00167-017-4681-9

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