Abstract
BackgroundTo systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury.MethodsSystematic review and meta-analysis according to PRISMA guidelines. A search in the databases MEDLINE (PubMed), CINAHL, EMBASE and Scopus was performed. Inclusion criteria were prospective studies including people of any age, assessing baseline knee abduction kinematics and/or kinetics during any weight-bearing activity for the lower extremity in individuals sustaining a future ACL injury and in those who did not.ResultsNine articles were included in this review. Neither 3D knee abduction angle at initial contact (Mean diff: -1.68, 95%CI: − 4.49 to 1.14, ACL injury n = 66, controls n = 1369), peak 3D knee abduction angle (Mean diff: -2.17, 95%CI: − 7.22 to 2.89, ACL injury n = 25, controls n = 563), 2D peak knee abduction angle (Mean diff: -3.25, 95%CI: − 9.86 to 3.36, ACL injury n = 8, controls n = 302), 2D medial knee displacement (cm; Mean diff:: -0.19, 95%CI: − 0,96 to 0.38, ACL injury n = 72, controls n = 967) or peak knee abduction moment (Mean diff:-10.61, 95%CI: - 26.73 to 5.50, ACL injury n = 54, controls n = 1330) predicted future ACL injury.ConclusionContrary to clinical opinion, our findings indicate that knee abduction kinematics and kinetics during weight-bearing activities may not be risk factors for future ACL injury. Knee abduction of greater magnitude than that observed in the included studies as well as factors other than knee abduction angle or moment, as possible screening measures for knee injury risk should be evaluated in future studies.
Highlights
To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury
Of the remaining ten articles, three articles [35–37] used the total number of lower extremity injuries as an outcome and one study [38] used a combined measure of knee abduction and trunk lean
Across the 8 studies included in our meta-analyses, we found no difference in Two dimensional (2D) knee abduction angle, Three dimensional (3D) knee abduction angle, Medial knee displacement (MKD) or peak knee abduction moment at baseline between those who sustained a future ACL injury and those who did not
Summary
To systematically review the association between knee abduction kinematics and kinetics during weight-bearing activities at baseline and the risk of future anterior cruciate ligament (ACL) injury. Some studies have reported individuals with ACL deficiency to exhibit an increased knee abduction angle compared to non-injured individuals [14–16]. This, together with the result of one early study establishing a relationship between increased knee abduction angle and knee abduction moment, respectively, and a higher risk of ACL injury in women [17], have given rise to knee abduction being widely accepted as an undesirable movement pattern [6, 8]. That women are reported to perform functional tasks with greater knee abduction than men [18], as well as having a higher risk of sustaining an ACL injury [1] has further perpetuated this hypothesis
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