Knee Injury Prevention Research Articles

A pilot study of the effect of Kinesiology tape on knee proprioception after physical activity in healthy women.

Kinesiology tape has gained significant popularity in recent years and is widely used as an adjunct for treatment and prevention of musculoskeletal injuries. However, evidence regarding its influence on knee proprioception is scarce. The purpose of this study was to evaluate the effect of Kinesiology tape on knee proprioception after physical activity in healthy women. It was hypothesized that Kinesiology tape enhances knee proprioception. Longitudinal analysis, pretest-posttest design. Twelve young women with healthy knees were tested for knee proprioception without the use of Kinesiology tape and wearing Kinesiology tape at the knee. The joint position sense was measured at the start and after a 30-min uphill walking protocol on a treadmill. Outcome was the knee angle deviation. No significant difference of proprioceptive performance between the application with Kinesiology tape and without Kinesiology tape was found after uphill walking (p > 0.05). However, when the participants' results for knee angle deviation were graded into good (< 6.1°) and poor ( > 6.1°), Kinesiology tape significantly enhanced those with poor proprioceptive ability after uphill walking, compared to the untaped knee (p = 0.002). This study has shown that the application of Kinesiology tape did not improve knee proprioception in a group of healthy young women. However, it also has demonstrated that Kinesiology tape provided significant proprioceptive enhancement at the knee joint after uphill walking in healthy women with poor proprioceptive ability. This may support its use in sports medicine for preventing knee injuries.

A comparison of a referral triage tool for knee osteoarthritis with surgeon’s decision making for total knee arthroplasty

A comparison of a referral triage tool for knee osteoarthritis with surgeon’s decision making for total knee arthroplasty

What do community football players think about different exercise-training programmes? Implications for the delivery of lower limb injury prevention programmes

BackgroundPlayers are the targeted end-users and beneficiaries of exercise-training programmes implemented during coach-led training sessions, and the success of programmes depends upon their active participation. Two variants of an exercise-training...

Work-Related Knee Injuries Treated in US Emergency Departments

To characterize work-related knee injuries treated in US emergency departments (EDs). We characterized work-related knee injuries treated in EDs in 2007 and examined trends from 1998 to 2007 by using the National Electronic Injury Surveillance System-occupational supplement. In 2007, 184,300 (± 54,000; 95% confidence interval) occupational knee injuries were treated in US EDs, accounting for 5% of the 3.4 (± 0.9) million ED-treated occupational injuries. The ED-treated knee injury rate was 13 (± 4) injuries per 10,000 full-time equivalent workers. Younger workers and older female workers had high rates. Strains/sprains and contusions/abrasions were common-frequently resulting from falls and bodily reaction/overexertion events. Knee injury rates declined from 1998 through 2007. Knee injury prevention should emphasize reducing falls and bodily reaction/overexertion events, particularly among all youth and older women.

Neuromuscular Training to Prevent Knee Injuries in Adolescent Female Soccer Players

To evaluate the effectiveness of a neuromuscular warm-up program in preventing acute knee injury in adolescent female football (soccer) players. Cluster randomized (by team) controlled trial, stratified by geographical district. Sample size was calculated (n = 8118) with 80% power to show a reduction of 50% in an estimated 1.15% annual incidence of anterior cruciate ligament (ACL) injury at P ≤ 0.05. Clubs in 8 regional districts of the Swedish Football Association, during the 2009 season (April through October). Female under-14 to under-18 football clubs (ages 12-17 years) were recruited. Reasons for the exclusion of clubs were lack of response, <2 training sessions per week, and the current use of an injury prevention program. The clubs were randomized to a neuromuscular warm-up intervention (Knäkontroll, SISU Idrottsböcker, Sweden, 2005) or to a control group, who were instructed to continue with their usual training and playing practices. The neuromuscular training program included 6 exercises that focused on knee control and core stability (1- and 2-legged knee squats, a pelvic lift, the bench, the lunge, and jump/landing). The exercises were to be done twice per week and were to take about 15 minutes, after a brief running warm-up. They progressed through 4 levels of difficulty. The team coaches supervised the program after instruction from study therapists. The primary outcome was the rate of ACL injuries. Diagnosis was confirmed, as appropriate, by a physician and by magnetic resonance imaging. Secondary outcomes were the rates of serious knee injury and any acute knee injury, defined as those with sudden onset during play that led to a player being unable to participate in training or competition. Severe injuries were those that caused absences of >4 weeks. Two study therapists evaluated the injuries. The coaches recorded data, including when the intervention was performed, any injuries, individual playing times, and periods of absence. Assessment of the primary outcome was done by physicians blinded to group assignment. During 278 298 hours of play, 96 knee injuries occurred in 92 players (intervention group 48, control group 44). The rate did not differ between groups. Of the 21 ACL injuries, 7 occurred in the intervention group and 14 in the control group, giving a rate ratio (RR) of 0.36 (95% confidence interval [CI] 0.15-0.85; P = 0.02). Severe injuries (intervention group 26, control group 31) did not differ between groups. They included 22 collateral or capsular sprains, 21 ACL injuries, 7 patella dislocations or subluxations, 6 meniscal or chondral lesions, and 1 tibial plateau fracture. Compliant players (those who performed ≥ 1 exercise session per week; 1303 players) had a lower rate of ACL injury (RR, 0.17; 95% CI, 0.05-0.57), of severe knee injury (RR, 0.18; 95% CI, 0.07-0.45), and of any acute knee injury (RR, 0.53; 95% CI, 0.30-0.94) than the control group. A short weekly neuromuscular exercise program reduced the rate of ACL injuries among adolescent female football (soccer) players. Those who were compliant with the intervention had fewer severe knee injuries and fewer injuries overall.

Comparison of gluteal and hamstring activation during five commonly used plyometric exercises

BackgroundAnterior cruciate ligament injuries occur frequently in athletics, and anterior cruciate ligament injury prevention programs may decrease injury risk. However, previous prevention programs that include plyometrics use a variety of exercises with little justification of exercise inclusion. Because gluteal and hamstring activation is thought to be important for preventing knee injuries, the purpose of this study was to determine which commonly used plyometric exercises produce the greatest activation of the gluteals and hamstrings. MethodsEMG (Electromyography) amplitudes of the hamstring and gluteal muscles during preparatory and loading phases of landing were recorded in 41 subjects during 5 commonly used plyometric exercises. Repeated measures ANOVAs (Analysis of Variance) were used on 36 subjects to examine differences in muscle activation. FindingsDifferences in hamstring (P<.01) and gluteal (P<.01) activities were identified across exercises during the preparatory and landing phases. The single-leg sagittal plane hurdle hops produced the greatest gluteal and hamstring activity in both phases. The 180° jumps did not produce significantly greater gluteal or hamstring activity than any other exercise. InterpretationSingle-leg sagittal plane hurdle hops may be the most effective exercise to activate the gluteals and hamstrings and may be important to include in anterior cruciate ligament injury prevention programs, given the importance of these muscles for limiting valgus loading of the knee. Because 180° jumps do not produce greater gluteal and hamstring activation than other plyometric exercises, their removal from injury prevention programs may be warranted without affecting program efficacy.

The effect of knee brace and knee sleeve on the proprioception of the knee in young non-professional healthy sportsmen

BackgroundProprioception has been defined as the capacity to feel the position of a joint in space as sensed by the central nervous system. Prophylactic knee braces are supposed to help in knee injury prevention not just with a mechanical support of the joint but also improving proprioception. The main aim of this study was to determine the effects of a knee brace and a knee sleeve on knee proprioception. The secondary aim was to determine if different starting angles of the knee and different movement directions influence knee proprioception. MethodsWe tested a group of twenty healthy male sport students without knee injuries. They were tested with the brace, with the sleeve and without support. The threshold of detection of passive knee movement with a starting knee angle of 30° and 60°, both in flexion and extension was determined. ResultsWe did not find any statistically significant change in the threshold of detection of passive knee movement wearing the brace or the sleeve compared to the unsupported condition (p=0.462, α=0.05). We found a significantly lower proprioceptive sensitivity starting at the more flexed knee angle (p=0.005, α=0.05) and moving in extension than in the other test situations (p=0.001, α=0.05). ConclusionMovement direction and starting position appear to influence the threshold of detection of passive knee movement. The results of this study also suggest that knee supports do not influence either positively or negatively knee proprioception of uninjured active subjects.

Postural stability and isokinetic strength do not predict knee valgus angle during single-leg drop-landing or single-leg squat in elite male rugby union players

BACKGROUND: Knee injuries have been identified as the most common injury in rugby. Knee valgus has been identified as a risk factor for ligament injuries in athletes and predictors of knee valgus may assist in the design of knee injury prevention programs. PURPOSE: The purposes of this study were to use postural stability (PS) and strength measures to predict knee valgus angle during dynamic tasks, identify relationships between PS and strength, and compare measures between positions. METHODS: Participants presenting positive during a gluteal dysfunction screening exam were enrolled. Participants performed PS, isokinetic strength, and biomechanical assessments. Stepwise multiple linear regression analyses were performed to identify predictors of knee valgus. Correlation coefficients identified relationships between PS and strength, and independent t-tests compared forwards and backs. RESULTS: Backs had significantly ( p< 0.05) better PS and greater strength as compared to forwards. Hip abduction strength was correlated (r = �0.52–�0.71, p< 0.05) withall eyes open staticPSmeasures. Regression analysis failed toidentify predictors of knee valgus angle. CONCLUSION: Although PS and strength were not multivariate predictors of knee valgus in male rugby players, bivariate correlations suggest that hip abduction strength training may be beneficial for enhancing PS.

Knee Proprioception and Strength and Landing Kinematics During a Single-Leg Stop-Jump Task

The importance of the sensorimotor system in maintaining a stable knee joint has been recognized. As individual entities, knee-joint proprioception, landing kinematics, and knee muscles play important roles in functional joint stability. Preventing knee injuries during dynamic tasks requires accurate proprioceptive information and adequate muscular strength. Few investigators have evaluated the relationship between knee proprioception and strength and landing kinematics. To examine the relationship between knee proprioception and strength and landing kinematics. Cross-sectional study. University research laboratory. Fifty physically active men (age = 26.4 ± 5.8 years, height = 176.5 ± 8.0 cm, mass = 79.8 ± 16.6 kg). Three tests were performed. Knee conscious proprioception was evaluated via threshold to detect passive motion (TTDPM). Knee strength was evaluated with a dynamometer. A 3-dimensional biomechanical analysis of a single-legged stop-jump task was used to calculate initial contact (IC) knee-flexion angle and knee-flexion excursion. The TTDPM toward knee flexion and extension, peak knee flexion and extension torque, and IC knee-flexion angle and knee flexion excursion. Linear correlation and stepwise multiple linear regression analyses were used to evaluate the relationships of both proprioception and strength against landing kinematics. The α level was set a priori at .05. Enhanced TTDPM and greater knee strength were positively correlated with greater IC knee-flexion angle (r range = 0.281-0.479, P range = .001-.048). The regression analysis revealed that 27.4% of the variance in IC knee-flexion angle could be accounted for by knee-flexion peak torque and TTDPM toward flexion (P = .001). The current research highlighted the relationship between knee proprioception and strength and landing kinematics. Individuals with enhanced proprioception and muscular strength had better control of IC knee-flexion angle during a dynamic task.

Letter to the Editor: Efficacy and Degree of Bias in Knee Injury Prevention Studies: A Systematic Review of RCTs

Letter to the Editor: Efficacy and Degree of Bias in Knee Injury Prevention Studies: A Systematic Review of RCTs

Reply to Letter to the Editor: Efficacy and Degree of Bias in Knee Injury Prevention Studies: A Systematic Review of RCTs

We appreciate the thoughtful comments of Dr. Berger regarding our recent publication [1]. He focused on the following methodologic points: randomization methods, concealment of allocations, and masking (blinding). Overall, we are in agreement with the position that every action should be taken to minimize susceptibility to bias by using the most appropriate methods for conducting randomized controlled trials. However, we are concerned that theoretical judgments were proposed by Dr. Berger without detailed review of the actual studies being evaluated. Specifically, he argues that “in point of fact, it is unlikely that any of the studies were properly randomized, or enjoyed the benefits of allocation concealment”. In addition, he stated “it is unlikely that even the one study [2] that claimed masking could have been truly masked”. We should start by examining the specific methods used in the excellent study by Brushoj et al. [2] as an example. With respect to randomization, each subject was randomly divided into a group performing the prevention training program or a group performing the placebo training program using a stochastic computer-generated method. With respect to allocation concealment, group assignment was performed (according to personal registration number) by the head nurse who maintained the allocation sequence and who otherwise did not participate in the study. With respect to masking, the subjects and program instructors did not know which of the training programs was being tested. All subjects with knee or shin pain were examined by one of the authors who was blinded to training group allocation. Data were entered in a blinded manner from coded collection forms. In light of these actual methods, we are interested in comments and direction from Dr. Berger on how to better design, conduct, and report randomization, allocation concealment, and masking in future orthopaedic prevention studies.

Efficacy and Degree of Bias in Knee Injury Prevention Studies: A Systematic Review of RCTs

Knee injury prevention programs have been developed to address the epidemic of knee injuries in young athletes. These programs include exercises that focus on balance, proprioception, and neuromuscular control. Some studies have suggested such specialized exercise programs may reduce the risk of knee injury. We conducted a systematic review of randomized controlled trials (RCTs) of knee injury prevention programs and evaluated the risks of bias in these studies. We performed a systematic search using MEDLINE (from 1966), CINAHL (from 1982), Cochrane (CENTRAL), and EMBASE (from 1974) in April 2011. The searches were limited to RCTs. Two reviewers independently assessed the internal validity of the included studies using the van Tulder critical appraisal tool for RCTs. Authors were contacted when internal validity was unclear in the methodology. Ten Level I studies (RCTs) met the inclusion criteria. The average risk of bias score for these studies was 7 of 11 (range, 5-10). Two of the 10 studies reported a reduction in knee injuries. Of the three studies that provided ACL injuries as an outcome measure, none showed a reduction in overall ACL injury. Current evidence suggests most (eight of 10) well-designed RCTs show no difference of treatment benefit. Perhaps refinements of interventions may lead to a reduction in knee and ACL injuries in future trials. Limitations in the number and heterogeneity of currently published RCTs of injury prevention programs place restraints on quantifying intervention efficacy with a meta-analytic approach. Future research articles should more clearly describe the different elements of their methodology, consistent with the standards set forth by the CONSORT statement.

Gender Differences in Knee Stability in Response to Whole-Body Vibration

The purpose of this study was to determine whether there are kinematic and electromyographic (EMG) differences between men and women in how the knee is controlled during a single-legged drop landing in response to whole-body vibration (WBV). Forty-five healthy volunteers, 30 men (age 22 ± 3 years; weight 76.8 ± 8.8 kg; height 179.0 ± 6.8 cm) and 15 women (age 22 ± 3 years; weight 61.0 ± 7.7 kg; height 161.9 ± 7.2 cm) were recruited for this study. Knee angles, vertical ground reaction forces, and the time to stabilize the knee were assessed after single-legged drop landings from a 30-cm platform. Surface EMG data in rectus femoris (RF) and hamstrings (H) and knee and ankle accelerometry signals were also acquired. The participants performed 3 pretest landings, followed by a 3-minute recovery and then completed 1 minute of WBV (30 Hz to 4 mm). Before vibration, the female subjects had a significantly higher peak vertical force value, knee flexion angles, and greater H preactivity (EMG(RMS) 50 milliseconds before activation) than did the male subjects. In addition, although not significant, the medial-lateral (ML) acceleration in both knee and ankle was also higher in women. After WBV, no significant differences were found for any of the other variables. However, there was a decrease in the RF to H activation ratio during the precontact phase and an increase in the ratio during the postcontact phase just in women, which leads to a decrement in ML acceleration. The gender differences reported in knee stability in response to WBV underline the necessity to perform specific neuromuscular training programs based on WBV together with instruction of the proper technique, which can assist the clinician in the knee injury prevention.

The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review

BackgroundLower limb injuries in sport are increasingly prevalent and responsible for large economic as well as personal burdens. In this review we seek to determine which easily implemented functional neuromuscular warm-up strategies are effective in preventing lower limb injuries during sports participation and in which sporting groups they are effective.MethodsSeven electronic databases were searched from inception to January 2012 for studies investigating neuromuscular warm-up strategies and injury prevention. The quality of each included study was evaluated using a modified version of the van Tulder scale. Data were extracted from each study and used to calculate the risk of injury following application of each evaluated strategy.ResultsNine studies were identified including six randomized controlled trials (RCT) and three controlled clinical trials (CCT). Heterogeneity in study design and warm-up strategies prevented pooling of results. Two studies investigated male and female participants, while the remaining seven investigated women only. Risk Ratio (RR) statistics indicated 'The 11+' prevention strategy significantly reduces overall (RR 0.67, confidence interval (CI) 0.54 to 0.84) and overuse (RR 0.45, CI 0.28 to 0.71) lower limb injuries as well as knee (RR 0.48, CI 0.32 to 0.72) injuries among young amateur female footballers. The 'Knee Injury Prevention Program' (KIPP) significantly reduced the risk of noncontact lower limb (RR 0.5, CI 0.33 to 0.76) and overuse (RR 0.44, CI 0.22 to 0.86) injuries in young amateur female football and basketball players. The 'Prevent Injury and Enhance Performance' (PEP) strategy reduces the incidence of anterior cruciate ligament (ACL) injuries (RR 0.18, CI 0.08 to 0.42). The 'HarmoKnee' programme reduces the risk of knee injuries (RR 0.22, CI 0.06 to 0.76) in teenage female footballers. The 'Anterior Knee Pain Prevention Training Programme' (AKP PTP) significantly reduces the incidence of anterior knee pain (RR 0.27, CI 0.14 to 0.54) in military recruits.ConclusionsEffective implementation of practical neuromuscular warm-up strategies can reduce lower extremity injury incidence in young, amateur, female athletes and male and female military recruits. This is typically a warm-up strategy that includes stretching, strengthening, balance exercises, sports-specific agility drills and landing techniques applied consistently for longer than three consecutive months. In order to optimize these strategies, the mechanisms for their effectiveness require further evaluation.

PLANTAR PRESSURE DISTRIBUTION CHANGES DEPENDING ON THE USE OF KNEE BRACES

Orthotic helps, especially the knee braces, are often used by both, doctors and patients. This trend responds to lifestyle changes, to technology improvements and also to wide offer of knee braces on the trade. The main purpose of the use of these orthoses is to support the knee, set it right and immobilize it [Chew, 2007]. Both, manufacturers and researchers that are interested in knee orthoses mainly concentrate on the influence they have on the region of knee and on their efficiency in treatment and prevention of knee disorders or injuries. Only a few studies have considered its influence on equilibrating the ongoing changes in the centre of gravity during standing or gait, or some of the dynamical parameters like COP (centre of pressure) process. Some previous studies dealt with the effect of artificial impulses (tape [O'Sullivan, 2008], ice [Nurse, 2001], prophylactic knee brace [Kaminski, 2006], knee sleeve [Chuang, 2007]) on stand and gait characteristics. The main purpose of this intraindividual study is to experimentally verify the possible changes of plantar pressure distribution during the stance phase of gait in relation to the application of three types of knee-joint braces in healthy individual.

Prevention of acute knee injuries in adolescent female football players: cluster randomised controlled trial

Objective To evaluate the effectiveness of neuromuscular training in reducing the rate of acute knee injury in adolescent female football players.Design Stratified cluster randomised controlled trial with clubs as the...

The epidemiology of knee injuries in children and adolescents

Injuries in childhood and adolescence are frequent and the knee is one of the most common sites of injuries. This study aimed to analyze the epidemiology, gender distribution, age, and circumstances of knee injuries in childhood at a Level I Trauma Center in Austria. All pediatric and adolescent trauma patients who presented in a 2-year period were recorded. Children managed with knee injuries were selected prospectively. Patients were divided into five age groups: infants (younger than 1 year); pre-school aged children (1-6 years); pre-pubertal school-aged children (7-10 years); early adolescent patients (11-14 years); and late adolescent patients (15-18 years). Five diagnosis-related groups were formed: extraarticular soft tissue injuries, intraarticular soft tissue injuries, patella disorders, fractures, and overload injuries. The study included 23,832 patients up to the age of 18 years, who presented with 1,199 knee injuries. There was a male predominance (m:f = 58,6%:41.4%). Boys had a lower mean age at presentation (11.9 years) as girls (12.3 years). The most common accident sites were outdoors (34.8%) and sports facilities (32.8%). Leading injury mechanisms were falls on level surfaces (58.1%) and traffic accidents (13.4%). The number of knee injuries and its severity increased with age. Knee injuries did not occur in infants. In general, extraarticular soft-tissue injuries were most common and fractures were rare. Knee injuries in children and adolescents are rare and extraarticular soft-tissue injury is the most frequent type of knee trauma. The number of knee injuries and its severity increases with age with a male predominance. Sports facilities and traffic injuries are important scenes of knee trauma. Mechanisms and patterns evaluated in this study can serve as the basis for knee-injury prevention efforts in children and adolescents and may be used for necessary precautions. IV.

Taping in Sports: a brief update

Athletic taping is an adjunct mechanism adopted as a preventive measure of injuries or post-injury rehabilitation and prophylaxis. The tape is chosen properly so that it could be able to properly strap the body parts, e.g., ankle, wrist, finger, etc. There are certain principles, guidelines, rules and regulations based on which taping has to be done. Besides injury prevention, taping is also used in sports as conservative management of pain, biomechanical effects, effects on balance, posture and neuromuscular system, rehabilitation. Taping has been found to be effective in cases of ankle, foot, hand and wrist injuries as well as appeared to be more valuable in rehabilitation than in prevention of knee and ankle injury. A modern and new approach of taping is kinesiology tape which provides athletes with a solution for working through minor injuries and recovering faster from major injuries and has also been found to be an ideal modality for use in chiropractice settings. It also helps in enhancement of endurance capacity and even performance level in certain cases. Contradictory opinions exist among scientists regarding the advantages and disadvantages of application of taping in sports. Nonetheless Athletic Taping is recommended with certain precautions for the benefit of the sportspersons and athletic performance.

Female soccer knee injury: Observed knowledge gaps in injury prevention among players/parents/coaches and current evidence (the KNOW study)

This study sought to determine if knowledge regarding the risk for knee injuries and the potential for their prevention is being translated to female adolescent soccer players (13-18 years), their parents, and coaches. Eligible participants in the 2007 indoor soccer season were surveyed to determine their knowledge of the risk for and the potential to prevent knee injuries, and their knowledge of effective prevention strategies, if they felt that injury prevention was possible. Team selection was stratified to be representative of both competitive and recreational level play and age group distributions within the selected soccer association. Of the study subjects, 773/1396 (55.4%) responded to the survey: 408 (53%) players, 292 (38%) parents, and 73 (9%) coaches. Most respondents (538 [71%]) were aware of the risk for knee injury. Coaches and parents were more likely than players to view knee injuries as preventable; however, appropriate prevention strategies were often not identified. Four hundred eighty-four (63.8%) respondents reported that they had never received information on knee injuries. Substantial knowledge gaps regarding knee injury prevention and effective preventative strategies were identified. Given the predominance of knee injuries in female adolescent soccer players, there is an urgent need for knowledge translation of prevention strategies to decrease both incidence and long-term consequences of knee injuries.

Simple verbal instruction improves knee biomechanics during landing in female athletes

Knee injuries are highly prevalent in athletic populations, particularly among female athletes. Many of these injuries occur during landing from a jump. Various comprehensive knee injury prevention programs have been developed to date. However, there is a need to determine which components of these programs contribute directly to changes in knee biomechanics. Therefore, the purpose of this study was to investigate the immediate effect of three different simple verbal instructions on knee biomechanics during landing in adult female recreational athletes. Three-dimensional kinematic and kinetic analysis of landing from a countermovement jump was conducted in a counterbalanced cross-over repeated measures design. Results indicated that the instruction to land with equal weight distribution reduced the asymmetry of peak vertical ground reaction force compared to the control condition. The instruction to land softly reduced peak vertical ground reaction force and increased peak knee flexion compared to the control condition. The instruction to land with knees over toes increased peak knee flexion compared to the control condition. These findings indicate that verbal instruction may be a key component of the effects seen in previous research studies that have investigated the benefits of more complex training programs designed to reduce knee injury risk in female athletes.