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Işın A, Köse Ö, Ak E, Emir Yetim E, Çevikol C, Melekoğlu T. The influence of the lower limb components on genu varum in football players: a full leg length magnetic resonance imaging study. BMC Sports Sci Med Rehabil 2025; 17:25. [PMID: 40001230 PMCID: PMC11863870 DOI: 10.1186/s13102-025-01075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 02/10/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND This study aimed to evaluate lower extremity alignment in football players with and without genu varum using magnetic resonance imaging (MRI) and to investigate the underlying mechanisms and contributing factors to malalignment. METHODS This prospective case-control study included 36 male football players aged 16-19 years, divided into two groups: 18 with genu varum and 18 controls with normal lower extremity alignment. Full-length lower extremity MRI was used to assess alignment parameters. The isokinetic strength of the concentric knee extensor-flexor and concentric hip abductor-adductor muscles was measured using an isokinetic dynamometer at angular velocities of 60°/sec and 180°/sec. Logistic regression was used to evaluate the risk factors for genu varum. RESULTS Genu varum group had a mean mechanical axis deviation (MAD) of 14 ± 5 mm (p < 0.001), with 11 players exceeding the clinical cutoff of 15 mm. Significant differences were observed in the lateral distal tibial angle (LDTA) (p = 0.014), lateral proximal femoral angle (LPFA) (p = 0.017), and medial distal femoral angle (mLDFA) (p = 0.002) between the groups. Muscle strength values were comparable between the groups, except for the hip adductor-abductor strength ratio at 60°/sec, which was significantly lower in the genu varum group (p = 0.008), while all other comparisons were non-significant (p > 0.05). The regression analysis demonstrated that the mechanisms responsible for varus alignment in football players differ between the dominant and non-dominant leg. CONCLUSIONS The findings in this study suggest that the proximal tibial deformity is a key factor in malalignment among football players with genu varum. Differences in alignment were observed between dominant and non-dominant legs. Strength values were similar between players with and without varus alignment, except for the 60˚/sec angular velocity Add/Abd ratio. CLINICAL TRIAL REGISTRATION NCT06606964 / 16.09.2024. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ali Işın
- Department of Coaching Education, Faculty of Sport Sciences, Akdeniz University, Antalya, Turkey
| | - Özkan Köse
- Department of Orthopedics and Traumatology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Emre Ak
- Department of Coaching Education, Faculty of Sport Sciences, Nişantaşı University, İstanbul, Turkey
- Sports Medicine and Athletic Performance Center, Gloria Sports Arena, Antalya, Turkey
| | - Emel Emir Yetim
- Department of Radiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Can Çevikol
- Department of Radiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Tuba Melekoğlu
- Department of Coaching Education, Faculty of Sport Sciences, Akdeniz University, Antalya, Turkey.
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Žlak N, Krajnc Z, Merčun A, Drobnič M, Kacin A. The Coronal Alignment of Lower Limbs in the Adolescent Football and Ice Hockey Players. Indian J Orthop 2024; 58:176-181. [PMID: 38312895 PMCID: PMC10831025 DOI: 10.1007/s43465-023-01061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/14/2023] [Indexed: 02/06/2024]
Abstract
Background To investigate the influence of sport-specific activities on coronal axial alignment of the lower limbs in adolescent football and ice hockey players. Methods This cross-sectional study targeted healthy adolescent male football and ice hockey players with at least 3 years of sports participation. 90 football and 38 ice hockey players aged 12-16 years were divided into five age-matched subgroups. Coronal alignment of the lower limbs was determined by measuring the players' intercondylar or intermalleolar (ICD-IMD) distance with a custom-made calliper. In addition, their sports history was recorded. An age-matched comparison between the two sports groups was performed using the two-way model ANOVA and a multiple regression model for ICD-IMD was constructed. Results were additionally compared with age-matched data from the general population published in recent literature. Results A statistically significant increase in ICD-IMD values (p < 0.05) was found between 12 (football 0 mm; ice hockey - 64 mm) and 16 years (football 340 mm; ice hockey 310 mm) in both sports groups. Results of regression analysis of pooled group data showed that ICD-IMD has low positive correlation (r = 0.407; r2 = 0.168; p < 0.05) with time of participation in sport, but no association with age of athletes at the start of their sport participation (r = - 0.018; r2 = 0.000; p > 0.05). There were no statistically significant differences between the two groups at any time point. Both sports groups showed a significant increase in ICD-IMD values (mean 198 mm) after the age of 14 compared to the general population. Conclusions Participation in football and ice hockey is associated with a similar increase in ICD-IMD in the adolescent years in male athletes. The observed increase was higher in both groups of athletes than in their peers who do not regularly participate in sports. Level of Evidence Level 4 (case series).
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Affiliation(s)
- Nik Žlak
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, 1000 Ljubljana, Slovenia
- Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Zmago Krajnc
- Department of Orthopaedic Surgery, University Medical Centre Maribor, Maribor, Slovenia
- Chair of Orthopaedics, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Aljaž Merčun
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, 1000 Ljubljana, Slovenia
- Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Matej Drobnič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška ulica 9, 1000 Ljubljana, Slovenia
- Chair of Orthopaedics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alan Kacin
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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Fröhlich S, Peterhans L, Stern C, Frey WO, Sutter R, Spörri J. Remarkably high prevalence of overuse-related knee complaints and MRI abnormalities in youth competitive alpine skiers: a descriptive investigation in 108 athletes aged 13-15 years. BMJ Open Sport Exerc Med 2020; 6:e000738. [PMID: 32537242 PMCID: PMC7264838 DOI: 10.1136/bmjsem-2020-000738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2020] [Indexed: 12/13/2022] Open
Abstract
Background/aim Competitive alpine skiing is known to be associated with a high risk of traumatic knee injuries. However, little is known about the exact prevalence of knee overuse injuries and their associations with structural changes, particularly in youth skiers. Accordingly, the aim of the present study was to describe the overuse-related knee complaints and MRI abnormalities in a cohort of youth skiers around the growth spurt. Methods 108 youth competitive alpine skiers aged 13–15 years were examined using an MRI of both knees, an interview on existing knee complaints and a physical examination. As a common baseline for these assessments, skiers were prospectively monitored by the use of the Oslo Sports Trauma Research Centre questionnaire on health problems over a period of 12 months preceding the major investigations. Results 88.0% of the youth skiers showed at least one MRI abnormality in the knees. The most frequent findings were distal femoral cortical irregularities (63%), focal periphyseal oedema (FOPE) zones (25.0%) and cartilage lesions (18.5%). 47.2% of all skiers suffered from at least one overuse-related knee complaint during the 12 months preceding the MRI examination, mostly at the distal and proximal patellar tendon. However, despite a certain association with corresponding MRI abnormalities, the sensitivity of an MRI-based detection of such complaints was strongly limited. Conclusion Youth competitive alpine skiers suffer from a remarkably large number of knee overuse injuries. Accordingly, an effective prevention strategy should include a systematic screening of clinical complaints, ideally already starting around the growth spurt.
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Affiliation(s)
- Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Loris Peterhans
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter O Frey
- University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Radiographic analysis of lower limb alignment in professional football players. Arch Orthop Trauma Surg 2019; 139:1771-1777. [PMID: 31463688 DOI: 10.1007/s00402-019-03266-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To radiographically analyze lower limb alignment in adult asymptomatic professional football players and to correlate these values to clinical measurements. MATERIALS AND METHODS Twenty-four asymptomatic players [24.2 (3.6) years] were enrolled. Standard bilateral lower limb anteroposterior weight-bearing radiographs were acquired and clinical measurement of intercondylar/intermalleolar (ICD/IMD) distance was performed. Coronal plane mechanical alignment was assessed by five angles: leg mechanical axis (LMA), lateral proximal femoral angle (LPFA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), and lateral distal tibial angle (LDTA). Their values were compared to the reference values for adult population. An inter-individual comparison between right/left and dominant/non-dominant leg was added. The sum of bilateral LMA was correlated against ICD/IMD and against ICD/IMD adjusted for body height. RESULTS Football players presented with ICD/IMD of 46.5 (19.8) mm. Two, out of five, lower leg coronal angles showed significant differences (p < 0.001) compared to reference data from literature: LMA 5.8 (3.0)º vs.1.2 (2.2)º and MPTA 83.5 (2.6)º vs. 87.2 (1.5)º. No significant differences between left/right leg and dominant/non-dominant leg were established. Summed up bilateral LMA showed a high correlation to IMD/ICD (r = 0.8395; R2 = 0.7048), and even higher to ICD/IMD adjusted for body height (r = 0.8543; R2 = 0.7298). CONCLUSIONS This study was radiographically confirming increased varus of elite football players toward general population. Apex of the varus deformity was located in the proximal tibia. Clinical measurement of ICD/IMD adjusted for body height highly correlated with the radiographic values of coronal alignment; therefore, it may be used in population studies.
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Petrillo S, Papalia R, Maffulli N, Volpi P, Denaro V. Osteoarthritis of the hip and knee in former male professional soccer players. Br Med Bull 2018; 125:121-130. [PMID: 29385409 DOI: 10.1093/bmb/ldy001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 01/01/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Professional soccer (PS) players are at great risk of osteoarthritis (OA) of the knee and hip. SOURCES OF DATA Following the PRISMA guidelines, the key words 'osteoarthritis' and 'soccer' or 'football' were matched with 'players' or 'former' or 'retired' and with 'hip' or 'knee' on December 24, 2017 in the following databases: PubMed, Cochrane, Google scholar, Embase and Ovid. Only comparative studies reporting the prevalence rate of OA of both hip and knee joint in former PS athletes (fPSa) and age and sex matched controls were considered. AREAS OF AGREEMENT In fPSa, the prevalence rate of OA of both hip and knee is significantly higher compared to age and sex matched controls. AREAS OF CONTROVERSY The pathological pathways responsible for the development of OA of the hip and knee in PS athletes (PSa) are still not clearly understood. GROWING POINTS The prevalence rate of clinical OA of the hip was 8.6% in fPSa and 5.6% in controls (odd ratio (OR) = 1.5; 95% CI: 1.06-2.31). The radiographic rate of OA was 21.2% in fPSa and 9.8% in controls (OR = 2.4; 95% CI: 1.66-3.69). A total of 14.6 and 53.7% of fPSa presented clinical and radiographic signs of OA of the knee, respectively, vs 12.9% (OR = 1.16; 95% CI: 0.86-1.55) and 31.9% (OR = 2.47; 95% CI: 2.03-3.00) of controls. Sonographic evidence of OA of the knee was found in 52% of fPSa and 33% of controls (OR = 2.2; 95% CI: 1.24-3.89). AREAS TIMELY FOR DEVELOPING RESEARCH Preventive training programmes should be developed to reduce the number of fPSa presenting early OA.
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Affiliation(s)
- Stefano Petrillo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Surgery, Via Giovanni Paolo II, 132 - 84084 Fisciano, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, England
| | - Piero Volpi
- Knee Surgery and Sports Traumatology Unit, Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128 Trigoria, Rome, Italy
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