Torsional deformities and overuse injuries: what does the literature tell us

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Abstract

Overuse injuries imply the occurrence of a repetitive or an increased load on a specific anatomical segment which is unable to recover from this redundant microtrauma, thus leading to an inflammatory process of tendons, physis, bursa, or bone.
Even if the aetiology is controversial, the most accepted is the traumatic one.
Limb malalignment has been cited as one of the major risk factors implicated in the development of overuse injuries.
Many authors investigated correlations between anatomical deviations and overuse injuries, but results appear mainly inconclusive.
Establishing a causal relationship between mechanical stimuli and symptoms will remain a challenge, but 3D motion analysis, musculoskeletal, and finite element modelling may help in clarifying which are the major risk factors for overuse injuries.

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Most cited references 93

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Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases.

Tron Krosshaug, Atsuo Nakamae, Barry P Boden … (2017)

The mechanisms of anterior cruciate ligament injury in basketball are not well defined. To describe the mechanisms of anterior cruciate ligament injury in basketball based on videos of injury situations. Case series; Level of evidence, 4. Six international experts performed visual inspection analyses of 39 videos (17 male and 22 female players) of anterior cruciate ligament injury situations from high school, college, and professional basketball games. Two predefined time points were analyzed: initial ground contact and 50 milliseconds later. The analysts were asked to assess the playing situation, player behavior, and joint kinematics. There was contact at the assumed time of injury in 11 of the 39 cases (5 male and 6 female players). Four of these cases were direct blows to the knee, all in men. Eleven of the 22 female cases were collisions, or the player was pushed by an opponent before the time of injury. The estimated time of injury, based on the group median, ranged from 17 to 50 milliseconds after initial ground contact. The mean knee flexion angle was higher in female than in male players, both at initial contact (15 degrees vs 9 degrees , P = .034) and at 50 milliseconds later (27 degrees vs 19 degrees , P = .042). Valgus knee collapse occurred more frequently in female players than in male players (relative risk, 5.3; P = .002). Female players landed with significantly more knee and hip flexion and had a 5.3 times higher relative risk of sustaining a valgus collapse than did male players. Movement patterns were frequently perturbed by opponents. Preventive programs to enhance knee control should focus on avoiding valgus motion and include distractions resembling those seen in match situations.

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The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis.

L Stefan Lohmander, P Martin Englund, Ludvig L Dahl … (2007)

The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome. Injuries of the anterior cruciate ligament and menisci are common in both athletes and the general population. At 10 to 20 years after the diagnosis, on average, 50% of those with a diagnosed anterior cruciate ligament or meniscus tear have osteoarthritis with associated pain and functional impairment: the young patient with an old knee. These individuals make up a substantial proportion of the overall osteoarthritis population. There is a lack of evidence to support a protective role of repair or reconstructive surgery of the anterior cruciate ligament or meniscus against osteoarthritis development. A consistent finding in a review of the literature is the often poor reporting of critical study variables, precluding data pooling or a meta-analysis. Osteoarthritis development in the injured joints is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcome is reinforced by additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity, and reinjury. A better understanding of these variables may improve future prevention and treatment strategies. In evaluating medical treatment, we now expect large randomized clinical trials complemented by postmarketing monitoring. We should strive toward a comparable level of quality of evidence in surgical treatment of knee injuries. In instances in which a randomized clinical trial is not feasible, natural history and other observational cohort studies need to be as carefully designed and reported as the classic randomized clinical trial, to yield useful information.

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Valgus knee motion during landing in high school female and male basketball players.

Kevin R. Ford, Gregory D. Myer, Timothy Hewett (2003)

The purpose of this study was to utilize three-dimensional kinematic (motion) analysis to determine whether gender differences existed in knee valgus kinematics in high school basketball athletes when performing a landing maneuver. The hypothesis of this study was that female athletes would demonstrate greater valgus knee motion (ligament dominance) and greater side-to-side (leg dominance) differences in valgus knee angle at landing. These differences in valgus knee motion may be indicative of decreased dynamic knee joint control in female athletes. Eighty-one high school basketball players, 47 female and 34 male, volunteered to participate in this study. Valgus knee motion and varus-valgus angles during a drop vertical jump (DVJ) were calculated for each subject. The DVJ maneuver consisted of dropping off of a box, landing and immediately performing a maximum vertical jump. The first landing phase was used for the analysis. Female athletes landed with greater total valgus knee motion and a greater maximum valgus knee angle than male athletes. Female athletes had significant differences between their dominant and nondominant side in maximum valgus knee angle. The absence of dynamic knee joint stability may be responsible for increased rates of knee injury in females but is not normally measured in athletes before participation. No method for accurate and practical screening and identification of athletes at increased risk of ACL injury is currently available to target those individuals that would benefit from neuromuscular training before sports participation. Prevention of female ACL injury from five times to equal the rate of males would allow tens of thousands of young females to avoid the potentially devastating effects of ACL injury on their athletic careers.

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Author and article information

Journal

Journal ID (nlm-ta): EFORT Open Rev

Journal ID (iso-abbrev): EFORT Open Rev

Journal ID (publisher-id): eor

Title: EFORT Open Reviews

Publisher: Bioscientifica Ltd (Bristol )

ISSN (Print): 2396-7544

ISSN (Electronic): 2058-5241

Publication date (Electronic): 11 January 2022

Publication date Collection: 01 January 2022

Volume: 7

Issue: 1

Pages: 26-34

Affiliations

[1 ]Department of Paediatric Orthopaedics , University of Basel Children’s Hospital, Basel, Switzerland

[2 ]Service of Orthopaedics and Traumatology , Department of Surgery, EOC, Lugano, Switzerland

[3 ]Laboratory for Movement Analysis , University of Basel Children’s Hospital, Basel, Switzerland

[4 ]Department of Biomedical Engineering , University of Basel, Basel, Switzerland

[5 ]Murdoch Children’s Research Institute , Melbourne, Victoria, Australia

[6 ]The University of Melbourne , Melbourne School of Engineering, Melbourne, Victoria, Australia

Author notes

Correspondence should be addressed to Elke Viehweger; Email: heideelke.viehweger@ 123456unibas.ch

Article

Publisher ID: EOR-21-0092

DOI: 10.1530/EOR-21-0092

PMC ID: 8788148

PubMed ID: 35076415

SO-VID: c99827a7-97ee-430d-aff5-221ccbe72a77

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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Keywords: malalignment,overuse injuries,gait analysis

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Keywords: malalignment, overuse injuries, gait analysis

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Torsional deformities and overuse injuries: what does the literature tell us

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EFORT Open Reviews

Most cited references 93

Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases.

The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis.

Valgus knee motion during landing in high school female and male basketball players.

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Cited by 2

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