Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-12-2019 | Arthroscopy and Sports Medicine

Radiographic analysis of lower limb alignment in professional football players

Authors: Zmago Krajnc, Matej Drobnič

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2019

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.

Junge A, Dvorak J (2004) Soccer injuries: a review on incidence and prevention. Sports Med 34(13):929–938. https://www.ncbi.nlm.nih.gov/pubmed/15487905. Accessed Aug 2018CrossRef

Buckwalter JAMJ (2004) Sports and osteoarthritis. Curr Opin Rheumatol Curr Opin Rheumatol 16:634–639CrossRef

Buckwalter JA (2003) Sports, joint injury, and posttraumatic osteoarthritis. J Orthop Sport Phys Ther 33:578–588CrossRef

Hootman JM, Dick R, Agel J (2007) Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 42(2):311–319. https://www.ncbi.nlm.nih.gov/pubmed/17710181. Accessed Aug 2018

Ekstrand J, Hägglund M, Waldén M (2011) Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med 45(7):553–558. https://www.ncbi.nlm.nih.gov/pubmed/19553225. Accessed Aug 2018CrossRef

Chantraine A (1985) Knee joint in soccer players: osteoarthritis and axis deviation. Med Sci Sports Exerc 17(4):434–439. https://www.ncbi.nlm.nih.gov/pubmed/3839890. Accessed Aug 2018CrossRef

Witvrouw E, Danneels L, Thijs Y, Cambier D, Bellemans J (2009) Does soccer participation lead to genu varum? Knee Surgery, Sport Traumatol Arthrosc 17(4):422–427CrossRef

Yaniv M, Becker T, Goldwirt M, Khamis S, Steinberg DM, Weintroub S (2006) Prevalence of bowlegs among child and adolescent soccer players. Clin J Sport Med 16(5):392–396CrossRef

Thijs Y, Bellemans J, Rombaut L, Witvrouw E (2012) Is high-impact sports participation associated with bowlegs in adolescent boys? Med Sci Sports Exerc 44(6):993–998CrossRef

10.

Krajnc Z, Rupreht M, Drobnič M (2015) Quantitative evaluation of growth plates around the knees of adolescent soccer players by diffusion-weighted magnetic resonance imaging. Biomed Res Int 2015:482017. https://www.ncbi.nlm.nih.gov/pubmed/26693482. Accessed Aug 2018CrossRef

11.

Brouwer GM, van Tol AW, Bergink AP, Belo JN, Bernsen RMD, Reijman M et al (2007) Association between valgus and varus alignment and the development and progression of radiographic osteoarthritis of the knee. Arthritis Rheum 56(4):1204–1211. https://www.ncbi.nlm.nih.gov/pubmed/17393449. Accessed Aug 2018CrossRef

12.

Colyn W, Agricola R, Arnout N, Verhaar JAN, Bellemans J (2016) How does lower leg alignment differ between soccer players, other athletes, and non-athletic controls? Knee Surg Sports Traumatol Arthrosc 24(11):3619–3626. https://www.ncbi.nlm.nih.gov/pubmed/27743081. Accessed Aug 2018CrossRef

13.

Kuijt M-TK, Inklaar H, Gouttebarge V, Frings-Dresen MHW (2012) Knee and ankle osteoarthritis in former elite soccer players: a systematic review of the recent literature. J Sci Med Sport 15(6):480–487. https://www.sciencedirect.com/science/article/pii/S1440244012000631. Accessed Aug 2018CrossRef

14.

Bellemans J, Colyn W, Vandenneucker H, Victor J (2012) The chitranjan ranawat award is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 470(1):45–53CrossRef

15.

Shetty GM, Mullaji A, Bhayde S, Nha KW, Oh HK (2014) Factors contributing to inherent varus alignment of lower limb in normal Asian adults: role of tibial plateau inclination. Knee 21(2):544–548. https://www.ncbi.nlm.nih.gov/pubmed/24139813. Accessed Aug 2018CrossRef

16.

Hsu RW, Himeno S, Coventry MB, Chao EY (1990) Normal axial alignment of the lower extremity and load-bearing distribution at the knee. Clin Orthop Relat Res (255):215–27. https://www.ncbi.nlm.nih.gov/pubmed/2347155. Accessed Aug 2018

17.

Paley D (2002) Principles of deformity corrections, 3rd edn. Springer, BerlinCrossRef

18.

Nakano N, Matsumoto T, Hashimura M, Takayama K, Ishida K, Araki D et al (2016) Coronal lower limb alignment in normal knees—a radiographic analysis of 797 normal knee subjects. Knee 23(2):209–213. https://www.ncbi.nlm.nih.gov/pubmed/26775257. Accessed Aug 2018CrossRef

19.

Heath CH, Staheli LT (1993) Normal limits of knee angle in white children--genu varum and genu valgum. J Pediatr Orthop 13(2):259–262. https://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8459023. Accessed Aug 2018

20.

Popkov D, Lascombes P, Berte N, Hetzel L, Baptista BR, Popkov A et al (2014) The normal radiological anteroposterior alignment of the lower limb in children. Skeletal Radiol 44(2):197–206CrossRef

21.

Mukhopadhyay S, Mukhopadhyay K, Acharyya B (2008) Clinico-radiological assessment of normal variation of alignment of femur and tibia in different age groups in Indian ethnic population. Internet J Orthop Surg 15(1):1–5

22.

Kellgren JH, Lawrence JS (1963) Atlas of standard radiographs: the epidemiology of chronics rheumatism, vol 2. Blackwell Scientific Publication, Oxford

23.

Cahuzac J, Vardon DS, de Gauzy J et al (1995) Developement of the clinical tibiofemoral angle in normal adolescents. Surgery 77(5):729–732

24.

Caine D, DiFiori J, Maffulli N (2006) Physeal injuries in children’s and youth sports: reasons for concern? Br J Sports Med 40(9):749–760. https://www.ncbi.nlm.nih.gov/pubmed/16807307. Accessed Aug 2018CrossRef

25.

Krabak BJ, Snitily B, Milani CJ (2016) Running injuries during adolescence and childhood. Phys Med Rehabil Clin N Am 27:179–202CrossRef

26.

Moreland JR, Bassett LW, Hanker GJ (1987) Radiographic analysis of the axial alignment of the lower extremity. J Bone Joint Surg Am 69(5):745–759. https://www.ncbi.nlm.nih.gov/pubmed/3597474. Accessed Aug 2018CrossRef

27.

Frisch A, Croisier JL, Urhausen A, Seil R, Theisen D (2009) Injuries, risk factors and prevention initiatives in youth sport. Br Med Bull 92(1):95–121CrossRef

28.

Nakase M, Kim W-C, Oka Y, Hosokawa M, Yoshida T, Yamada N et al (2015) Detection of early changes after growth plate injury using MRI. J Magn Reson Imaging 42(6):1698–1704. https://doi.org/10.1002/jmri.24942 CrossRef

29.

Heuter C (1862) Antomical study of the limb joints of newborns and adults. Virchows Arch 25:572–599CrossRef

30.

Volkmann R (1869) Impairments of the musculoskeletal system. Handbook for common and special surgery. Ferdinand Enkle, Stuttgart, pp 845–920

31.

Asadi K, Mirbolook A, Heidarzadeh A, Kivi MM, Meybodi MKE, Rad MR (2015) Association of soccer and genu varum in adolescents. Trauma Mon 20(2):47–51CrossRef

Title: Radiographic analysis of lower limb alignment in professional football players
Authors: Zmago Krajnc
Matej Drobnič
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03266-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Radiographic analysis of lower limb alignment in professional football players

Abstract

Introduction

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 12/2019

Surgical treatment of low-grade chondrosarcoma involving the appendicular skeleton: long-term functional and oncological outcomes

Computed tomography versus plain radiography assessment of acetabular fracture reduction is more predictive for native hip survivorship

Selective fasciotomy for acute traumatic lower leg compartment syndrome: is it feasible?

Navigation versus experience: providing training in accurate lumbar pedicle screw positioning

Shock-wave therapy improved outcome with plantar fasciitis: a meta-analysis of randomized controlled trials

Hemostatic techniques to reduce blood transfusion after primary TKA: a meta-analysis and systematic review