The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis

Lima, Yuri Lopes; Ferreira, Victor; Lima, Pedro Olavo de Paula; Bezerra, Márcio Almeida; Oliveira, Rodrigo Ribeiro de; Almeida, Gabriel Peixoto Leão

doi:10.1016/j.ptsp.2017.07.003

Cited by 88 publications

(72 citation statements)

References 54 publications

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“…In addition, ankle function can also contribute to frontal plan knee motions. If ankle dorsiflexion is limited, for example, due to decreased extensibility of the gastrocnemius/soleus complex, athlete might try to compensate for this by moving their knee medially toward valgus during athletic tasks …”

Section: Introductionmentioning

confidence: 99%

Investigation of knee control as a lower extremity injury risk factor: A prospective study in youth football

Räisänen

Arkkila

Vasankari

et al. 2018

Scandinavian Med Sci Sports

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This prospective study in youth football examined the relationship between frontal plane knee projection angle (FPKPA) during the single-leg squat and sustaining an acute lower extremity injury or acute non-contact lower extremity injury. Secondly, side-to-side asymmetry in FPKPA and sex as injury risk factors were explored. In addition, we investigated the influence of age, sex, and leg dominance on the FPKPA. A total of 558 youth football players (U11 to U14) participated in the single-leg squat test and prospective injury registration. FPKPA was not found as a risk factor for injuries at this age. There was no difference in the mean FPKPA between sexes. However, FPKPA was associated with age; oldest subjects displayed the smallest FPKPA. Among boys, the frontal plane knee control improved by age. Among girls, the relationship between age and FPKPA was not as clear, but the oldest girls displayed the smallest mean FPKPA in the study (12.2° ± 8.3°). The FPKPA was greater on the dominant kicking leg compared to the non-dominant support leg (P < .001 for boys, P = .001 for girls). However, side-to-side asymmetry in FPKPA was not associated with future injuries. In conclusion, frontal plane knee control in the single-leg squat was not associated with lower extremity injuries among young football players. As the single-leg squat to 90° knee flexion was too demanding for many subjects, easier single-leg squat test procedure or a different movement control test, such as a double-legged squat, could be more suitable for the young football players.

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Section: Introductionmentioning

confidence: 99%

Investigation of knee control as a lower extremity injury risk factor: A prospective study in youth football

Räisänen

Arkkila

Vasankari

et al. 2018

Scandinavian Med Sci Sports

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“…Greater ankle mobility among females is due to the greater capacity of plantarflexors, as compared to males [31]. Greater passive ankle dorsiflexion ROM was associated with greater hip and knee flexion and lower GRFs during a jump-landing task in healthy individuals [15]. Dorsiflexion deficits may limit the ability to fully achieve a closed-packed, stable position of the ankle during dynamic activities, such as gait and jump-landing [17].…”

Section: Discussionmentioning

confidence: 99%

“…Deficits in ankle dorsiflexion ROM may occur due to the decreased extensibility of the gastrocnemius/soleus complex and restricted posterior talar glide on the tibia, thus creating DKV [14]. A significant correlation was found between ankle dorsiflexion flexibility and the peak knee abduction angle (r = 0.355, p = 0.048) during landing [15]. Moreover, individuals with greater ankle dorsiflexion ROM demonstrated smaller GRFs and greater knee-flexion displacement during landing, which may be associated with a reduced risk of anterior cruciate ligament (ACL) injury [16].…”

Section: Introductionmentioning

confidence: 99%

Bottom-Up Kinetic Chain in Drop Landing among University Athletes with Normal Dynamic Knee Valgus

Jamaludin

Sahabuddin

Najib

et al. 2020

IJERPH

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The study investigated the influence of ankle strength and its range of motion (ROM) on knee kinematics during drop landing. Fifteen male and fifteen female university athletes with a normal range of dynamic knee valgus (DKV) (knee frontal plane projection angle: men = 3° to 8°, females = 7° to 13°) were recruited. They performed drop landing at height 30 cm and 45 cm with three-dimensional motion capture and analysis. Knee angles were compared at specific landing phases. Isokinetic ankle strength was tested at 60°/s angular velocity while the weight-bearing lunge test was conducted to evaluate ankle ROM. For males, strength for both plantarflexors and dorsiflexors were associated with knee kinematics at both heights (30 cm: r = −0.50, p = 0.03; 45 cm: r = −0.45, p = 0.05) during maximum vertical ground reaction force (MVGRF) phase. For females, ankle invertor strength and knee kinematics were associated at both 30cm (r = 0.53; p = 0.02,) and 45 cm landing heights (r = 0.49, p = 0.03), while plantarflexor strength and knee kinematics showed a significant association during initial contact (r = 0.70, p < 0.01) and MVGRF (r = 0.55, p = 0.02) phases at height 30 cm only. Male and female athletes with normal range of DKV showed a significant relationship between ankle strength and knee kinematics at specific landing phases. These relationships varied with increased landing height.

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“…It should be noted that the occurrence of DKV is more pronounced in the female gender [28], although this does not mean that there is no risk in the male population [29]. Several factors have been analyzed as triggers of this alteration in knee movement, but two of the recent factors that have shown some evidence have been a reduced ankle dorsiflexion [30] and a deficit of strength or impaired activation of the abductor and adductor hip muscles, in particular a weakness in the abductors and external rotators of the hip [31,32]. Recent evidence suggests that knee and ankle bracing may reduce DKV [33,34].…”

Section: Introductionmentioning

confidence: 99%

Acute Effects of ACL Injury-Prevention Warm-Up and Soccer-Specific Fatigue Protocol on Dynamic Knee Valgus in Youth Male Soccer Players

Marco

Cortell-Tormo

García-Jaén

et al. 2020

IJERPH

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Childhood anterior cruciate ligament (ACL) injuries—which can pose a major risk to a child’s sporting career—have been on the rise in the last few decades. Dynamic knee valgus (DKV) has been linked to an increased risk of ACL injury. Therefore, the aim of this study was to analyze the acute effects of an ACL injury prevention protocol (ACL-IPP) and a soccer-specific fatigue protocol (SSFP) on DKV in youth male soccer players. The research hypothesis was that DKV would be reduced by the ACL-IPP and increased by the SSFP. Eighteen youth male soccer players were divided according to baseline DKV. Those with moderate or large DKV performed a neuromuscular training protocol based on activation of the abductor and external rotator hip muscles. Those with little or no DKV performed a soccer-specific fatigue protocol. DKV was assessed using the single-leg squat pre- and post-protocols in both legs. The ACL-IPP significantly decreased DKV during single-leg squat (p < 0.01, effect size = 1.39), while the SSFP significantly increased baseline DKV in the dominant leg during single-leg squat (p = 0.012; effect size = 1.74). In conclusion, the ACL-IPP appears to acutely reduce the DKV in youth male soccer players, and the SSFP seems to acutely increase the DKV in those players who showed a light or no DKV in a non-fatigue situation. By using the SSFP, it may be possible to determine which players would benefit from injury prevention programs due to increased DKV during game scenarios, while hip abductor and external rotator neuromuscular training may be beneficial for players who have moderate and severe DKV during single-leg squat under non-fatigued scenarios.

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The association of ankle dorsiflexion and dynamic knee valgus: A systematic review and meta-analysis

Cited by 88 publications

References 54 publications

Investigation of knee control as a lower extremity injury risk factor: A prospective study in youth football

Investigation of knee control as a lower extremity injury risk factor: A prospective study in youth football

Bottom-Up Kinetic Chain in Drop Landing among University Athletes with Normal Dynamic Knee Valgus

Acute Effects of ACL Injury-Prevention Warm-Up and Soccer-Specific Fatigue Protocol on Dynamic Knee Valgus in Youth Male Soccer Players

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