Lower Extremity Alignment and Dynamic Control With Associated Injury Risk in College Athletes With Knee Hyperextension

Knee hyperextension, also called genu recurvatum or back knee, is commonly seen in women, people with ligamentous laxity, stroke and cerebral palsy patients. This faulty posture would result in excessive tension of the passive tissues such as anterior cruciate ligament (ACL) and posterior capsule of the knee. Subjects may also develop compensations at hip and ankle joint, as well as lower extremity malalignment. Muscles surrounding the knee could also become dysfunctional when performing functional tasks requiring stability during terminal knee extension, during which uncontrolled knee hyperextension could easily be utilized to lock the joint for stability in gait and stair climbing. In athletes, landing from a jump on an extended knee is one of the common reasons resulting in ACL injury. Little is known about the injury rate of athletes with knee hyperextension who participate in sports involving jump-landing activities.

The aim of the study is to explore if knee hyperextension is associated with poor lower extremity alignment and dynamic control and injury rate in athletes requiring jump-landing activities.

One of the study hypothesis is that athlete with knee hyperextension can find more compensatory lower extremity alignments and poor control in dynamic movement than control group.

The other hypothesis is with or without knee hyperextension, the parameter of lower extremity alignment and dynamic control can predict injury rate in jump landing athlete.

Study Overview

• Status: Completed
• Conditions: Knee Hyperextension

Detailed Description

Investigators expect to recruit 100 subjects into 2 group- control group and knee hyperextension group (KH group). In knee hyperextension group, investigators will include college athletes having knee hyperextension alignment, no lower extremity injuries in past three months, and participating in jump-landing activities. Control group will match the gender, age, height, weight and sports to KH group. Inclusion criteria is the same as KH group, except the knee hyperextension angle is <5⁰ in control group. Every subjects will receive the first time assessment and follow up by filling the injury-follow-up form every months for about four months.

At the first assessment, investigators will measure lower extremity alignments include pelvic angle in sagittal plane, hip anteversion, tibiofemoral angle, knee hyperextension angle in supine and standing position, tibial rotation angle, and navicular drop; lower extremity muscle flexibility include rectus femoris, hamstrings, gastrocnemius, soleus, iliotibial band; lower extremity muscle strength include hip, knee, muscle group; dynamic control task will record tibio-femoral acceleration, angle change ground reaction force and EMG muscle firing during vertical jump and drop jump.

• Study Type: Observational
• Enrollment (Actual): 64

Contacts and Locations

Study Locations

• Taiwan
  • 北投區
    • Taipei City, 北投區, Taiwan, 112
      • National Yng Ming University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

college athletes in Yang-Ming University and University of Taipei

Description

Inclusion Criteria:

• age ≥ 20 years old
• knee hyperextension ≥ 5⁰
• participate in jump- landing sports
• training at least 3 days per week
• no lower extremity injury last 3 months

Exclusion Criteria:

• having knee surgery before
• In the past three months have occurred lower extremity musculoskeletal injury leading the person can't participate in training or competition for at least three days

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Knee hyperextension group; athletes who has knee hyperextension
Control group; athletes who doesn't have knee hyperextension

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Injury type	Record injury type	4 months
Injury duration	time loss during the game or training (days)	4 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Lower extremity alignments-pelvic tilt on sagittal plane	pelvic tilt on sagittal plane in degree	1st day
Lower extremity alignments-hip anteversion	hip anteversion in degree	1st day
Lower extremity alignments-tibiofemoral angle	tibiofemoral angle in degree	1st day
Lower extremity alignments-knee hyperextension angle	knee hyperextension angle in supine and standing posture in degree	1st day
Lower extremity alignments-tibial rotation angle	tibial rotation angle in degree	1st day
Lower extremity alignments-hip external rotation angle	hip external rotation angle in degree	1st day
Lower extremity alignments-hip internal rotation angle	hip internal rotation angle in degree	1st day
Lower extremity alignments-navicular drop	navicular drop normalized with foot length in %	1st day
Rectus femoris flexibility	measure knee angle in prone knee bend position	1st day
Hamstrings flexibility	measure knee angle in 90-90 straight leg raise test	1st day
Gastrocnemius flexibility	measure ankle dorsiflexion angle in standing position without rearfoot lift off the floor	1st day
Soleus flexibility	measure ankle dorsiflexion angle in knee flex standing position without rearfoot lift off the floor	1st day
Iliotibial band flexibility	use Ober's test to measure the angle below horizontal level	1st day
Dynamic task parameters-acceleration and angle	anteroposterior acceleration and angle changes at knee joint	1st day
Dynamic task parameters-ground reaction force	ground reaction force	1st day
Dynamic task parameters-Electromyography (EMG)	use EMG to detect muscle firing during jump task	1st day
knee extensors muscle strength	knee extensors by hand held dynamometer	1st day
knee flexors muscle strength	knee flexors by hand held dynamometer	1st day

Collaborators and Investigators

• Sponsor: National Yang Ming University

Study record dates

Study Major Dates

• Study Start (ACTUAL): February 27, 2018
• Primary Completion (ACTUAL): August 30, 2018
• Study Completion (ACTUAL): December 31, 2018

Study Registration Dates

• First Submitted: January 26, 2018
• First Submitted That Met QC Criteria: February 1, 2018
• First Posted (ACTUAL): February 8, 2018

Study Record Updates

• Last Update Posted (ACTUAL): April 10, 2019
• Last Update Submitted That Met QC Criteria: April 8, 2019
• Last Verified: April 1, 2019

More Information

Terms related to this study

• Keywords: Injury rate
• Other Study ID Numbers: YM106052E

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No