Download PDF
CC BY-NC-ND 4.0 · Sports Med Int Open 2025; 09: a24172488
DOI: 10.1055/a-2417-2488
Training & Testing

Functional Knee Stability in Elite Field Hockey Depends on Playing Class and Gender

Lucie Hiepen
1   Department of Orthopaedics, Trauma and Reconstruc- tion Surgery, St Marien-Hospital Mülheim an der Ruhr, Mülheim, Germany
2   Sektion für Neonatologie und Pädiatrische Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
,
Niklas Bosserhoff
3   Department of Trauma Surgery, Orthopedics and Sport Orthopedics, Asklepios Klinik Sankt Georg, Hamburg, Germany
,
Florian Schaudig
1   Department of Orthopaedics, Trauma and Reconstruc- tion Surgery, St Marien-Hospital Mülheim an der Ruhr, Mülheim, Germany
,
Falko Heitzer
1   Department of Orthopaedics, Trauma and Reconstruc- tion Surgery, St Marien-Hospital Mülheim an der Ruhr, Mülheim, Germany
4   Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen Faculty of Medicine, Essen, Germany
,
Marcus Jäger
1   Department of Orthopaedics, Trauma and Reconstruc- tion Surgery, St Marien-Hospital Mülheim an der Ruhr, Mülheim, Germany
4   Chair of Orthopaedics and Trauma Surgery, University of Duisburg-Essen Faculty of Medicine, Essen, Germany
,
Constantin Mayer
1   Department of Orthopaedics, Trauma and Reconstruc- tion Surgery, St Marien-Hospital Mülheim an der Ruhr, Mülheim, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Field hockey, a physically demanding Olympic sport, carries a high risk of lower limb injuries, yet data on injury risk in elite field hockey are limited. Functional knee stability is important for injury prevention and a safe return to sport. This study is the first to investigate functional knee stability in elite field hockey, considering gender and playing class, and establishes reference data for functional knee stability by using a standardized test battery that assesses one- and two-legged stability, jumping tests, speed, and agility. Seventy-two elite field hockey players, 30 males and 42 females (age 19.82±3.74 years) were divided into High Playing Class (HPC) and Moderate Playing Class (MPC). HPC players showed significantly better performance in all functional tests except balance tests (p<0.01–0.024). Females showed significantly better one- and two-leg stability (p<0.01) with lower injury rates, indicating the relevance of gender considerations. The study emphasizes the importance of balance and stability in the prevention of lower limb injuries in Olympic field hockey and also highlights the importance of considering pre-existing deficits in functional knee capability when assessing athletes for return to sport. These results can help improve athletic performance, identify individual strengths and weaknesses, prevent injury or re-injury, and facilitate return to sport after injury.

Keywords

knee function - functional test battery - return to sport criteria - field hockey - reference data


Publication History

Received: 10 January 2024

Accepted after revision: 26 July 2024

Accepted Manuscript online:
23 October 2024

Article published online:
13 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Bibliographical Record
Lucie Hiepen, Niklas Bosserhoff, Florian Schaudig, Falko Heitzer, Marcus Jäger, Constantin Mayer. Functional Knee Stability in Elite Field Hockey Depends on Playing Class and Gender. Sports Med Int Open 2025; 09: a24172488.
DOI: 10.1055/a-2417-2488
 

  • References

  • 1 Dewar H, Clarke J. Peak running intensities in field hockey – a positional analysis. J Hum Kinet 2021; 79: 135-144
    Search in Google Scholar
  • 2 Delves RIM, Bahnisch J, Ball K. et al. Quantifying mean peak running intensities in elite field hockey. J Strength Cond Res 2021; 35: 2604-2610
    Search in Google Scholar
  • 3 Ihsan M, Yeo V, Tan F. et al. Running demands and activity profile of the new four-quarter match format in menʼs field hockey. J Strength Cond Res 2021; 35: 512-518
    Search in Google Scholar
  • 4 Lim JZ, Sim A, Kong PW. Wearable technologies in field hockey competitions: a scoping review. Sensors (Basel) 2021; 21: 5242
    Search in Google Scholar
  • 5 Jennings D, Cormack SJ, Coutts AJ. et al. GPS analysis of an international field hockey tournament. Int J Sports Physiol Perform 2012; 7: 224-231
    Search in Google Scholar
  • 6 Gabbett TJ. GPS analysis of elite womenʼs field hockey training and competition. J Strength Cond Res 2010; 24: 1321-1324
    Search in Google Scholar
  • 7 Lythe J, Kilding AE. Physical demands and physiological responses during elite field hockey. Int J Sports Med 2011; 32: 523-528
    Search in Google Scholar
  • 8 Taylor JB, Wright AA, Dischiavi SL. et al. Activity demands during multi-directional team sports: a systematic review. Sports Med 2017; 47: 2533-2551
    Search in Google Scholar
  • 9 Braun HJ, Shultz R, Malone M. et al. Differences in ACL biomechanical risk factors between field hockey and lacrosse female athletes. Knee Surg Sports Traumatol Arthrosc 2015; 23: 1065-1070
    Search in Google Scholar
  • 10 Smith M, Weir G, Donnelly CJ. et al. Field hockey sport-specific postures during unanticipated sidestepping: Implications for anterior cruciate ligament injury prevention. J Sports Sci 2020; 38: 2603-2610
    Search in Google Scholar
  • 11 Barboza SD, Joseph C, Nauta J. et al. Injuries in field hockey players: A systematic review. Sports Med 2018; 48: 849-866
    Search in Google Scholar
  • 12 Theilen T-M, Mueller-Eising W, Wefers Bettink P. et al. Injury data of major international field hockey tournaments. Br J Sports Med 2016; 50: 657-660
    Search in Google Scholar
  • 13 Agel J, Rockwood T, Klossner D. Collegiate ACL injury rates across 15 sports: National Collegiate Athletic Association injury surveillance system data update (2004–2005 Through 2012–2013). Clin J Sport Med 2016; 26: 518-523
    Search in Google Scholar
  • 14 Bourne MN, Webster KE, Hewett TE. Is fatigue a risk factor for anterior cruciate ligament rupture?. Sports Med 2019; 49: 1629-1635
    Search in Google Scholar
  • 15 Alentorn-Geli E, Myer GD, Silvers HJ. et al. Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 2009; 17: 705-729
    Search in Google Scholar
  • 16 DosʼSantos T, Stebbings GK, Morse C. et al. Effects of the menstrual cycle phase on anterior cruciate ligament neuromuscular and biomechanical injury risk surrogates in eumenorrheic and naturally menstruating women: A systematic review. PLoS One 2023; 18: e0280800
    Search in Google Scholar
  • 17 Abrams GD, Harris JD, Gupta AK. et al. Functional performance testing after anterior cruciate ligament reconstruction: A systematic review. Orthop J Sports Med 2014; 2: 2325967113518305
    Search in Google Scholar
  • 18 Kyritsis P, Bahr R, Landreau P. et al. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med 2016; 50: 946-951
    Search in Google Scholar
  • 19 Goh S, Boyle J. Self evaluation and functional testing two to four years post ACL reconstruction. Aust J Physiother 1997; 43: 255-262
    Search in Google Scholar
  • 20 Gribble PA, Kelly SE, Refshauge KM. et al. Interrater reliability of the star excursion balance test. J Athl Train 2013; 48: 621-626
    Search in Google Scholar
  • 21 Losciale JM, Bullock G, Cromwell C. et al. Hop testing lacks strong association with key outcome variables after primary anterior cruciate ligament reconstruction: A systematic review. Am J Sports Med 2020; 48: 511-522
    Search in Google Scholar
  • 22 Luedke LE, Geisthardt TW, Rauh MJ. Y-Balance test performance does not determine non-contact lower quadrant injury in collegiate American football players. Sports (Basel) 2020; 8: 27
    Search in Google Scholar
  • 23 King E, Richter C, Jackson M. et al. Factors influencing return to play and second anterior cruciate ligament injury rates in level 1 athletes after primary anterior cruciate ligament reconstruction: 2-year follow-up on 1432 reconstructions at a single center. Am J Sports Med 2020; 48: 812-824
    Search in Google Scholar
  • 24 Herbst E, Hoser C, Hildebrandt C. et al. Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part II: clinical application of a new test battery. Knee Surg Sports Traumatol Arthrosc 2015; 23: 1283-1291
    Search in Google Scholar
  • 25 Hildebrandt C, Müller L, Zisch B. et al. Functional assessments for decision-making regarding return to sports following ACL reconstruction. Part I: development of a new test battery. Knee Surg Sports Traumatol Arthrosc 2015; 23: 1273-1281
    Search in Google Scholar
  • 26 Gokeler A, Welling W, Zaffagnini S. et al. Development of a test battery to enhance safe return to sports after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25: 192-199
    Search in Google Scholar
  • 27 Ruhlemann A, Mayer C, Haversath M. et al. Functional knee performance differences in handball are depending on playing class. Int J Sports Med 2020; 41: 652-660
    Search in Google Scholar
  • 28 Mayer C, Ruhlemann A, Busch A. et al. Measures of knee capability in handball players differ by age: A cross sectional study. Sports Med Int Open 2022; 6: E60-E68
    Search in Google Scholar
  • 29 Rohde M, Ruhlemann A, Busch A. et al. Evaluation of the Back-in-Action test battery in uninjured high school American football players. Int J Sports Phys Ther 2023; V18: 746-757
    Search in Google Scholar
  • 30 Houel DD N, Faury A, Seyfried D. Accuracy and reliability of the Myotest Pro system to evaluate a squat jump. Procedia Engineering 2011; 13: 434-438
    Search in Google Scholar
  • 31 Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J 2012; 24: 69-71
    Search in Google Scholar
  • 32 Gorostiaga EM, Granados C, Ibanez J. et al. Differences in physical fitness and throwing velocity among elite and amateur male handball players. Int J Sports Med 2005; 26: 225-232
    Search in Google Scholar
  • 33 Alonso AC, Luna NM, Mochizuki L. et al. The influence of anthropometric factors on postural balance: the relationship between body composition and posturographic measurements in young adults. Clinics (Sao Paulo) 2012; 67: 1433-1441
    Search in Google Scholar
  • 34 Peterson JR, Krabak BJ. Anterior cruciate ligament injury: mechanisms of injury and strategies for injury prevention. Phys Med Rehabil Clin N Am 2014; 25: 813-828
    Search in Google Scholar
  • 35 Zech A, Hollander K, Junge A. et al. Sex differences in injury rates in team-sport athletes: A systematic review and meta-regression analysis. J Sport Health Sci 2022; 11: 104-114
    Search in Google Scholar
  • 36 Barboza SD, Nauta J, Emery C. et al. A warm-up program to reduce injuries in youth field hockey players: A quasi-experiment. J Athl Train 2019; 54: 374-383
    Search in Google Scholar
  • 37 Thorborg K, Krommes KK, Esteve E. et al. Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+programmes. Br J Sports Med 2017; 51: 562-571
    Search in Google Scholar
  • 38 Gouttebarge V, Zuidema V. Prevention of musculoskeletal injuries in recreational field hockey: the systematic development of an intervention and its feasibility. BMJ Open Sport Exerc Med 2018; 4: e000425
    Search in Google Scholar
  • 39 Hewett TE, Myer GD, Ford KR. et al. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 2005; 33: 492-501
    Search in Google Scholar
  • 40 Dingenen B, Gokeler A. Optimization of the return-to-sport paradigm after anterior cruciate ligament reconstruction: A critical step back to move forward. Sports Med 2017; 47: 1487-1500
    Search in Google Scholar
  • 41 Grindem H, Snyder-Mackler L, Moksnes H. et al. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med 2016; 50: 804-808
    Search in Google Scholar
  • 42 Lambert C, Pfeiffer T, Lambert M. et al. Side differences regarding the limb symmetry index in healthy professional athletes. Int J Sports Med 2020; 41: 729-735
    Search in Google Scholar
  • 43 Ronden AE, Koc BB, van Rooij L. et al. Low percentage of patients passed the ̀Back in Actioń test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction. J Clin Orthop Trauma 2022; 34: 102025
    Search in Google Scholar
  • 44 Csapo R, Pointner H, Hoser C. et al. Physical fitness after anterior cruciate ligament reconstruction: Influence of graft, age, and sex. Sports (Basel) 2020; 8: 30
    Search in Google Scholar