A Cross-Sectional Analysis of Sagittal Knee Laxity and Isokinetic Muscle Strength in Soccer Players

Abstract

In this cross-sectional study, sagittal knee laxity and isokinetic strength of knee extensor and flexor muscle groups were measured and differences related to leg dominance were evaluated. A total of 44 healthy male soccer players (who had trained regularly at least for the last five years) and 44 sedentary people as their control counterparts were involved in this study. All participants were tested using a KT-1000 knee arthrometer for knee laxity. Isokinetic concentric knee peak torque and hamstring/quadriceps (H/Q) ratio were also measured at 60, 180, 300°/s through a Cybex 2 - 340 dynamometer. Posterior laxity in the non-dominant side of soccer players was significantly higher than in the dominant side (p < 0.005) while there were no significant anterior and total anteroposterior (total AP) laxity differences in both groups. Soccer players had significantly lower anterior and total AP laxity values than controls (p < 0.0001) while there was no significant difference between posterior laxity values in both sides. Dominant extremity demonstrated significantly higher knee flexor peak torque and H/Q ratio at 180°/s in soccer players (p < 0.05). Similarly in sedentary controls, H/Q ratio at 60°/s of the dominant side was significantly higher than that in the non-dominant side (p < 0.05). Soccer players had significantly higher extensor and flexor peak torque values and H/Q ratios than sedentary subjects for both extremities. In both groups, there were no significant correlations between knee laxity and isokinetic knee extensor and flexor strength and H/Q ratios except weak negative correlation between posterior knee laxity and isokinetic extensor peak torque at 60, 180 and 300°/s (p < 0.005, r = - 0.43, p < 0.05, r = - 0.39, p < 0.05, r = - 0.32 respectively) in the non-dominant side of soccer players and at 300°/s (p < 0.05, r = - 0.32) in the non-dominant side of controls. Soccer players demonstrated significantly less sagittal knee laxity and higher isokinetic strength of the knee flexors and extensors compared to sedentary controls. Isokinetic strength difference was found to be higher for the flexor muscle group. Further prospective studies are needed to explain whether the increased H/Q ratio decreases the risk of ligamentous injury.

Soccer - knee laxity - isokinetic strength - hamstring/quadriceps ratio

References

• 1 Agre J C, Baxter T L. Musculoskeletal profile of male collegiate soccer players.  Arch Phys Med Rehabil. 1987;  68 147-150
• 2 Amato M, Lemoine F, Gonzales J, Schmidt C, Afriat P, Bernard P L. Influence of age and physical activity on isokinetic characteristics of hamstrings and quadriceps muscles of young gymnasts and soccer players.  Ann Readapt Med Phys. 2001;  44 581-590
• 3 Andersson C, Gillquist J. Instrumented testing for evaluation of sagittal knee laxity.  Clin Orthop Rel Res. 1990;  256 178-184
• 4 Bach B R, Matteoni K J. Knee laxity testing devices. Insall J, Scott WN Surgery of the Knee. 3rd ed. Vol. 1. Philadelphia; Churchill Livingstone 2001: 600-627
• 5 Brannan T L, Schulthies S S, Myrer J W, Durrant E. A comparison of anterior knee laxity in female intercollegiate gymnasts to a normal population.  J Athletic Training. 1995;  30 298-301
• 6 Burket L N. Causative factors in hamstring strains.  Med Sci Sports Exerc. 1970;  2 39-42
• 7 Capranica L, Cama G, Fanton F, Tessitore A, Figura F. Force and power of preferred and non-preferred leg in young soccer players.  J Sports Med Phys Fitness. 1992;  32 358-363
• 8 Chandler T J, Wilson G D, Stone M H. The effect of squat exercise on knee stability.  Med Sci Sport Exerc. 1989;  3 299-303
• 9 Chapman J P, Chapman L J, Allen J J. The measurement of foot preference.  Neuropsychologia. 1987;  25 579-584
• 10 Chen C Y, Jiang C C, Jan M H, Lai J S. Role of flexors in knee stability.  J Formos Med Assoc. 1995;  94 255-60
• 11 Cometti G, Maffiuletti N A, Pousson M, Chatard J C, Maffulli N. Isokinetic strength and anaerobic power of elite, subelite and amateur French soccer players.  Int J Sports Med. 2001;  22 45-51
• 12 Daniel D M, Malcolm L L, Losse G, Stone M L, Sachs R, Burks R. Instrumented measurements of anterior laxity of the knee.  J Bone Joint Surg (Am). 1985;  67 720-725
• 13 Daniel D M, Stone M L, Sachs R, Malcolm L. Instrumented measurements of anterior knee laxity in patients with acute anterior cruciate ligament disruption.  Am J Sports Med. 1985;  13 401-407
• 14 Diaz M A, Estevez E C, Guijo P S. Joint hyperlaxity and musculocutaneous lesions: Study of a population of homogenous age, sex and physical exertion.  Br J Rheumatol. 1993;  32 120-122
• 15 Edixhoven P, Huiskes R, Graaf R. Anteroposterior drawer measurements in the knee using an instrumented knee device.  Clin Orthop Rel Res. 1989;  247 232-242
• 16 Ekstrand J, Gillquist J, Möller M. Incidence of soccer injuries and their relation to training and team success.  Am J Sport Med. 1983;  11 63-67
• 17 Forster I W, Warren-Smith C D, Tew M. Is the KT-1000 reliable?.  J Bone Joint Surg (Br). 1989;  71 843-847
• 18 Gaspar L, Kiss I, Farkas C, Lampe I, Szepesi K. Measuring the looseness of the knee joint by using the KT-1000 arthrometer.  Magy Traumatol Orthop Helyrealitto Seb. 1992;  35 245-254
• 19 Hang Y S, Fung W C, Hang D. Quantitative test of knee laxity in Chinese.  J Formos Med Assoc. 1993;  92 907-910
• 20 Hanten W P, Pace M B. Reliability of measuring anterior laxity of the knee joint using a knee ligament arthrometer.  Phys Ther. 1987;  67 357-359
• 21 Highenboten C L, Jackson A, Meske N B. Genucom, KT-1000 and Stryker knee laxity measuring device comparisons.  Am J Sport Med. 1989;  17 743-746
• 22 Kalenak A, Morehouse C A. Knee stability and knee ligament injuries.  JAMA. 1975;  234 1143-1145
• 23 Karageanes S J, Blackburn K, Vangelos Z A. The association of the menstrual cycle with the laxity of the anterior cruciate ligament in adolescent female athletes.  Clin J Sports Med. 2000;  10 162-168
• 24 Kayatekin M. The effect of regular training on knee flexor and extensor muscle strength in soccer players.  Turkish J Sport Med. 1995;  30 85-94
• 25 Kettunen J A, Kujala U M, Raety H, Videman T, Sarna S, Impivaara O. Determinants of sagittal knee laxity in former elite athletes.  Sports Exerc and Injury. 1997;  3 164-167
• 26 Konig D P, Rutt J, Kumm D, Breidenbach E. Diagnosis of anterior instability. Comparison between the Lachman test, the KT-1000 arthrometer and the ultrasound Lachman test.  Unfallchirurg. 1998;  101 209-213
• 27 Maehlum S, Daljord O A. Football injuries in Oslo. A one year study.  Br J Sport Med. 1984;  18 186-190
• 28 McLaughlin K M, Perrin D H. Reliability of KT-1000 arthrometer measures obtained at three joint positions.  Athletic Training. 1991;  26 354-356
• 29 More R C, Karras B T, Neiman R, Fritschy D, Woo S L, Daniel D M. Hamstrings - an anterior cruciate ligament protagonist: an in vitro study.  Am J Sport Med. 1993;  21 231-237
• 30 Nawata K, Teshima R, Morio Y, Hagino H. Anterior-posterior knee laxity increased by exercise.  Acta Orthop Scand. 1999;  70 261-264
• 31 Nicholas J A. Injuries to knee ligaments. Relationship to looseness and tightness in football players.  JAMA. 1970;  212 2236-2239
• 32 Oberg B, Möller M, Gillquist J, Ekstrand J. Isokinetic torque levels for knee extensor and knee flexor in soccer players.  Int J Sports Med. 1986;  7 50-53
• 33 Ostenberg A, Roos E, Ekdahl C, Roos H. .  Isokinetic knee extensor strength and functional performance in healthy female soccer players Scand J Med Sci Sports. 1998;  8 257-264
• 34 Rangger C, Daniel D M, Stone M L, Kaufmann K. Diagnosis of an ACL disruption with KT-1000 arthrometer measurements.  Knee Surg Sport Traumatol Arthrosc. 1993;  1 60-66
• 35 Reference, Maintenance and User's Guide for the Knee Ligament Arthrometer. 1st ed. San Diego, California; MEDmetric Corporation 1993
• 36 Renstrom P, Arms S W, Stanwyck T S, Johnson R J, Pope M H. Strain within the anterior cruciate ligament during hamstring and quadriceps activity.  Am J Sport Med. 1986;  14 83-87
• 37 Rosene J M, Fogarty T D. Anterior tibial translation in collegiate athletes with normal anterior cruciate ligament integrity.  J Athletic Training. 1999;  34 93-98
• 38 Sadeghi H, Allard P, Prince F, Labelle H. Symmetry and limb dominance in able-bodied gait.  Gait Posture. 2000;  12 34-45
• 39 Sakai H, Tanaka S, Kurosawa H, Masujima A. The effect of exercise on anterior knee laxity in female basketball players.  Int J Sport Med. 1992;  13 552-554
• 40 Sherman O H, Markolf K L, Ferkel R D. Measurements of anterior laxity in normal and anterior cruciate absent knees with two instrumented test devices.  Clin Orthop Rel Res. 1987;  215 156-161
• 41 Skinner H B, Wyatt M P, Stone M L, Hodgdon J A, Barrack R L. Exercise-related joint laxity.  Am J Sports Med. 1986;  14 30-34
• 42 Sojka P, Johansson H, Sjolander P, Lorentzon R, Djupsjobacka M. Fusimotor neurons can be reflexly influenced by activity in receptor afferents from the posterior cruciate ligament.  Brain Res. 1989;  27 177-183
• 43 Solomonow M, Baratta R, Zhou B H, Shoji H, Bose W, Beck C, D'Ambrosia R. The synergistic action of the anterior cruciate ligament and thigh muscles in maintaining joint stability.  Am J Sports Med. 1987;  15 207-213
• 44 Solomonow M, Krogsgaard M. Sensorimotor control of knee stability. A review.  Scand J Med Sci Sports. 2001;  11 64-80
• 45 Steiner M E. Hypermobility and knee injuries.  Phys Sportmed. 1987;  15 159-165
• 46 Steiner M E, Grana W A, Chillag K, Schelberg-Karnes E. The effect of exercise on anterior-posterior knee laxity.  Am J Sports Med. 1986;  14 24-29
• 47 Torzilli P A, Panariello R A, Forbes A, Santner T J, Warren R F. Measurement reproducibility of two commercial knee devices.  J Orthop Res. 1991;  9 730-737
• 48 Ülkar B, Demir H, Ergen E. Arthrometric tibial displacement measurements of female ballet dancers: differences among extremities.  Turkish J Sport Med. 2000;  35 9-14
• 49 Vergis A, Hindrikis M, Gillquist J. Sagittal plane translations of the knee in anterior cruciate deficient subjects and controls.  Med Sci Sports Exerc. 1997;  29 1561-1566
• 50 Weisman G, Pope M H, Johnson R J. Cyclic loading in knee ligament injuries.  Am J Sports Med. 1980;  8 24-30
• 51 Yamagishi T, Fujii K. Anterior knee laxity in skiers before and after racing.  Knee Surg Sport Traumatol Arthrosc. 1998;  69 169-72
• 52 Yde J, Nielsen A B. Sports injuries in adolescents' ball games soccer, handball and basketball.  Br J Sport Med. 1990;  24 51-54