Knee Injuries in Leisure-Time Physical Activities: A Prospective One-Year Follow-Up of a Finnish Population Cohort

Abstract

This prospective one-year follow-up study compared the risks of knee injuries in various commuting and lifestyle activities as well as in recreational and competitive sports in a 15 to 74-year-old Finnish population cohort. A cohort of 3657 persons was randomly selected from the nationwide population register of Finland. Ninety-two percent of them accepted to participate (n = 3363). The subjects were interviewed by telephone three times during the one-year follow-up. The recorded data included all physical activities that lasted 15 minutes or more, and all injuries that were sustained during these activities. Fifteen percent (n = 321) of all reported injuries affected the knee. The individual risk of knee injury per 1000 exposure hours was low in commuting activities (cycling, walking), 0.06 (95 % CI 0.04 to 0.09) and in lifestyle activities (gardening, hunting, fishing, home repair etc.), 0.04 (0.03 - 0.06). In recreational and competitive sports, the knee injury risk was almost ten times higher, 0.44 (0.39 - 0.50). For commuting activities (p = 0.046) and for recreational and competitive sports (p < 0.001), there was a decreasing injury rate with age. In lifestyle activities (p = 0.038), in turn, there was an increasing trend of injuries with aging. In commuting activities (hazard ratio, HR 5.99, 95 % CI 1.40 to 25.6), the risk of knee injury was significantly higher in women than in men. In conclusion, the knee injury risk per exposure hours is almost ten times lower in commuting and lifestyle activities compared to recreational and competitive sports. The knee injury risk is especially high in the age group of 15 to 25 years, especially in various team sports and ball games. At population level, however, widely practiced low-to-moderate intensity activities with relatively low injury risk per exposure hours produce a large absolute number of knee injuries.

Knee injury - physical activity - leisure time injury - epidemiology

References

• 1 Buhl-Nielsen A, Yde J. Epidemiology of acute knee injuries: a prospective hospital investigation.  J Trauma. 1991;  31 1644-1648
• 2 Caine D J, Caine C G, Lindner (eds) K J. Epidemiology of Sports Injuries. Champaign, IL; Human Kinetics 1996
• 3 de Loes M. Medical treatment and costs of sports-related injuries in total population.  Int J Sports Med. 1990;  11 66-72
• 4 de Loes M, Dahlstedt L J, Thomee R. A 7-year study on risks and costs of knee injuries in male and female youth participants in 12 sports.  Scand J Med Sports. 2000;  10 90-97
• 5 de Loes M, Goldie I. Incidence rate of injuries during sport activity and physical exercise in a rural Swedish municipality: incidence rates in 17 sports.  Int J Sports Med. 1988;  9 461-467
• 6 Ettlinger C F, Johnson R J, Shealy J E. A method to help reduce the risk of serious knee sprains incurred in alpine skiing.  Am J Sports Med. 1995;  23 531-537
• 7 Harel Y, Overpeck M D, Jones D H, Scheidt P C, Bijur P E, Trumble A C, Anderson J. The effects of recall on estimating annual nonfatal injury rates for children and adolescents.  Am J Public Health. 1994;  84 599-605
• 8 Haapanen N, Miilunpalo S, Vuori I, Oja P, Pasanen M. Characteristics of leisure time physical activity associated with decreased risk of premature all-cause and cardiovascular disease mortality in middle-aged men.  Am J Epidemiol. 1996;  143 870-880
• 9 Hewett T E, Lindenfeld T N, Riccobene J V, Noyes F R. The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study.  Am J Sports Med. 1999;  27 699-706
• 10 Hootman J M, Macera C A, Ainsworth B E, Addy C L, Martin M, Blair S N. Epidemiology of musculoskeletal injuries among sedentary and physically active adults.  Med Sci Sports Exerc. 2002;  34 838-844
• 11 Hootman J M, Macera C A, Ainsworth B E, Martin M, Addy C L, Blais S N. Predictors of lower extremity injury among recreationally active adults.  Clin J Sports Med. 2002;  12 99-106
• 12 Hutchinson M R, Ireland M L. Knee injuries in female athletes.  Sports Med. 1995;  4 288-302
• 13 Kujala U M, Taimela S, Antti-Poika I, Orava S, Tuominen R, Myllynen P. Acute injuries in soccer, ice hockey, volleyball, basketball, judo, and karate: analysis of national registry data.  BMJ. 1995;  311 1465-1468
• 14 Mock C, Acheampong F, Adjei S, Koepsell T. The effect of recall on estimation of incidence rates for injury in Ghana.  Int J Epidemid. 1999;  28 750-755
• 15 Myklebust G, Bahr R. Return to play guidelines after anterior cruciate ligament surgery.  Br J Sports Med. 2005;  39 127-131
• 16 Parkkari J, Kannus P, Natri A, Lapinleimu I, Palvanen M, Heiskanen M, Vuori I, Järvinen M. Active living and injury risk.  Int J Sports Med. 2004;  25 209-216
• 17 Parkkari J, Kujala U, Kannus P. Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work.  Sports Med. 2001;  31 985-995
• 18 Pate R, Pratt M, Blair S N, Haskell W L, Macera C A, Bouchard C, Buchner D, Ettinger W, Heath G W, King A C. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.  JAMA. 1995;  273 402-407
• 19 Powell K E, Heath G E, Kresnow M ‐J, Sacks J J, Branche C M. Injury rates from walking, gardening, weightlifting, outdoor bicycling, and aerobics.  Med Sci Sports Exerc. 1998;  30 1246-1249
• 20 Requa R K, DeAvilla L N, Garrick J G. Injuries in recreational adult fitness activities.  Am J Sports Med. 1993;  21 461-467
• 21 Selvin S. Statistical Analysis of Epidemiologic Data. 3rd edition. New York; Oxford University Press 2004
• 22 Sitler M, Ryan J, Hopkinson W, Wheeler J, Santomier J, Kolb R, Polley D. The efficacy of a prophylactic knee brace to reduce knee injuries in football: a prospective, randomized study at West Point.  Am J Sports Med. 1990;  8 310-315
• 23 Snellman K, Parkkari J, Kannus P, Leppala J, Vuori I, Jarvinen M. Sports injuries in floorball. A prospective one-year follow-up study.  Int J Sports Med. 2001;  22 531-536
• 24 Suni J H, Oja P, Miilunpalo S I, Pasanen M E, Vuori I M, Bos K. Health-related fitness test battery for middle-aged adults: associations with physical activity pattern.  Int J Sports Med. 1999;  20 183-191
• 25 Thacker S B, Stroup D F, Branche C M, Gilchrist J, Goodman R A, Porter Kelling E. Prevention of knee injuries in sports. A systematic review of the literature.  J Sports Med Phys Fitness. 2003;  43 165-179
• 26 Wedderkopp N, Kaltoft M, Lundgaard B, Rosendahl M, Froberg K. Prevention of injuries in young female players in European team handball. A prospective intervention study.  Scand J Med Sci Sports. 1999;  9 41-47