Category: Knee

Why are there more ACL injuries in women’s football?

Posted on | by Matthew Blackwell

With the World Cup kicking off in Australia and New Zealand this year, the popularity of women’s football (soccer) is at an all-time high, with more women and girls getting involved every day. However, female football players are at a higher risk of anterior cruciate ligament (ACL) injuries compared to their male counterparts.1 Why are there more ACL injuries in women’s football, and how can knee bracing help in prevention and protection?

What is an ACL injury and how do they happen?

The anterior cruciate ligament (ACL) is one of the major stabilizing ligaments in the knee joint. Running diagonally in the middle of the knee, it prevents the tibia from sliding out in front of the femur and provides rotational stability to the knee.

ACL injury

Although the ACL can be torn when the knee receives excessive external force, unlike most other ligaments it can also be injured in non-contact situations, with the latter accounting for 70% of all reported ACL injuries.2

In football and other field/court sports, non‐contact ACL injury typically involves a sharp stop, a sudden change of direction, or landing from a jump with inadequate knee and hip flexion (at or near full extension).1 The most common occurrence is from a combination of a deceleration manoeuvre with a change of direction while the foot is planted and the knee is nearly or fully extended; the excessive torsional force that results from the player trying to change direction can potentially strain or rupture the ACL.

Why ACL injuries are more common in female footballers

Studies have shown that female athletes are two- to ten-times more likely to suffer an ACL injury than male athletes.1 The phenomenon has had a noticeable impact on the 2023 Women’s World Cup, with several high-profile players missing out on the tournament as a result. There are a number of factors involved.

Differences in anatomy

The anatomy of female players predisposes them to an increased incidence of ACL injuries. Women generally have slimmer muscles, and a more considerable pelvic angle than men. The Q-angle, which refers to the angle formed between the hip and the knee, is higher in females, leading to more exertion placed on the ACL. The variance in the anatomy of the knee joint and surrounding bones results in lower overall knee stability, amplified by repetitive jumps or twists.

Hormonal predisposition

Research has suggested that the menstrual cycle poses a higher risk for ACL injuries during ovulation.3 Estrogen levels are higher during ovulation; high estrogen levels alter the collagen production, resulting in increased ligament laxity which can lead to decreased levels of overall knee stability.

Biomechanical Aspects

Studies have revealed distinct differences in landing techniques between men and women following a jump or leap.4 Females have landing mechanisms which increase the pressure placed on their knees. Furthermore, females are more likely than males to land with knee valgus position, making it harder to control the forces and positions during motions leading to tearing of the ACL.

How a knee brace can help reduce ACL injuries

Clinical studies have demonstrated that wearing a knee brace during activity can help prevent ACL injury as well as protect against reinjury.5,6,7 DonJoy® knee braces utilize patented technology that reduces ACL strain.

The Four-Points-of-Leverage™ system featured in DonJoy knee braces consists of a rigid cuff and strap configuration. Through this, a posterior force is applied to the tibia, which prevents anterior movement and reduces the strain on the ACL.8

Four points of leverage

FourcePoint® hinge technology works to enhance DonJoy’s Four-Points-of-Leverage design by damping knee joint extension, which improves the mechanical performance of the brace and reduces shear forces at the knee. Addressing the “at-risk” position, the hinge resistance engages in the last 25 degrees of knee extension.

FourcePoint hinge

The FourcePoint hinge combined with the Four-Points-of-Leverage cuff and strapping design provides a more comfortable brace that reduces anterior shear forces at the knee. The stability this provides is beneficial for both female football players looking to avoid ACL injuries during training, and those who are recovering from an existing injury, as it reduces strain on the healing ACL graft.9,10

To find out more about DonJoy knee braces, go to enovis-medtech.eu.

References

  1. Silvers, H. J., & Mandelbaum, B. R. (2007). Prevention of anterior cruciate ligament injury in the female athlete. British journal of sports medicine, 41 Suppl 1(Suppl 1), i52–i59.
  2. Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train 1999;34(2):86-92.
  3. Yu, W. D., Liu, S. H., Hatch, J. D., Panossian, V., & Finerman, G. A. (1999). Effect of estrogen on cellular metabolism of the human anterior cruciate ligament. Clinical orthopaedics and related research, (366), 229–238.
  4. Butler, R. J., Willson, J. D., Fowler, D., & Queen, R. M. (2013). Gender differences in landing mechanics vary depending on the type of landing. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 23(1), 52–57.
  5. Tuang, B.H.H., Ng, Z.Q., Li, J.Z., Sirisena D. (2023). Biomechanical Effects of Prophylactic Knee Bracing on Anterior Cruciate Ligament Injury Risk: A Systematic Review. Clin J Sport Med. Jan 1;33(1):78-89.
  6. Perrone, G.S., Webster, K.E., Imbriaco, C., Portilla, G.M., Vairagade, A., Murray, M.M., Kiapour, A.M. (2019). Risk of Secondary ACL Injury in Adolescents Prescribed Functional Bracing After ACL Reconstruction. Orthop J Sports Med. Nov 12;7(11):2325967119879880.
  7. Bodendorfer, B.M., Anoushiravani, A.A., Feeley, B.T., Gallo, R.A. (2013). Anterior cruciate ligament bracing: evidence in providing stability and preventing injury or graft re-rupture. Phys Sportsmed. Sep;41(3):92-102.
  8. Fleming, B. C., Renstrom, P. A., Beynnon, B. D., Engstrom, B., & Peura, G. (2000). The influence of functional knee bracing on the anterior cruciate ligament strain biomechanics in weightbearing and nonweightbearing knees. The American journal of sports medicine, 28(6), 815–824.
  9. Théoret, D., & Lamontagne, M. (2006). Study on three-dimensional kinematics and electromyography of ACL deficient knee participants wearing a functional knee brace during running. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 14(6), 555–563.
  10. Stanley, C. J., Creighton, R. A., Gross, M. T., Garrett, W. E., & Yu, B. (2011). Effects of a knee extension constraint brace on lower extremity movements after ACL reconstruction. Clinical orthopaedics and related research, 469(6), 1774–1780.

The experts striving to improve anterior knee pain treatment

Posted on | by Matthew Blackwell

One in three patients of sports medicine clinics seek treatment for anterior knee pain1,2. The pain caused by this condition can prevent exercise or participation in sports, and can even lead to chronic disability and inability to work.

But a group of world experts is on a mission to improve the understanding and treatment of anterior knee pain. Along with knee brace manufacturers like DonJoy, their goal is to get people moving again.

What is anterior knee pain?

Anterior knee pain is another name for Patellofemoral Pain Syndrome (PFPS), a term used to refer to pain originating from the patellofemoral joint or its surrounding soft tissues. Due to the pain being felt in all parts of the knee, anterior knee pain is actually a misleading name, though its use remains popular.

This chronic condition usually worsens with activities such as running, squatting, and climbing stairs, as well as sitting. 

What is The Patellofemoral Foundation?

Founded in 2003 by Dr John Fulkerson, The Patellofemoral Foundation is a non-profit organization dedicated to improving the care of individuals with anterior knee problems through targeted education and research.

The author of many articles and books on patellofemoral pain, Dr Fulkerson is Professor of Orthopedic Surgery at Yale University. As well as sitting on the boards of a range of orthopedic associations, he has also been team doctor for the U.S. Olympic Ice Hockey team, the NHL Hartford Whalers, and the AHL Hartford Wolfpack.

Over the past two decades, The Patellofemoral Foundation has made progress in the understanding of anterior knee pain. Anatomic and clinical studies funded by it or carried out by its members have revealed previously unrecognized sources of pain leading to specific pain treatments around the front of the knee3.

During this time, technological advancements in radiology such as computerized tomography and MRI have also allowed greater understanding of the mechanical behavior of the patella.

The Patellofemoral Foundation

Yet despite this progress, much remains to be done to improve things for patients suffering from anterior knee pain. Among the objectives the foundation still seeks to achieve are to refine the indications for anterior knee pain management and surgery, improve bracing and non-operative measures, standardize operative approaches, and develop an educational network that reaches deep into the sports medicine and orthopedic communities.

One of the companies supporting the foundation in its efforts is Enovis. With its DonJoy brand offering a full range of patellofemoral knee braces, the orthopedics manufacturer has an important role to play in the conservative management of patients with anterior knee pain.

Tru-Pull® and the role of bracing in anterior knee pain treatment

A conservative aspect of anterior knee pain treatment is knee bracing. Wearing a patellofemoral knee brace can increase stability of the patella to reduce anterior knee pain4.

Developed in partnership with Dr Fulkerson, DonJoy’s Tru-Pull Advanced® knee brace is designed to place a dynamic pull on the patella during knee extension to improve alignment and reduce anterior pain.

Available in sleeve or hinged versions, the Tru-Pull Advanced provides support for patients with patellofemoral malalignment, subluxation, and dislocations.

Also available is the Tru-Pull Lite™, a shorter, more slimline version for enhanced comfort and ease of use. It is recommended for acute mild to moderate anterior knee pain, support for patella instability, lateral subluxation, and maltracking.

Tru-Pull Lite knee brace

DonJoy PateLax™ – flexible support for anterior knee pain

DonJoy PateLax™ is a new knitted elastic support that protects and supports the patella and is used to address overuse injuries such as anterior knee pain.

The brace offers targeted compression and a comfortable fit with its soft, breathable, elastic materials in a 3D-knit design.

DonJoy PateLax offers the following features:

  • Its anatomically contoured knee pad provides a massaging effect and helps improve proprioception by aiding stability and guidance of the patella
  • The patellar tendon pad with strap helps relieve tension at the tip of the patella and the tibial tuberosity (the bump on the top of the tibia where the patellar tendon connects)
  • Medial and lateral support of the knee are provided by a pair of flexible bilateral stays
  • Compression-reduced edges help provide a comfortable fit by diverting pressure at the ends of the support
  • Breathability, comfort, and freedom of movement are aided by stretch zones over the patella and the back of the knee
  • Non-slip silicone-coated bands help keep the brace in place

Stylish, modern, and easy to wash, DonJoy PateLax is a comfortable and convenient way for people to address anterior knee pain.

Learn more

References

  1. Chesworth, B. M., Culham, E., Tata, G. E., & Peat, M. (1989). Validation of outcome measures in patients with patellofemoral syndrome. The Journal of orthopaedic and sports physical therapy, 10(8), 302–308.
  2. Boling, M., Padua, D., Marshall, S., Guskiewicz, K., Pyne, S., & Beutler, A. (2010). Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scandinavian journal of medicine & science in sports, 20(5), 725–730.
  3. Fulkerson J. P. (2002). Diagnosis and treatment of patients with patellofemoral pain. The American journal of sports medicine, 30(3), 447–456.
  4. Selfe, J., Thewlis, D., Hill, S., Whitaker, J., Sutton, C., & Richards, J. (2011). A clinical study of the biomechanics of step descent using different treatment modalities for patellofemoral pain. Gait & posture, 34(1), 92–96.

How wearing a soft brace can help jumper’s knee pain

Posted on | by Matthew Blackwell

One of the risks of regular participation in sports and physical activity is the potential for incurring overuse injuries such as jumper’s knee or Osgood-Schlatter disease. Painful conditions like these can be a barrier to further participation, but evidence shows that wearing a soft brace can help prevent or reduce knee pain,1,2 and a new elastic knee support from DonJoy could offer just the solution.

What is jumper’s knee?

The tendon which connects the kneecap (patella) to the shin bone (tibia) is called the patellar tendon. Inflammation of this tendon is called patellar tendonitis – more commonly known as “jumper’s knee.”

Jumper’s knee is an overuse injury often sustained from sporting activities involving repeated jumping on hard surfaces. The repetitive stress placed on the patella tendon from jumping and landing puts strain on the tendon which can leave it inflamed.

As well as causing swelling, jumper’s knee also causes pain below the patella, which can be felt more acutely when jumping, running, walking, or when bending and straightening the leg.

What is Osgood-Schlatter disease?

Another potential source of knee pain is Osgood-Schlatter disease. This condition causes painful swelling where the patella tendon connects to the top of the tibia. The most common sufferers of Osgood-Schlatter disease are young athletes – particularly boys aged 10-15 – who take part in sports or activities involving lots of running and/or jumping.

While they are still growing, the ends of children’s bones have not yet hardened, making them more susceptible to stress. Activities that put stress on the knee, such as running, bending, or squatting, can irritate these areas of cartilage and lead to painful swelling.

How to help jumper’s knee pain or Osgood-Schlatter disease

There are a number of ways to help prevent or reduce jumper’s knee pain or Osgood-Schlatter disease:

  • Follow the RICE protocol. REST the knee where possible. Apply an ICE pack to the knee for up to 30 minutes. Wear an elastic support on the knee for COMPRESSION. And use a pillow for ELEVATION to raise the foot and reduce swelling
  • Anti-inflammatories can help with the pain and swelling
  • Wear a soft brace. The support that soft braces provide can help to prevent jumpers’s knee, or aid recovery

Try DonJoy PateLax™ – flexible support for the patella

DonJoy PateLax™ is a new knitted elastic support designed to protect and support the patella, as well as provide relief at the patellar tendon insertion. It can be used to address overuse injuries such as jumper’s knee and Osgood-Schlatter disease.

Made from soft, breathable, elastic materials in a 3D-knit design, the brace offers a comfortable way to support the knee with targeted compression.

DonJoy PateLax offers the wearer a range of beneficial features:

  • An anatomically contoured knee pad aids stability and guidance of the patella, provides a massaging effect, and helps improve proprioception
  • A patellar tendon pad with strap helps relieve tension at the tip of the patella and the tibial tuberosity (the bump on the top of the tibia where the patellar tendon connects)
  • A pair of flexible bilateral stays help provide medial and lateral support to the knee
  • Compression-reduced edges help divert pressure at the ends of the support to provide a comfortable fit
  • Stretch zones over the patella and the back of the knee aid breathability, comfort, and freedom of movement
  • Non-slip silicone-coated bands help provide extra secure hold under stress
DonJoy PateLax elastic knitted knee brace

DonJoy PateLax is indicated for the following uses:

  • Support and compression following injury to the patellar tendon
  • Proprioceptive and neuromuscular stimulation through compression
  • Overuse injuries such as Osgood-Schlatter disease
  • Patellofemoral pain syndrome
  • Patellar tendinitis
  • Patellar maltracking

Easy to wash and with a stylish, modern design, DonJoy PateLax is a great option for people wanting to help prevent or protect their knees from painful overuse injuries.

Learn more

References

  1. Sinclair JK, Selfe J, Taylor PJ, Shore HF, Richards JD. Influence of a knee brace intervention on perceived pain and patellofemoral loading in recreational athletes. Clin Biomech (Bristol, Avon). 2016 Aug;37:7-12.
  2. Phillips R, Choo S, Nuelle CW. Bracing for the Patellofemoral Joint. J Knee Surg. 2022 Feb;35(3):232-241.