The Influence of the Lower Limb Components on Genu Varum in Football Players: a Full Leg Length Magnetic Resonance Imaging Study
The Influence of the Lower Limb Components on Genu Varum in Football Players: a Full Leg Length Magnetic Resonance Imaging Study
Objectives: To evaluate lower extremity alignments in football players with and without genu varum using magnetic resonance imaging (MRI), to determine the mechanisms underlying malalignment and the factors contributing to it.
Methods: This is a prospective case-control study with football players with/without lower extremity malalignment. Full-length lower extremity MRI was used to evaluate the lower extremity alignment parameters. In addition, the isokinetic strength of the concentric knee extensor-flexor and concentric hip abductor-adductor muscles was measured using an isokinetic dynamometer at two different angular velocities: 60˚/sec and 180˚/sec. The investigators created a logistic regression model to investigate whether the alignment parameters used to evaluate lower extremity alignment in football players are risk factors for the development of genu varum.
Genu varum deformity is a common condition among football players, occurring in 73% of cases . Previous studies have shown that football players are at a higher risk of developing genu varum than athletes in other sports . Genu varum can have a negative impact on an athlete's physical abilities by disrupting static and dynamic balance through alterations in the gravitational axis of the lower extremities. In addition, genu varum can damage the tibiofemoral articular cartilage, increasing the risk of knee osteoarthritis later in life . It is also associated with several intra-articular pathologies, including meniscal lesions, anterior knee pain, and anterior cruciate ligament injuries . Therefore, it is important to understand the cause of this deformity and take protective-corrective measures for football players.
In recent years, researchers have studied the relationship between genu varum and football participation. Researchers have used various methods, including the caliper, goniometer, and photographic technique, to analyze deformities. However, these methods have limitations, making it difficult to examine etiological factors and differences in anthropometric components . In a study conducted by Colyn, Arnout, Verhaar and Bellemans 6, a comparison was made between football players and other athletes and non-athletes using digital radiology measurements. The findings indicated that male football players exhibited genu varum, with the proximal tibia identified as the primary factor determining this. Similarly, Krajnc and Drobnič studied lower limb alignment in asymptomatic adult professional football players and found that the proximal tibia was the source of varus deformity. However, it has been suggested that additional research is required to fully comprehend the involved mechanisms. Furthermore, Witvrouw, Danneels, Thijs, Cambier and Bellemans 9proposed that an imbalanced strength distribution between the adductor and abductor muscles may result in genu varum in football players. This is because kicking, a frequent activity in football, often strengthens the adductor muscles, which can alter the average adductor/abductor strength ratio. However, the authors note that no data on the adductor/abductor strength of football players is available in the literature. They suggest further research to address this knowledge gap.
Asymmetrical movements in football, resulting from the difference between the kicking and supporting legs, may lead to different mechanisms causing genu varum formation in the dominant and non-dominant legs. It is crucial to acknowledge that not all football players exhibit varus knee alignment. Consequently, in order to ascertain the mechanisms that contribute to the formation of genu varum, it is essential to conduct a comparative analysis between football players exhibiting and those lacking a varus deformity. This comparison can assist in identifying the mechanisms that cause genu varum in football players and the factors likely to contribute to these mechanisms. The study had three objectives: (i) to evaluate lower extremity alignments in football players with and without genu varum using magnetic resonance imaging (MRI), (ii) to determine the mechanisms underlying malalignment and the factors contributing to it; and (iii) to investigate the relationship between lower extremity alignment and isokinetic strength.
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