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Female sex is associated with greater rotatory knee laxity in collegiate athletes

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose/hypothesis

The purpose of this observational study was to determine which factors, including sex, are associated with increased rotatory knee laxity in collegiate athletes with no history of knee injuries. It was hypothesized that increased rotatory knee laxity, measured by a quantitative pivot shift test, would correlate with female sex, increased anterior translation during the Lachman test, generalized ligamentous laxity, and knee hyperextension.

Methods

Ninety-eight collegiate athletes with a median age of 20 (range 18–25) years with no history of knee injuries were tested. IKDC and Marx activity scores were obtained and subjects underwent measurement of anterior translation during the Lachman test with a Rolimeter and measurement of knee hyperextension with a goniometer for both knees. A standardized pivot shift test was performed in both knees and quantified using image analysis technology. Generalized ligamentous laxity was assessed using the modified Beighton score.

Results

The average anterior translation of the lateral compartment during the pivot shift test was 1.6 mm (range 0.1–7.1) with a mean side-to-side difference of 0.6 mm (range 0–2.7). The average anterior translation during the Lachman test was 9.0 (range 2–15). The anterior translation of the lateral compartment during the pivot shift test was significantly higher in females (median, 1.6; range 0.3–4.9) than in males (1.1, 0.1–7.1 mm) (p < 0.05). Anterior translation of the lateral compartment during the pivot shift test was significantly correlated with anterior translation during the Lachman test (r = 0.34; p < 0.05). There was no significant correlation between anterior translation of the lateral compartment during the pivot shift test and knee hyperextension or modified Beighton score (n.s).

Conclusion

The data from this study show that female sex is associated with increased rotatory knee laxity measured during the pivot shift test and anterior translation during the Lachman test in collegiate athletes. In the future, these data may be helpful in diagnosing and managing ACL injuries in athletes and could be used in the clinic as a baseline by which to compare and identify patients who might exhibit increased rotatory laxity.

Level of evidence

Diagnostic level II.

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Author information

Author notes

  1. Thomas R. Pfeiffer and Ajay C. Kanakamedala have contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Trauma Surgery and Sports Medicine, Cologne Merheim Medical Center, Witten/Herdecke University, 51109, Cologne, Germany

    Thomas R. Pfeiffer

  2. Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA

    Thomas R. Pfeiffer, Ajay C. Kanakamedala, Elmar Herbst, Kanto Nagai, Conor Murphy, Jeremy M. Burnham & Volker Musahl

  3. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Elmar Herbst

  4. Department of Physical Therapy, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA

    Adam Popchak

  5. Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S Water Street, Pittsburgh, PA, 15203, USA

    Richard E. Debski

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  1. Thomas R. Pfeiffer
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Contributions

TP, AK, EH, KN, AA, and CM were involved in the acquisition of data. TP, AK, AP, and VM were involved in the interpretation and analysis of the data. AK and TP drafted the original manuscript. RD and VM conceived and designed the original project. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Volker Musahl.

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Conflict of interest

All other authors declare that they have no conflict of interest related to this study.

Funding

Funding for this project was generously provided by the Coulter Foundation at the University of Pittsburgh.

Ethical approval

Approval was obtained from the University of Pittsburgh Institutional Review Board (PRO15050261).

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Investigation performed at the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

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Pfeiffer, T.R., Kanakamedala, A.C., Herbst, E. et al. Female sex is associated with greater rotatory knee laxity in collegiate athletes. Knee Surg Sports Traumatol Arthrosc 26, 1319–1325 (2018). https://doi.org/10.1007/s00167-017-4684-6

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  • DOI: https://doi.org/10.1007/s00167-017-4684-6

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