Fernquest Scott, Lloyd Thomas, Pereira Claudio, Gimpel Mo, Birchall Richard, Broomfield John, Glyn-Jones Sion, Palmer Antony
Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Southampton Football Club, Southampton, UK.
J Orthop Res. 2023 May;41(5):973-983. doi: 10.1002/jor.25442. Epub 2022 Oct 5.
The aim of this study was to explore the association between developing coronal-plane leg alignment and activity levels during adolescence. We performed a cross-sectional cohort study with individuals from soccer club academies and an age-matched control population. Outcome measures were the hip knee angle (HKA), medial proximal tibial physeal angle (MPTPhyA), lateral distal femoral physeal angle (LDFPhyA) on full leg length magnetic reasonance imagine scans, and the physical activity questionnaire (PAQ) score. The cohort comprised 57 elite male soccer players, 34 male and 34 female controls aged 11-21 years. Mean HKA became more varus with age, with little change after 16 years or skeletal maturity. Skeletally mature elite male soccer players were significantly more varus than male controls with a HKA 2.28° less than male controls (p < 0.001). Skeletally mature male controls had a HKA 1.34° less than female controls (p < 0.001). A negative correlation existed between HKA and PAQ score (coefficient -0.24, p = 0.029). A positive correlation existed between HKA and MPTPhyA (coefficient 0.32, p = 0.008). In conclusion, high activity levels during adolescence are associated with the development of varus leg alignment. Mean HKA becomes more varus with age until skeletal maturity. The development of varus alignment may represent a physiological adaptation to load at the proximal tibial physis. Clinical Significance: A time period may exist for intervention before the development of varus leg alignment in young athletes, such as training load modification or proximal tibial morphology monitoring.
本研究的目的是探讨青少年时期冠状面下肢力线发育与活动水平之间的关联。我们对足球俱乐部青训营的个体以及年龄匹配的对照人群进行了一项横断面队列研究。结果测量指标为全腿长度磁共振成像扫描上的髋膝角（HKA）、胫骨近端内侧骨骺角（MPTPhyA）、股骨远端外侧骨骺角（LDFPhyA）以及体力活动问卷（PAQ）得分。该队列包括57名精英男性足球运动员、34名年龄在11至21岁之间的男性对照者和34名女性对照者。平均HKA随年龄增长而内翻增加，16岁或骨骼成熟后变化不大。骨骼成熟的精英男性足球运动员的内翻程度明显高于男性对照者，其HKA比男性对照者小2.28°（p < 0.001）。骨骼成熟的男性对照者的HKA比女性对照者小1.34°（p < 0.001）。HKA与PAQ得分之间存在负相关（系数 -0.24，p = 0.029）。HKA与MPTPhyA之间存在正相关（系数0.32，p = 0.008）。总之，青少年时期的高活动水平与内翻下肢力线的发育有关。平均HKA随年龄增长而内翻增加，直至骨骼成熟。内翻力线的发展可能代表了胫骨近端骨骺对负荷的一种生理适应。临床意义：在年轻运动员出现内翻下肢力线之前，可能存在一个干预时期，例如调整训练负荷或监测胫骨近端形态。
