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Cited by 21Connective tissue disorders researchLower Extremity Biomechanics and PathologiesSports injuries and prevention

The extent and risk of knee injuries in children aged 9–14 with Generalised Joint Hypermobility and knee joint hypermobility - the CHAMPS-study Denmark

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Junge, Tina, Larsen, Lisbeth Runge, Juul-Kristensen, Birgit, Wedderkopp, Niels·2015·BMC Musculoskeletal Disorders
DOI 10.1186/s12891-015-0611-5PMC PMC4465013
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Abstract

BACKGROUND: Generalised Joint Hypermobility (GJH) is suggested as an aetiological factor for knee injuries in adolescents and adults. It is presumed that GJH causes decreased joint stability, thereby increasing the risk of knee injuries during challenging situations like jumping and landing. The aim was to study the extent and risk of knee injuries in children with GJH and knee hypermobility. METHODS: In total, 999 children (9-14 years) were tested twice during spring 2012 and 2013 with Beighton's Tests (BT) for hypermobility, a 0-9 scoring system. GJH was classified with cut-point ≥5/9 on both test rounds. On basis of weekly cell phone surveys of knee pain, children requiring clinical examination were seen. Traumatic and overuse knee injuries were registered by WHO ICD-10 diagnoses. Logistic regression and Poisson regression models with robust standard errors were used to examine the association between GJH and knee injuries, taking into account clustering on school class levels. RESULTS: Totally, 36 children were classified GJH on both test rounds. Overuse knee injuries were the most frequent injury type (86 %), mainly apophysitis for both groups (61 %), other than patella-femoral pain syndrome for the control group (13 %). For traumatic knee injuries, distortions and contusions were most frequent in both groups (51 % resp. 36 %), besides traumatic lesions of knee tendons and muscles for the control group (5 %). No significant association was found between overuse knee injuries and GJH with/without knee hypermobility (OR 0.69, p = 0.407 resp. OR 0.75, p = 0.576) or traumatic knee injuries and GJH with/without knee hypermobility (OR 1.56, p = 0.495 resp. OR 2.22, p = 0.231). CONCLUSIONS: Apophysitis, distortions and contusions were the most frequent knee injuries. Despite the relatively large study, the number of children with GJH and knee injuries was low, with no significant increased risk for knee injuries for this group. This questions whether GJH is a clinically relevant risk factor for knee injuries in school children aged 9-14 years. A fluctuation in the individual child's status of GJH between test rounds was observed, suggesting that inter- and intra-tester reproducibility of BT as well as growth may be considered important confounders to future studies of children with GJH.

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  • There is high quality evidence of an increased risk of soft tissue injuries in adolescents with identified EDS or joint hypermobility.

    “There is high quality evidence of an increased risk of soft tissue injuries in adolescents with identified EDS or joint hypermobility evolving from mixed pediatric and adult studies.”

    From Pediatric joint hypermobility: a diagnostic framework and narrative review (2023) · cites this paper as [28]

    The Background and Discussion report increased knee-injury risk in some sports-specific studies of young people with joint hypermobility. But the Results found no significant association in this study of children aged 9–14. The paper does not establish high-quality evidence for increased soft-tissue injuries generally, or address injury risk in adolescents with identified EDS. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • A prospective study of children aged 9-14 years did not demonstrate an increased risk of injury.

    “While a prospective study of children aged 9–14 years did not demonstrate an increased risk of injury it appears underpowered with only 36 of the 999 children classified as hypermobile (Beighton score ≥ 5–9) [28].”

    From Pediatric joint hypermobility: a diagnostic framework and narrative review (2023) · cites this paper as [28]

    The Discussion reports no observed impact of generalised joint hypermobility on knee injuries in this prospective cohort of children aged 9–14. The Methods report 999 children tested and 36 meeting the ≥5/9 Beighton criterion on both rounds; the Discussion also notes the low number with hypermobility and knee injuries. The source studied knee injuries, not injury risk generally, so the unqualified wording is broader than its finding. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • That prospective study appears underpowered with only 36 of the 999 children classified as hypermobile (Beighton score ≥ 5-9).

    “While a prospective study of children aged 9–14 years did not demonstrate an increased risk of injury it appears underpowered with only 36 of the 999 children classified as hypermobile (Beighton score ≥ 5–9) [28].”

    From Pediatric joint hypermobility: a diagnostic framework and narrative review (2023) · cites this paper as [28]

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Research works printed but not linked: 40

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Authors
Junge, T., Larsen, L. R., Juul-Kristensen, B., & Wedderkopp, N.
Affiliations
  • University of Southern Denmark (DK)
  • University College Lillebaelt (DK)
Corresponding author
Junge, Tina
ORCID
Venue
BMC Musculoskeletal Disorders
Publisher
Springer Science and Business Media LLC
Published
2015-06-12
Volume
16
Issue
1
Pages
143-143
ISSN
1471-2474 (ISSN-L)
DOI
10.1186/s12891-015-0611-5
PMC
PMC4465013
OpenAlex
W1945066413
Cited by
21
References
52
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 5 · 2022: 1 · 2021: 1 · 2019: 4 · 2018: 1 · 2017: 2 · 2016: 2
FWCI
1.15
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Musculoskeletal Disorders (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion, cc-by-sa)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by-sa)
Funders
  • Gigtforeningen
  • Nordisk Institut for Kiropraktik og Klinisk Biomekanik
  • Nordea-fonden
  • Syddansk Universitet
  • TrygFonden
  • Egmont Fonden
  • IMK Almene Fond
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
  • Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
Keywords
generalized joint hypermobility, knee injury, children, adolescents, overuse injuries, apophysitis, traumatic knee injury, knee contusion, knee stability, patellofemoral pain, injury risk factors, Denmark
MeSH terms
Adolescent, Age Factors, Biomechanical Phenomena, Child, Denmark, Female, Humans, Joint Instability, Knee Injuries, Knee Joint, Longitudinal Studies, Male, Pain Measurement, Physical Examination, Risk Factors, Logistic Models, Odds Ratio

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