Risk Factors for Knee Injury in Golf: A Systematic Review

Abstract

Background Golf is commonly considered a low-impact sport that carries little risk of injury to the knee and is generally allowed following total knee arthroplasty (TKA). Kinematic and kinetic studies of the golf swing have reported results relevant to the knee, but consensus as to the loads experienced during a swing and how the biomechanics of an individual's technique may expose the knee to risk of injury is lacking. Objectives Our objective was to establish (1) the prevalence of knee injury resulting from participation in golf and (2) the risk factors for knee injury from a biomechanical perspective, based on an improved understanding of the internal loading conditions and kinematics that occur in the knee from the time of addressing the ball to the end of the follow-through.Methods A systematic literature search was conducted to determine the injury rate, kinematic patterns, loading, and muscle activity of the knee during golf. Results A knee injury prevalence of 3-18% was established among both professional and amateur players, with no clear dependence on skill level or sex; however, older players appear at greater risk of injury. Studies reporting kinematics indicate that the lead knee is exposed to a complex series of motions involving rapid extension and large magnitudes of tibial internal rotation, conditions that may pose risks to the structures of a natural knee or TKA. To date, the loads experienced by the lead knee during a golf swing have been reported inconsistently in the literature. Compressive loads ranging from 100 to 440% bodyweight have been calculated and measured using methods including inverse dynamics analysis and instrumented knee implants. Additionally, the magnitude of loading appears to be independent of the club used. Conclusions This review is the first to highlight the lack of consensus regarding knee loading during the golf swing and the associated risks of injury. Results from the literature suggest the lead knee is subject to a higher magnitude of stress and more demanding motions than the trail knee. Therefore, recommendations regarding return to golf following knee injury or surgical intervention should carefully consider the laterality of the injury.Electronic supplementary material The online version of this article

Could knee joint mechanics during the golf swing be contributing to chronic knee injuries in professional golfers?

“…Knee joint angles were calculated using an X-Y-Z Cardan sequence (flexion/extension [X], abduction/adduction [Y], internal/external rotation [Z]). External knee moments were also calculated in Visual 3D with the shank as the reference segment and were normalised to the participant's body mass (Lynn & Noffal, 2010;Baker et al, 2017). Positive joint angles around the X, Y and Z axes represented flexion, abduction and external rotation of both knees.…”

“…It is also important to consider how moments and movements of the lower limb joints could contribute to injuries (Marshall & McNair, 2013). A recent systematic review reported that 3-18% of golfing injuries occurred at the knee, however the reviewed studies gave little information on the exact nature of the injuries or which knee was affected (Baker et al, 2017). Baker et al stated that although golf is considered a 'low-impact' sport, the prevalence of knee injuries was comparable to high-impact sports such as basketball.…”

Golf Swing Biomechanics: A Systematic Review and Methodological Recommendations for Kinematics

“…Many reviews have been published on golf analysis, including seven focused on health matters: three on low-back pain [9][10][11], one on knee injuries [12], two on injuries in general [3,13], and one on the link between health and golf [2]. Another study focused on electromyographic activity (EMG) measurements during the golf swing [14], with the objective of identifying more activated muscle groups.…”

Analysis of Knee Joint Injury Caused by Physical Training of Freshmen Students Based on 3T MRI and Automatic Cartilage Segmentation Technology: A Prospective Study

“…Knee joint injuries are common in physical training, and some injuries are irreversible ( 1 ). Different forms of motion can cause different knee joint injuries due to different knee joint mechanics ( 2 , 3 ). Studies have found that the incidence of knee joint pain is significantly higher in people who regularly train on long-distance walking ( 4 ), and accumulated high-intensity walking training can directly lead to meniscus injury ( 5 ).…”