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

Abstract

BackgroundGeneralised 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.MethodsIn 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.ResultsTotally, 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).ConclusionsApophysitis, 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.

Hypermobility in Adolescent Athletes: Pain, Functional Ability, Quality of Life, and Musculoskeletal Injuries

“…2,30,39 The current study did not find increased self-reported injury frequency in elite-level adolescent athletes with GJH, which is consistent with the results of a recent study on children. 19 However, this is in contrast to the results of a previous systematic review, in which GJH was associated with an increased risk of knee injuries in athletes from a wide age range (9-39 years old) who participated in different sports, especially contact sports. 33 Our results also contrast with those of a 5-year follow-up study, in which more adult dancers with GJH had multiple joint pain and had to take time off from dancing (greater than 6 weeks) due to injury.…”

The association between generalized joint hypermobility and active horizontal shoulder abduction in 10–15 year old competitive swimmers

“…The current study is in line with previous studies showing the prevalence of GJH increasing by age for girls and decreasing by age for boys [ 8 , 23 , 24 ]. Thus, the choice of cut off points for classification of GJH may vary from ≥4/9 to ≥6/9 within this age group [ 8 , 11 , 12 , 25 ].…”

“…This is recognised as a relatively high prevalence compared with a normal child population (mean age 13.8 years), where only 7 % of the girls were classified GJH at this cut off point [ 25 ]. It seems difficult to determine a single cut off point for children and adolescents, since joint mobility represents a variable fluctuating condition during maturation [ 24 ]. It is therefore recommended that future studies present data of GJH prevalence with different cut off points, in addition to age and gender, as presented in the current study.…”

Measurement properties of clinical assessment methods for classifying generalized joint hypermobility—A systematic review

“…The validity for BS and the association with pain showed moderate positive to conflicting evidence in five studies (all on children) [El‐Metwally et al, , , , Tobias et al, ; Sohrbeck‐Nøhr et al, ]. For the validity of BS and the association with injuries the validity showed conflicting evidence in three studies (one in children) [Roussel et al, ; Cameron et al, ; Junge et al, ]. For the validity of BS and the association with different diseases (Temporo‐Mandibular Disorders, Chronic Fatigue Syndrome, Adhesive Capsulitis) there was limited positive to conflicting evidence in three studies [Nijs et al, ; Hirsch et al, ; Terzi et al, ].…”