Epidemiology of gradual-onset knee injuries in team ball-sports: A systematic review with meta-analysis of prevalence, incidence, and burden by sex, sport, age, and participation level

Lionel Chia; Danilo De Oliveira Silva; Matthew Whalan; Marnee J McKay; Justin Sullivan; Colin W Fuller; Evangelos Pappas

doi:10.1016/j.jsams.2022.08.016

Epidemiology of gradual-onset knee injuries in team ball-sports: A systematic review with meta-analysis of prevalence, incidence, and burden by sex, sport, age, and participation level

J Sci Med Sport. 2022 Oct;25(10):834-844. doi: 10.1016/j.jsams.2022.08.016. Epub 2022 Aug 31.

Authors

Lionel Chia¹, Danilo De Oliveira Silva², Matthew Whalan³, Marnee J McKay⁴, Justin Sullivan⁵, Colin W Fuller⁶, Evangelos Pappas⁷

Affiliations

¹ Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Australia; Cleveland Guardians Baseball Co., USA. Electronic address: lclionelchia@gmail.com.
² La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Australia. Electronic address: https://twitter.com/DrDanilo_Silva.
³ Research and Development Department, Football Australia, Australia; Figtree Physiotherapy, Australia; Centre of Medical and Exercise Physiology, School of Medical, Indigenous & Health Sciences, University of Wollongong, Australia. Electronic address: https://twitter.com/FigtreePhysio.
⁴ Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Australia. Electronic address: https://twitter.com/marneemac.
⁵ Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Australia.
⁶ Colin Fuller Consultancy Ltd, United Kingdom.
⁷ Faculty of Medicine and Health, Sydney School of Health Sciences, Discipline of Physiotherapy, The University of Sydney, Australia; School of Medicine and Illawarra Health and Medical Research Institute, The University of Wollongong, Australia. Electronic address: https://twitter.com/evpappas.

PMID: 36109306
DOI: 10.1016/j.jsams.2022.08.016

Abstract

Objectives: To systematically evaluate the literature and estimate the prevalence, incidence, and burden of gradual-onset knee injuries in team ball-sports.

Design: Systematic review with meta-analysis.

Methods: Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, SPORTDiscus, SCOPUS) were searched from inception to June 2021. Cohort studies of team ball-sports reporting the number of gradual-onset knee injuries were included. Study quality was assessed using a modified Newcastle-Ottawa scale. Studies were pooled using a Freeman-Tukey Double arcsine transformation (prevalence) and a Poisson random effects regression model (incidence, burden).

Results: Forty-nine studies that captured gradual-onset knee injuries (unclassified, patellofemoral pain, tendinopathies, and iliotibial band friction syndrome) across 15 team ball-sports were included. For unclassified gradual-onset knee injuries, prevalence was 4 % (95 % Confidence Interval (CI) 2 % to 7 %, I² = 96 %), incidence was 0.32 per 1000 player-hours (95 % CI 0.25 to 0.43, I² = 88 %), and burden was 3.24 days lost per 1000 player-hours (95 % CI 1.95 to 5.37, I² = 99 %). For patellofemoral pain, prevalence was 6 % (95 % CI 1 % to 13 %, I² = 93 %), and incidence was 0.07 per 1000 player-hours (95 % CI 0.04 to 0.12, I² = 67 %). For tendinopathies, prevalence was 1 % (95 % CI 0 % to 2 %, I² = 68 %), incidence was 0.07 per 1000 player-hours (95 % CI 0.04 to 0.11, I² = 76 %), and burden was 2.14 days lost per 1000 player-hours (95 % CI 1.23 to 3.71, I² = 92 %).

Conclusions: Estimates of prevalence, incidence and burden generated from this systematic review quantify the extent of gradual-onset knee injuries in team ball-sports. Further research is required to assess whether age, sport, and participation level are predictors of gradual-onset knee injuries.

Keywords: Anterior knee pain; Overuse; Patellofemoral; Repetitive; Risk; Tendinopathy.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Athletic Injuries* / epidemiology
Humans
Incidence
Knee Injuries* / epidemiology
Patellofemoral Pain Syndrome* / epidemiology
Prevalence
Tendinopathy* / epidemiology