Physiotherapists can identify female football players with high knee valgus angles during vertical drop jumps using real-time observational screening

J Orthop Sports Phys Ther. 2014 May;44(5):358-65. doi: 10.2519/jospt.2014.4969. Epub 2014 Apr 14.


Study design: Clinical measurement, controlled laboratory study.

Objectives: To assess the relationships among real-time observational screening of frontal plane knee control and knee valgus angles and abduction moments calculated from 3-D motion analysis during a vertical drop jump. A secondary purpose was to investigate interrater agreement for 3 independent physiotherapists.

Background: Current approaches to screen for anterior cruciate ligament injury risk are based on complex biomechanical analyses or 2-dimensional video reviews. There is a need for simple and efficient, low-cost screening methods.

Methods: Sixty Norwegian elite female football (soccer) players performed a vertical drop-jump task. Using real-time observational screening, 3 physiotherapists independently scored each participant's frontal plane knee control as good, reduced, or poor, based on specific criteria. Screening test scores were correlated to frontal plane knee kinematics and kinetics using 3-D motion analysis. Interrater agreement was determined using kappa correlation coefficients.

Results: Knee valgus angles differed significantly among players rated as having poor, reduced, or good knee control (10.3° ± 3.4°, 5.4° ± 4.1°, and 1.9° ± 4.3°, respectively). The correlation between the observation test scores and valgus angles was moderate for all raters (0.54-0.60, P≤.001), but the observation scores correlated poorly with abduction moments (0.09-0.11, P>.05). The highest discriminative accuracy was found for knee valgus angles across all raters (area under the receiver-operating-characteristic curve, 0.85-0.89). The interrater agreement between the physiotherapists was substantial to almost perfect, with percentage agreement and kappa coefficients ranging from 70% to 95% and 0.52 to 0.92, respectively.

Conclusion: Physiotherapists can reliably identify female athletes with high knee valgus angles in a vertical drop-jump landing using real-time observational screening.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anterior Cruciate Ligament Injuries*
  • Biomechanical Phenomena
  • Female
  • Humans
  • Knee Injuries / diagnosis
  • Knee Joint / physiopathology*
  • Observer Variation
  • Physical Therapists*
  • Risk Assessment / methods
  • Soccer / injuries*
  • Task Performance and Analysis*
  • Young Adult