Trends in Australian knee injury rates : An epidemiological analysis of 228,344 knee injuries over 20 years

Journal article

Maniar, Nirav, Verhagen, Evert, Bryant, Adam Leigh and Opar, David Andrew. (2022). Trends in Australian knee injury rates : An epidemiological analysis of 228,344 knee injuries over 20 years. The Lancet Regional Health - Western Pacific. 21, p. Article 100409. https://doi.org/10.1016/j.lanwpc.2022.100409
AuthorsManiar, Nirav, Verhagen, Evert, Bryant, Adam Leigh and Opar, David Andrew
Abstract

Background
Acute knee injuries are a key predisposing risk factor for knee osteoarthritis. Public health interventions require in-depth epidemiological evidence to determine which knee injuries are problematic in critical age and sex demographics.

Methods
Descriptive epidemiological analysis of longitudinal data on knee injuries (July 1998 – June 2018) from the National Hospital Morbidity Database in Australia were studied. The main outcomes where the population-related knee injury frequency, incidence per 100,000 and annual growth rate (%) over the 20-year observation period. Age-group and sex differences were also studied to determine demographic-specific trends.

Findings
228,344 knee injuries were diagnosed over the 20-year analysis period. Significantly rising annual incidences were observed for total knee injuries, anterior cruciate ligament (ACL) injuries and knee contusions in males and females. Posterior cruciate ligament (PCL) injuries and knee dislocations were also rising in females, but not males. Greater annual growth rates were observed for females compared to males for total knee injuries, knee contusions, PCL injuries and knee dislocations. Demographic analysis revealed that the highest annual growth rate in injury incidence (10.4%) was observed for ACL injuries in females aged 5–14 years old.

Interpretation
Increasing annual incidence of knee injuries was observed over the 20-year period. Males have a higher incidence of knee injury per capita than females, but the gap appears to have narrowed over the 20-year analysis period. Younger Australians show a precipitous rise in the annual number of ACL injuries, particularly for females aged 5–14 years. These trends warrant urgent intervention.

Funding
None.

Year2022
JournalThe Lancet Regional Health - Western Pacific
Journal citation21, p. Article 100409
PublisherElsevier Ltd
ISSN2666-6065
Digital Object Identifier (DOI)https://doi.org/10.1016/j.lanwpc.2022.100409
PubMed ID35345847
Scopus EID2-s2.0-85126847314
PubMed Central IDPMC8956823
Open accessPublished as ‘gold’ (paid) open access
Page range1-11
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online22 Mar 2022
Publication process dates
Deposited02 Mar 2023
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Effect of prior injury on changes to biceps femoris architecture across an Australian football league season
Timmins, Ryan, Bourne, Matthew N., Hickey, Jack, Maniar, Nirav, Tofari, Paul, Williams, Morgan and Opar, David. (2017). Effect of prior injury on changes to biceps femoris architecture across an Australian football league season. Medicine and Science in Sports and Exercise. 49(10), pp. 2102 - 2109. https://doi.org/10.1249/MSS.0000000000001333
Criteria for progressing rehabilitation and determining return to play clearance following hamstring strain injury: A systematic review
Hickey, Jack, Timmins, Ryan G., Maniar, Nirav, Williams, Morgan and Opar, David. (2017). Criteria for progressing rehabilitation and determining return to play clearance following hamstring strain injury: A systematic review. Sports Medicine. 47(7). https://doi.org/10.1007/s40279-016-0667-x
Predictive modeling of hamstring strain injuries in elite Australian footballers
Ruddy, Joshua, Shield, Anthony J., Maniar, Nirav, Williams, Morgan D., Duhig, Steven J., Timmins, Ryan, Hickey, Jack, Bourne, Matthew N. and Opar, David. (2017). Predictive modeling of hamstring strain injuries in elite Australian footballers. Medicine and Science in Sports and Exercise. 50(5), pp. 1 - 30. https://doi.org/10.1249/MSS.0000000000001527
Running exposure is associated with the risk of hamstring strain injury in elite Australian footballers
Ruddy, Joshua D., Pollard, Christopher, Timmins, Ryan, Williams, Morgan, Shield, Anthony and Opar, David. (2017). Running exposure is associated with the risk of hamstring strain injury in elite Australian footballers. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2016-096777
Drop punt kicking induces eccentric knee flexor weakness associated with reductions in hamstring electromyographic activity
Duhig, Steven J., Williams, Morgan, Minett, Geoffrey M., Opar, David and Shield, Anthony J.. (2017). Drop punt kicking induces eccentric knee flexor weakness associated with reductions in hamstring electromyographic activity. Journal of Science and Medicine in Sport. 20(6), pp. 595 - 599. https://doi.org/10.1016/j.jsams.2016.09.006
Muscle activation patterns in the Nordic hamstring exercise: Impact of prior strain injury
Bourne, Matthew N., Opar, David, Williams, Morgan, Najjar, Aiman Al and Shield, Anthony J.. (2016). Muscle activation patterns in the Nordic hamstring exercise: Impact of prior strain injury. Scandinavian Journal of Medicine & Science in Sports. 26(6). https://doi.org/10.1111/sms.12494
Hamstring strength and flexibility after hamstring strain injury: A systematic review and meta-analysis
Maniar, Nirav, Shielf, Anthony J., Williams, Morgan D., Timmins, Ryan G. and Opar, David A.. (2016). Hamstring strength and flexibility after hamstring strain injury: A systematic review and meta-analysis. British Journal of Sports Medicine. 50(15), pp. 909-920. https://doi.org/10.1136/bjsports-2015-095311
Effect of high-speed running on hamstring strain injury risk
Duhig, Steven, Shield, Anthony, Opar, David, Gabbett, Tim, Ferguson, Cameron and Williams, Morgan. (2016). Effect of high-speed running on hamstring strain injury risk. British Journal of Sports Medicine. 50(24). https://doi.org/10.1136/bjsports-2015-095679
Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study
Timmins, Ryan G., Bourne, Matthew N., Shield, Anthony J., Williams, Morgan, Lorenzen, Christian and Opar, David. (2016). Short biceps femoris fascicles and eccentric knee flexor weakness increase the risk of hamstring injury in elite football (soccer): a prospective cohort study. British Journal of Sports Medicine. 50(24). https://doi.org/10.1136/bjsports-2015-095362
Architectural changes of the biceps femoris long head after concentric or eccentric training
Timmins, Ryan G., Ruddy, Joshua D., Presland, Joel, Maniar, Nirav and Williams, Morgan. (2016). Architectural changes of the biceps femoris long head after concentric or eccentric training. Medicine and Science in Sports and Exercise. 48(3), pp. 499-508. https://doi.org/10.1249/MSS.0000000000000795
Reliability of measures of quadriceps muscle function using magnetic stimulation
Tofari, Paul J., Opar, David, Kemp, Justin Guy, Billaut, Francois and Cormack, Stuart John. (2016). Reliability of measures of quadriceps muscle function using magnetic stimulation. Muscle & Nerve. https://doi.org/10.1002/mus.24926
Architectural adaptations of muscle to training and injury: A narrative review outlining the contributions by fascicle length, pennation angle and muscle thickness
Timmins, Ryan G., Shield, Anthony J., Williams, Morgan D., Lorenzen, Christian and Opar, David. (2016). Architectural adaptations of muscle to training and injury: A narrative review outlining the contributions by fascicle length, pennation angle and muscle thickness. British Journal of Sports Medicine. 50(23). https://doi.org/10.1136/bjsports-2015-094881
Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players
Chalker, Wade J., Shield, Anthony J., Opar, David and Keogh, Justin W. L.. (2016). Comparisons of eccentric knee flexor strength and asymmetries across elite, sub-elite and school level cricket players. PeerJ. 4, pp. 1 - 10. https://doi.org/10.7717/peerj.1594
What do submarines have in common with diabetes?
Rio, Ebony, Timmins, Ryan Gregory and Opar, David. (2016). What do submarines have in common with diabetes? British Journal of Sports Medicine. 50(16), pp. 955 - 956. https://doi.org/10.1136/bjsports-2016-096646
The juxtaposition of science and medicine in sport. Can we all play together nicely?
Opar, David and Rio, Ebony. (2015). The juxtaposition of science and medicine in sport. Can we all play together nicely? British Journal of Sports Medicine. 49(10), pp. 640 - 641. https://doi.org/10.1136/bjsports-2015-094819
Eccentric knee flexor strength and risk of hamstring injuries in Rugby Union: A prospective study
Bourne, Matthew, Opar, David, Williams, Morgan and Shield, Anthony. (2015). Eccentric knee flexor strength and risk of hamstring injuries in Rugby Union: A prospective study. American Journal of Sports Medicine. 43(11), pp. 2663 - 2670. https://doi.org/10.1177/0363546515599633
Acute injuries in track and field athletes : A 3-year observational study at the penn relays carnival with epidemiology and medical coverage implications
Opar, David, Drezner, Jonathan, Shield, Anthony, Williams, Morgan, Webner, David, Sennett, Brian, Kapur, Rahul, Cohen, Marc, Ulager, James, Cafengiu, Ana and Cronholm, Peter F. (2015). Acute injuries in track and field athletes : A 3-year observational study at the penn relays carnival with epidemiology and medical coverage implications. American Journal of Sports Medicine. 43(4), pp. 816 - 822. https://doi.org/10.1177/0363546514562553
Comparison of anthropometry, upper body strength and lower body power characteristics in different levels of Australian Football players
Bilsborough, Johann, Greenway, Kate, Opar, David, Livingstone, Steuart, Cordy, Justin, Bird, S. and Coutts, Aaron. (2015). Comparison of anthropometry, upper body strength and lower body power characteristics in different levels of Australian Football players. Journal of Strength and Conditioning Research. 29(3), pp. 826 - 834. https://doi.org/10.1519/JSC.0000000000000682
The effect of previous hamstring strain injury on the change in eccentric hamstring strength during preseason training in elite Australian footballers
Opar, David A., Williams, Morgan D., Timmins, Ryan G., Hickey, Jack, Duhig, Steven J. and Shield, Anthony J.. (2015). The effect of previous hamstring strain injury on the change in eccentric hamstring strength during preseason training in elite Australian footballers. American Journal of Sports Medicine. 43(2), pp. 377-384. https://doi.org/10.1177/0363546514556638
Biceps femoris long head architecture: A reliability and retrospective injury study
Timmins, Ryan Gregory, Shield, Anthony, Williams, Morgan, Lorenzen, Christian and Opar, David. (2015). Biceps femoris long head architecture: A reliability and retrospective injury study. Medicine and Science in Sports and Exercise. 47(5), pp. 905 - 913. https://doi.org/10.1249/MSS.0000000000000507
The effect of using different regions of interest on local and mean skin temperature
Maniar, Nirav, Bach, Aaron, Stewart, Ian and Costello, Joseph. (2015). The effect of using different regions of interest on local and mean skin temperature. Journal of Thermal Biology. 49-50, pp. 33 - 38. https://doi.org/10.1016/j.jtherbio.2015.01.008
The accuracy and precision of DXA for assessing body composition in team sport athletes
Bilsborough, Johann, Greenway, Kate, Opar, David, Livingstone, Steuart, Cordy, Justin and Coutts, Aaron. (2014). The accuracy and precision of DXA for assessing body composition in team sport athletes. Journal of Sports Sciences. 32(19), pp. 1821 - 1828. https://doi.org/10.1080/02640414.2014.926380
Is there a potential relationship between prior hamstring strain injury and increased risk for future anterior cruciate ligament injury?
Opar, David and Serpell, Benjamin. (2014). Is there a potential relationship between prior hamstring strain injury and increased risk for future anterior cruciate ligament injury? Archives of Physical Medicine and Rehabilitation. 95(2). https://doi.org/10.1016/j.apmr.2013.07.028
Reduced biceps femoris myoelectrical activity influences eccentric knee flexor weakness after repeat sprint running
Timmins, R. G., Opar, D. A., Williams, M. D., Schache, A. G., Dear, N. M. and Shield, A. J.. (2014). Reduced biceps femoris myoelectrical activity influences eccentric knee flexor weakness after repeat sprint running. Scandinavian Journal of Medicine & Science in Sports. 24(4), pp. e299-e305. https://doi.org/10.1111/sms.12171
The financial cost of hamstring strain injuries in the Australian Football League
Hickey, Jack, Shield, Anthony J., Williams, Morgan D. and Opar, David A. (2014). The financial cost of hamstring strain injuries in the Australian Football League. British Journal of Sports Medicine. 48(8), pp. 729-730. https://doi.org/10.1136/bjsports-2013-092884
Acute hamstring strain injury in track-and-field athletes: A 3-year observational study at the Penn Relay Carnival
Opar, David, Drezner, Jonathan, Shield, Anthony, Williams, Morgan, Webner, David, Sennett, Brian, Kapur, Rahul, Cohen, M., Ulager, James and Cafengiu, Ana. (2014). Acute hamstring strain injury in track-and-field athletes: A 3-year observational study at the Penn Relay Carnival. Scandinavian Journal of Medicine & Science in Sports. 24(4). https://doi.org/10.1111/sms.12159
A novel device using the Nordic hamstring exercise to assess eccentric knee flexor strength: A reliability and retrospective injury study
Opar, David, Piatowski, Timothy, Williams, Morgan and Shield, Anthony J.. (2013). A novel device using the Nordic hamstring exercise to assess eccentric knee flexor strength: A reliability and retrospective injury study. Journal of Orthopaedic and Sports Physical Therapy. 43(9), pp. 636 - 640. https://doi.org/10.2519/jospt.2013.4837
Rate of torque and electromyographic development during anticipated eccentric contraction is lower in previously strained hamstrings
Opar, David A., Williams, Morgan D., Timmins, Ryan G. and Dear, Nuala M. (2013). Rate of torque and electromyographic development during anticipated eccentric contraction is lower in previously strained hamstrings. The American Journal of Sports Medicine. 41(1), pp. 116-125. https://doi.org/10.1177/0363546512462809
The role of neuromuscular inhibition in hamstring strain injury recurrence
Fyfe, Jackson, Opar, David, Williams, Morgan and Shield, Anthony. (2013). The role of neuromuscular inhibition in hamstring strain injury recurrence. Journal of Electromyography and Kinesiology. 23(3), pp. 523-530. https://doi.org/10.1016/j.jelekin.2012.12.006
Knee flexor strength and bicep femoris electromyographical activity is lower in previously strained hamstrings
Opar, David A., Williams, Morgan D., Timmins, Ryan G., Dear, Nuala M. and Shield, Anthony J. (2013). Knee flexor strength and bicep femoris electromyographical activity is lower in previously strained hamstrings. Journal of Electromyography and Kinesiology. 23(3), pp. 696-703. https://doi.org/10.1016/j.jelekin.2012.11.004
Hamstring strain injuries : Factors that lead to injury and re-injury
Opar, David A., Williams, Morgan D. and Shield, Anthony J. (2012). Hamstring strain injuries : Factors that lead to injury and re-injury. Sports Medicine. 42(3), pp. 209-226. https://doi.org/10.2165/11594800-000000000-00000