Table 1.
Characteristics of studies in causes of dynamic knee valgus (DKV).
| TRUNK | |||
| Study | Participants | Outcome parameters | Results |
| Wilson et al. 2006 | F = 22 (19.4 ± 0.7y) M = 24 (19.9 ± 2.3y) Division 1A or 1AA basketball, soccer, or volleyball players. |
Peak isometric torque: trunk flexion, lateral flexion and extension Knee valgus: FPPA (2-D) during SLS |
BOTH: SLS Greater trunk lateral flexion strength among participant with lower knee valgus angles (FPPA) |
| Stickler et al. 2015 | F = 40 (22.88 ± 0.32y) | Handheld dynamometer isometric: side lying plank test (trunk lateral flexion) Knee valgus: FPPA (2-D) during SLS |
FEMALE: SLS Greater trunk lateral flexion strength among female with lower knee valgus angles (FPPA) |
| Nakagawa et al. 2015 | F = 20 M = 10 (both: 22.3 ± 3.0y) Control group (healthy without PFP) |
Handheld dynamometer isometric: trunk extension, flexion with rotation and side bridge Knee valgus: Electromagnetic tracking system (3-D) during SLS |
BOTH: SLS Greater strength of trunk lateral flexion (side bridge test) among healthy participant with lower knee valgus angles. |
| KNEE | |||
| Study | Participants | Outcome parameters | Results |
| Wilson et al. 2006 | F = 22 (19.4 ± 0.7y) M = 24 (19.9 ± 2.3y) Division 1A or 1AA basketball, soccer, or volleyball players. |
Peak isometric torque: Knee flexion and extension Knee valgus: FPPA (2-D) during SLS |
BOTH: SLS Greater strength of knee flexor among participant with higher knee valgus angles (positive correlation) |
| Claiborne et al. 2006 | F = 15 (23.5 ± 3.7y) M = 15 (26.4 ± 5.2y) |
Isokinetic eccentric/concentric strength: knee extension and flexion Knee valgus: FPKM (Frontal plane knee motion) in 3-D during SLS |
Both: SLS Participants with greater knee strength exhibited less valgus motion |
| Wild et al. 2013 | F = 33 (10–13y, Tanner stage II) | Isokinetic eccentric/concentric strength: knee extension and flexion Knee valgus: 3-D motion analyses system during SLL |
Female: SLL Females with lower flexor (hamstring) strength displayed significantly greater knee valgus angles. |
| ACTIVATION | |||
| Palmieri-Smith et al. 2008 | F = 18 (24.0 ± 5.2y) M = 10 (23.6 ± 3.8y) recreationally active (Tegner score 5 or 6). |
EMG: Dynamic and MVIC rectus femoris, vastus lateralis, vastus medialis, medial hamstring, lateral hamstring Knee valgus: 3-D motion capture kinematic during SLL |
Female: SLL A greater muscle pre-activity of vastus lateralis and lateral hamstring was associated with greater peak knee valgus angle. A smaller peak valgus angle was associated with increased pre-activity of the vastus medialis muscle Both or males: SLL Muscle activation was not associated with the peak knee valgus angle |
| Brown et al. 2013 | F = 35 (15.1 ± 1.2y) basketball, field hockey, and soccer players |
EMG: Dynamic and MVIC vastus lateralis (VL), rectus femoris, lateral hamstring (LH) Knee valgus: 3-D motion analyses system during SLL |
Female: SLL Muscle pre-activity of vastus lateralis, rectus femoris, lateral hamstring, and VL: LH ratio was not a significant predictive. |
| HIP | |||
| Study | Participants | Outcome parameters | Results |
| Neamatallah 2020 | F = 17 (25.7 ± 4.5y) M = 17 (26.9 ± 3.8y) physically active (participating in least 3 h of exercise per week) |
Isokinetic muscle strength concentric/eccentric: hip abduction and hip extension Knee valgus: 3D motion analysis during SLS/SLL (Forward Landing - FL, Single Medial Landing -SML, Single Lateral Landing - SLL) |
FEMALE: SLS Female with greater hip abduction concentric and hip extension eccentric strength had lower knee valgus angles SLL (FL, SML, SLL) Female with greater hip abduction concentric strength (very strong negative correlation) and hip abduction eccentric strength (strong negative correlation) had lower knee valgus angles. |
| Claiborne et al. 2006 | F = 15 (23.5 ± 3.7y) M = 15 (26.4 ± 5.2y) |
Isokinetic eccentric/concentric strength: Hip (abduction/adduction, flexion/extension, and internal/external rotation Knee valgus: FPKM (Frontal plane knee motion) in 3-D during SLS |
BOTH: SLS Greater strength of concentric hip abduction among participant with lower knee valgus angles. (Weak to moderate negative correlation) |
| Suzuki 2015 | F = 23 (19.96 ± 0.77y) M = 20 (20.20 ± 1.54y) intercollegiate basketball players |
Hand-held dynamometer – hip extensor, abductor and external rotator Knee valgus 3-D analysis system during SLL (SML) |
FEMALE: SLL Greater knee valgus angle at IC among participant with lower strength of hip extension, hip abduction and external rotation. |
| Stickler et al. 2015 | F = 40 (22.88 ± 0.32y) | Handheld dynamometer isometric: hip abduction, extension, external rotation Knee valgus: FPPA (2-D) during SLS |
FEMALE: SLS Female with greater hip abduction, hip extension and external rotation strength had lower knee peak valgus angles (FPPA) |
| Wilson et al. 2006 | F = 22 (19.4 ± 0.7y) M = 24 (19.9 ± 2.3y) Division 1A or 1AA basketball, soccer, or volleyball players. |
Peak isometric torque: Hip abduction and external rotation Knee valgus: FPPA (2-D) during SLS |
BOTH: SLS Greater hip external rotation strength among participant with greater knee valgus angles (positive correlation) |
| Jacobs & Matacola 2005 | F = 10 (22.1 ± 2.3y) M = 8 (24.1 ± 2.2y) Recreationally active adults. |
Isokinetic peak eccentric torque: Hip abductor Knee valgus: 3-D analysis system during SLL |
FEMALE: SLL Female with larger eccentric peak torque had lower peak knee valgus angles MALE: SLL No significant correlations between eccentric peak torque and knee valgus |
| ACTIVATION/COACTIVATION | |||
| Mauntel et al. 2013 | MKD group (20.2 ± 1.8y) F = 10 M = 10 Control group (20.2 ± 1.5y) F = 10 M = 10 physically active, defined as participation in at least 30 min. of physical activity, 3 times per week for at least 6 months |
EMG Dynamic (descent phase of SLS) and MVIC Gluteus maximus and medius, hip adductors (hip coactivation ratios) Knee valgus: 3-D motion analysis during SLS |
BOTH: SLS Hip coactivation ratios shows smaller gluteus medius to hip adductor (GMed:Hip Add) and gluteus maximus to hip adductor (GMax:Hip Add) coactivation ratios in valgus group than in the control group |
| Neamatallah 2020 | F = 17 (25.7 ± 4.5y) M = 17 (26.9 ± 3.8y) physically active (participating in least 3 h of exercise per week) |
EMG Dynamic and MVIC Gluteus maximus and medius Knee valgus: 3D motion analysis during SLS/SLL (Forward Landing, Single Medial Landing, Single Lateral Landing) |
FEMALE: SLL (FL) Higher G Max EMG activity was associated with higher knee valgus angles among female (positive correlation). MALE: SLS: Higher G Med. EMG activity was associated with higher knee valgus angles among male (positive correlation). |
| ANKLE AND FOOT | |||
| Study | Participants | Outcome parameters | Results |
| Wyndow et al. 2016 | Both = 30 (22 ± 3y) | Ankle dorsiflexion Range: knee-to-wall lunge test Foot mobility was quantified as the difference in dorsal midfoot height or midfoot width, between non-weight bearing and bilateral weight bearing positions Knee valgus: 2-D FPPA during SLS |
BOTH: SLS higher midfoot width mobility, or lower ankle joint dorsiflexion range and midfoot height mobility, were associated with a greater knee valgus angles (FPPA) |
| Mauntel et al. 2013 | Valgus group (20.2 ± 1.8y) F = 10 M = 10 Control group (20.2 ± 1.5y) F = 10 M = 10 physically active, defined as participation in at least 30 min. of physical activity, 3 times per week for at least 6 months |
Ankle dorsiflexion range (in extended position) Supine Leg straight – goniometer measurement (in flexed) Supine Knee flexed – goniometer measurement Knee valgus: 3-D motion analysis during SLS |
BOTH: SLS Valgus group displayed significantly less passive ankle dorsiflexion with the knee extended and flexed |
| Kagaya et al. 2015 | F = 130 (16.9 ± 0.6y) high-school basketball players, basketball experience, 6.7 ± 2.0 y. |
Rear-foot eversion alignment – dynamic heel-floor test (HFT) Knee valgus: 2D video images (Knee-in distance) during SLS and SLL |
FEMALE: SLS and SLL The KID were greater in the HFT-positive (≥5˚ angle) than in the HFT-negative group (<5˚ angle) |
Abbreviations: ACL—Anterior Cruciate Ligament, PFP—patellofemoral pain, SLS—Single Leg Squat, SLL—Single Leg Landings, BOTH—both sex (female and male), FPKM—Frontal Plane Knee Motion, FPPA—Frontal Plane Projection Angle, MKD—Medial Knee Displacement, EMG—Electromyography, MVIC—Maximum Voluntary Isometric Contraction, HFT—Heel-fFlot Test, KID—Knee-In Distance.