Sport Specialization's Association with an Increased Risk of Developing Anterior Knee Pain in Adolescent Female Athletes

Overview

Journal J Sport Rehabil

Specialties Orthopedics
Rehabilitation Medicine

Date 2014 Mar 14

PMID 24622506

Citations 75

Authors

Randon Hall

Kim Barber Foss

Timothy E Hewett

Gregory D Myer

Affiliations

Soon will be listed here.

Abstract

Objectives: To determine if sport specialization increases the risk of anterior knee pain in adolescent female athletes.

Design: Retrospective cohort epidemiology study.

Methods: Female basketball, soccer, and volleyball players (N = 546) were recruited from a single county public school district in Kentucky consisting of 5 middle schools and 4 high schools. A total of 357 multisport and 189 single-sport (66 basketball, 57 soccer, and 66 volleyball) athlete subjects were included due to their diagnosis of patellofemoral pain (PFP) on physical exam. Testing consisted of a standardized history and physician-administered physical examination to determine the presence of PFP. This study compared self-reported multisport athletes with sport-specialized athletes participating in only 1 sport. The sports-participation data were normalized by sport season, with each sport accounting for 1 season of exposure. Incidence rate ratios and 95% confidence intervals (CI) were calculated and used to determine significant differences between athletes who specialized in sport in early youth and multisport athletes.

Results: Specialization in a single sport increased the relative risk of PFP incidence 1.5-fold (95% CI 1.0-2.2, P = .038) for cumulative PFP diagnoses. Specific diagnoses such as Sinding Larsen Johansson/ patellar tendinopathy (95% CI 1.5-10.1, P = .005) and Osgood Schlatter disease (95% CI 1.5-10.1, P = .005) demonstrated a 4-fold greater relative risk in single-sport compared with multisport athletes. Incidence of other specific PFP diagnoses such as fat pad, plica, trauma, pes anserine bursitis, and iliotibial-band tendonitis was not different between single-sport and multisport participants (P > .05).

Conclusion: Early sport specialization in female adolescents is associated with increased risk of anterior knee-pain disorders including PFP, Osgood Schlatter, Sinding Larsen-Johansson compared with multisport athletes.

Citing Articles

Abnormal patellar sagittal spatial kinematics in patients with patellofemoral pain: an in vivo dynamic CT study.

Yuan M, Chen Y, Li J, Yang H, Yu F, Lv F J Orthop Surg Res. 2025; 20(1):193.

PMID: 39994699 PMC: 11849214. DOI: 10.1186/s13018-025-05610-9.

Investigating the effects of previous injury on subsequent training loads, physical fitness, and injuries in youth female basketball players.

Huang Y, Wang S, Li C, Wang Y, Bai Z, Lv B Front Physiol. 2025; 16:1506611.

PMID: 39917078 PMC: 11798967. DOI: 10.3389/fphys.2025.1506611.

Management of persistent patellofemoral pain conditions using a tricompartmental offloading knee brace: a case series.

Okrainetz J, Mossel N J Can Chiropr Assoc. 2025; 68(3):214-223.

PMID: 39877546 PMC: 11771451.

Effects of Early Sport Specialization on Injury Load Management and Athletic Success of National Basketball Association Players.

Sang L, Bach K, Feeley B, Pandya N Orthop J Sports Med. 2025; 13(1):23259671241304732.

PMID: 39758145 PMC: 11700406. DOI: 10.1177/23259671241304732.

The prevention of injuries among youth basketballers according to the "Sequence of Prevention": a systematic review.

Aarts D, Barendrecht M, Kemler E, Gouttebarge V S Afr J Sports Med. 2024; 33(1):v33i1a10829.

PMID: 39498370 PMC: 11534288. DOI: 10.17159/2078-516X/2021/v33i1a10829.

References

Myer G, Faigenbaum A, Ford K, Best T, Bergeron M, Hewett T . When to initiate integrative neuromuscular training to reduce sports-related injuries and enhance health in youth?. Curr Sports Med Rep. 2011; 10(3):155-66. PMC: 3105332. DOI: 10.1249/JSR.0b013e31821b1442. View

Crossley K, Bennell K, Cowan S, Green S . Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid?. Arch Phys Med Rehabil. 2004; 85(5):815-22. DOI: 10.1016/s0003-9993(03)00613-0. View

Faigenbaum A, Loud R, Glover S, OConnell J, WESTCOTT W . Effects of different resistance training protocols on upper-body strength and endurance development in children. J Strength Cond Res. 2001; 15(4):459-65. View

DALTON S . Overuse injuries in adolescent athletes. Sports Med. 1992; 13(1):58-70. DOI: 10.2165/00007256-199213010-00006. View

Vaeyens R, Gullich A, Warr C, Philippaerts R . Talent identification and promotion programmes of Olympic athletes. J Sports Sci. 2009; 27(13):1367-80. DOI: 10.1080/02640410903110974. View

Hands B . Changes in motor skill and fitness measures among children with high and low motor competence: a five-year longitudinal study. J Sci Med Sport. 2007; 11(2):155-62. DOI: 10.1016/j.jsams.2007.02.012. View

. Intensive training and sports specialization in young athletes. American Academy of Pediatrics. Committee on Sports Medicine and Fitness. Pediatrics. 2000; 106(1 Pt 1):154-7. View

LaBella C, Huxford M, Smith T, Cartland J . Preseason neuromuscular exercise program reduces sports-related knee pain in female adolescent athletes. Clin Pediatr (Phila). 2008; 48(3):327-30. DOI: 10.1177/0009922808323903. View

Barber Foss K, Hornsby M, Edwards N, Myer G, Hewett T . Is body composition associated with an increased risk of developing anterior knee pain in adolescent female athletes?. Phys Sportsmed. 2012; 40(1):13-9. PMC: 3398745. DOI: 10.3810/psm.2012.02.1947. View

10.

McGuine T . Sports injuries in high school athletes: a review of injury-risk and injury-prevention research. Clin J Sport Med. 2006; 16(6):488-99. DOI: 10.1097/01.jsm.0000248848.62368.43. View

11.

Fransen J, Pion J, Vandendriessche J, Vandorpe B, Vaeyens R, Lenoir M . Differences in physical fitness and gross motor coordination in boys aged 6-12 years specializing in one versus sampling more than one sport. J Sports Sci. 2012; 30(4):379-86. DOI: 10.1080/02640414.2011.642808. View

12.

Irrgang J, Anderson A, Boland A, Harner C, Kurosaka M, Neyret P . Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med. 2001; 29(5):600-13. DOI: 10.1177/03635465010290051301. View

13.

Higgins L, Taylor M, Park D, Ghodadra N, Marchant M, Pietrobon R . Reliability and validity of the International Knee Documentation Committee (IKDC) Subjective Knee Form. Joint Bone Spine. 2007; 74(6):594-9. DOI: 10.1016/j.jbspin.2007.01.036. View

14.

Jayanthi N, Pinkham C, Dugas L, Patrick B, LaBella C . Sports specialization in young athletes: evidence-based recommendations. Sports Health. 2014; 5(3):251-7. PMC: 3658407. DOI: 10.1177/1941738112464626. View

15.

Myer G, Faigenbaum A, Chu D, Falkel J, Ford K, Best T . Integrative training for children and adolescents: techniques and practices for reducing sports-related injuries and enhancing athletic performance. Phys Sportsmed. 2011; 39(1):74-84. DOI: 10.3810/psm.2011.02.1854. View

16.

Kujala U, Jaakkola L, Koskinen S, Taimela S, Hurme M, Nelimarkka O . Scoring of patellofemoral disorders. Arthroscopy. 1993; 9(2):159-63. DOI: 10.1016/s0749-8063(05)80366-4. View

17.

Myer G, Ford K, Barber Foss K, Goodman A, Ceasar A, Rauh M . The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech (Bristol). 2010; 25(7):700-7. PMC: 2900391. DOI: 10.1016/j.clinbiomech.2010.04.001. View

18.

Distefano L, Padua D, Troy Blackburn J, Garrett W, Guskiewicz K, Marshall S . Integrated injury prevention program improves balance and vertical jump height in children. J Strength Cond Res. 2010; 24(2):332-42. DOI: 10.1519/JSC.0b013e3181cc2225. View

19.

Fagan V, Delahunt E . Patellofemoral pain syndrome: a review on the associated neuromuscular deficits and current treatment options. Br J Sports Med. 2008; 42(10):789-95. DOI: 10.1136/bjsm.2008.046623. View

20.

Brenner J . Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics. 2007; 119(6):1242-5. DOI: 10.1542/peds.2007-0887. View