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Thaller, Peter Helmut; Fürmetz, Julian; Chen, Fuhuan; Degen, Nikolaus; Manz, Kirsi Marjaana and Wolf, Florian (2018): O-Beine und intensives Fußballtraining im Wachstumsalter. Systematisches Review und Metaanalyse. In: Deutsches Ärzteblatt International, Vol. 115, No. 24: pp. 401-408

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Background: In many countries around the world, football (association football, or "soccer" predominantly in North America) is the sport most commonly played by children and adolescents. It is widely thought that football players are more likely to develop genu varum (bowlegs);an association with knee arthritis also seems likely. The goals of this systematic review and meta-analysis are to provide an overview of the available evidence on genu varum after intensive soccer training in childhood and adolescence, and to discuss the possible pathogenetic mechanisms. Methods: We systematically searched the PubMed, Medline, Embase, and Cochrane Library databases for studies of the relation between leg axis development and intensive football playing during the growing years. Results: Controlled studies employing the intercondylar distance (ICD) as the target variable were evaluated in a meta-analysis, with the mean difference as a measure of effect strength. This meta-analysis included 3 studies with a total of 1344 football players and 1277 control individuals. All three studies individually showed a significant difference in the mean ICD values of the two groups. The pooled effect estimator for the mean difference was 1.50 cm (95% confidence interval [0.53;2.46]). Two further studies that could not be included in the meta-analysis had similar conclusions. Asymmetrical, varus muscle forces and predominantly varus stress on the osseous growth plates neighboring the knee joint, especially during the prepubertal growth spurt, seem to be the cause of this phenomenon. Conclusion: Intensive soccer playing during the growing years can promote the development of bowlegs (genu varum) and, in turn, increase the risk of knee arthritis. Physicians should inform young athletes and their parents of this if asked to advise about the choice of soccer as a sport for intensive training. It cannot be concluded, however, that football predisposes to bowlegs when played merely as a leisure activity.

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