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Anterior cruciate ligament rupture secondary to a ‘heel hook’: a dangerous martial arts technique


The ‘heel hook’ is a type of knee lock used in some forms of martial arts to stress the knee and cause opponent to concede defeat. While the knee is in a flexed and valgus disposition, an internal rotation force is applied to the tibia. Reports are lacking on serious knee trauma as a result of this technique. We report the case of a 32-year-old Mixed Martial Arts exponent who sustained complete anterior cruciate ligament rupture and an medial collateral ligament injury from the use of a ‘heel hook’.

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  1. 1.

    Arriaza R, Leyes M (2005) Injury profile in competitive karate: prospective analysis of three consecutive World Karate Championships. Knee Surg Sports Traumatol Arthrosc 13:603–607

  2. 2.

    Bergfeld JA, Safran MR (1998) Knee-ligaments. In: Safran MR, McKeag DB, Van Camp SP (eds) Manual of sports medicine. Lippincott-Raven, Philadelphia

  3. 3.

    Buse GJ (2006) No holds barred sport fighting: a 10 year review of mixed martial arts competition. Br J Sports Med 40:169–172

  4. 4.

    Daniel DM, Stone ML, Dobson BE et al (1994) Fte of the ACL-injured patient. A prospective outcome study. Am J Sports Med 22:632–644

  5. 5.

    Gentry C (2001) No holds barred: evolution. Archon, Richardson

  6. 6.

    Hsu WH, Fisk JA, Yamamoto Y et al (2006) Differences in torsional joint stiffness of the knee between genders: a human cadaveric study. Am J Sports Med 34:765–770

  7. 7.

    Huang KC, Hsu WH, Wang TC (2007) Acute injury of anterior cruciate ligament during karate training. Knee 14:245–248

  8. 8.

    Koshida S, Deguchi T, Miyashita K et al (2008) The common mechanism of anterior cruciate ligament injuries in judo: a retrospective analysis. Br J Sports Med. doi:10.1136/bjsm.2008.051425

  9. 9.

    Lundberg GD (1996) Blunt force violence in America—shades of gray or red. Ultimate/extreme fighting. JAMA 275:1684–1685

  10. 10.

    Majewski M, Susanne H, Klaus S (2006) Epidemiology of athletic knee injuries: a 10-year study. Knee 13:184–188

  11. 11.

    Zetaruk MN, Violan MA, Zurakowski D et al (2005) Injuries in martial arts: a comparison of five styles. Br J Sports Med 39:29–33

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Correspondence to Joseph F. Baker.

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Baker, J.F., Devitt, B.M. & Moran, R. Anterior cruciate ligament rupture secondary to a ‘heel hook’: a dangerous martial arts technique. Knee Surg Sports Traumatol Arthrosc 18, 115 (2010). https://doi.org/10.1007/s00167-009-0877-y

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  • Anterior cruciate ligament
  • Martial arts
  • Knee lock
  • Knee
  • Ligament