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From the Cincinnati Children’s Hospital Research Foundation, Sports Medicine Biodynamics Center, Division of Molecular Cardiovascular Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, the University of Cincinnati, College of Medicine, Department of Orthopaedic Surgery, Sports Medicine, Cincinnati, Ohio, the Wellington Orthopaedic and Sports Medicine Center, Cincinnati, Ohio, the || Department of Biomedical Engineering and Orthopaedic Research Center, Cleveland Clinic Foundation, Cleveland, Ohio, and the ¶ Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
* Address correspondence to Timothy E. Hewett, PhD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229 (e-mail: tim.hewett{at}chmcc.org).
Background: Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes.
Hypothesis: Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk.
Study Design: Cohort study; Level of evidence, 2.
Methods: There were 205 female athletes in the high-risk sports of soccer, basketball, and volleyball prospectively measured for neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads using kinetics (joint moments) during a jump-landing task. Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament.
Results: Nine athletes had a confirmed anterior cruciate ligament rupture; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture. Knee abduction angle (P < .05) at landing was 8° greater in anterior cruciate ligament–injured than in uninjured athletes. Anterior cruciate ligament–injured athletes had a 2.5 times greater knee abduction moment (P < .001) and 20% higher ground reaction force (P < .05), whereas stance time was 16% shorter; hence, increased motion, force, and moments occurred more quickly. Knee abduction moment predicted anterior cruciate ligament injury status with 73% specificity and 78% sensitivity; dynamic valgus measures showed a predictive r 2 of 0.88.
Conclusion: Knee motion and knee loading during a landing task are predictors of anterior cruciate ligament injury risk in female athletes.
Clinical Relevance: Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury. The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective, targeted interventions.
Key Words: neuromuscular control • dynamic valgus • knee joint load • anterior cruciate ligament (ACL) injury • injury prevention • gender differences
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