Sports Medicine

, Volume 41, Issue 7, pp 541–557 | Cite as

Sex Differences in Proximal Control of the Knee Joint

  • Jurdan Mendiguchia
  • Kevin R. Ford
  • Carmen E. Quatman
  • Eduard Alentorn-Geli
  • Timothy E. Hewett
Review Article


Following the onset of maturation, female athletes have a significantly higher risk for anterior cruciate ligament (ACL) injury compared with male athletes. While multiple sex differences in lower-extremity neuromuscular control and biomechanics have been identified as potential risk factors for ACL injury in females, the majority of these studies have focused specifically on the knee joint. However, increasing evidence in the literature indicates that lumbo-pelvic (core) control may have a large effect on knee-joint control and injury risk. This review examines the published evidence on the contributions of the trunk and hip to knee-joint control. Specifically, the sex differences in potential proximal controllers of the knee as risk factors for ACL injury are identified and discussed. Sex differences in trunk and hip biomechanics have been identified in all planes of motion (sagittal, coronal and transverse). Essentially, female athletes show greater lateral trunk displacement, altered trunk and hip flexion angles, greater ranges of trunk motion, and increased hip adduction and internal rotation during sport manoeuvres, compared with their male counterparts. These differences may increase the risk of ACL injury among female athletes. Prevention programmes targeted towards trunk and hip neuromuscular control may decrease the risk for ACL injuries.


Anterior Cruciate Ligament Anterior Cruciate Ligament Injury Ground Reaction Force Female Athlete Knee Flexion Angle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors acknowledge funding support from National Institutes of Health/NIAMS Grants R01-AR049735, R01-AR05563, R01-AR056259 and R03-AR057551. The authors have no conflicts of interest that are directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2011

Authors and Affiliations

  • Jurdan Mendiguchia
    • 1
    • 2
  • Kevin R. Ford
    • 1
    • 3
  • Carmen E. Quatman
    • 1
    • 4
  • Eduard Alentorn-Geli
    • 5
  • Timothy E. Hewett
    • 1
    • 3
    • 4
    • 6
  1. 1.Sports Medicine Biodynamics Center and Human Performance LaboratoryCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of Physical TherapyStudies, Research and Sport Medicine Center, Government of Navarra CEIMDPamplonaSpain
  3. 3.Department of Pediatrics, College of MedicineUniversity of CincinnatiCincinnatiUSA
  4. 4.Departments of Physiology & Cell Biology, and Orthopaedic SurgeryThe Ohio State University Sports Medicine Sports Health & Performance InstituteColumbusUSA
  5. 5.Department of Orthopaedic SurgeryHospital del Mar i l’Esperança — IMASBarcelonaSpain
  6. 6.The School of Allied Medical Professions and The College of Medicine, Family Medicine and Biomedical EngineeringThe Ohio State UniversityColumbusUSA

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