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Sex Differences in Proximal Control of the Knee Joint

Sports Medicine volume 41, pages 541–557 (2011)Cite this article

Abstract

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.

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Acknowledgements

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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Affiliations

  1. Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Jurdan Mendiguchia, Kevin R. Ford, Carmen E. Quatman &  Timothy E. Hewett PhD

  2. Department of Physical Therapy, Studies, Research and Sport Medicine Center, Government of Navarra CEIMD, Pamplona, Spain

    Jurdan Mendiguchia

  3. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA

    Kevin R. Ford &  Timothy E. Hewett PhD

  4. Departments of Physiology & Cell Biology, and Orthopaedic Surgery, The Ohio State University Sports Medicine Sports Health & Performance Institute, Columbus, OH, USA

    Carmen E. Quatman &  Timothy E. Hewett PhD

  5. Department of Orthopaedic Surgery, Hospital del Mar i l’Esperança — IMAS, Barcelona, Spain

    Eduard Alentorn-Geli

  6. The School of Allied Medical Professions and The College of Medicine, Family Medicine and Biomedical Engineering, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH, 43221-3502, USA

    Timothy E. Hewett PhD

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  1. Jurdan Mendiguchia
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  2. Kevin R. Ford
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  3. Carmen E. Quatman
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  4. Eduard Alentorn-Geli
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  5. Timothy E. Hewett PhD
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Correspondence to Timothy E. Hewett PhD.

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Mendiguchia, J., Ford, K.R., Quatman, C.E. et al. Sex Differences in Proximal Control of the Knee Joint. Sports Med 41, 541–557 (2011). https://doi.org/10.2165/11589140-000000000-00000

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Keywords

  • Anterior Cruciate Ligament
  • Anterior Cruciate Ligament Injury
  • Ground Reaction Force
  • Female Athlete
  • Knee Flexion Angle