Dynamic valgus alignment and functional strength in males and females during maturation

The effect of gender on force, muscle activity, and frontal plane knee alignment during maximum eccentric leg-press exercise

PURPOSE

To investigate for gender differences during eccentric leg-press exercise. Tears of the anterior cruciate ligament (ACL) are considered to be related to eccentric tasks, altered neuromuscular control (e.g., reduced co-contraction of hamstrings), and increased knee abduction (valgus alignment). Based on these observations and the fact that ACL tears are more common in women, it was hypothesized that men and women differ significantly with regard to key parameters of force, knee stabilization, and muscle activity when exposed to maximum eccentric leg extension.

METHODS

Thirteen women and thirteen men were matched for age and physical activity. They performed maximum isokinetic eccentric leg-pressing against footplates of varied stability. The latter was done because earlier studies had shown that perturbational test conditions might be relevant in respect of ACL injuries. Key parameters of force, frontal plane knee stabilization, and muscle recruitment of significant muscles crossing the knee were recorded.

RESULTS

The 'force stabilization deficit' (difference between maximum forces under normal and perturbed leg-pressing) did not differ significantly between genders. Likewise, parameters of muscle activity and frontal plane leg stabilization revealed no significant differences between men and women.

CONCLUSION

This study is novel, in that gender differences in parameters of force, muscle activity, and leg kinematic were investigated during functional conditions of eccentric leg-pressing. No gender differences were observed in the measured parameters. However, the conclusion should be viewed with caution because the findings concurred with, but also contrasted, previous research in this field.

LEVEL OF EVIDENCE

Diagnostic study, Level III.

Longitudinal sex differences during landing in knee abduction in young athletes

PURPOSE

The objective of this study was to determine whether biomechanical and neuromuscular risk factors related to abnormal movement patterns increased in females, but not males, during the adolescent growth spurt.

METHODS

A total of 315 subjects participated in two testing sessions approximately 1 yr apart. Male and female subjects were classified on the basis of their maturation status as pubertal or postpubertal. Three trials of a drop vertical jump (DVJ) were collected. Maximum knee abduction angle and external moments were calculated during the DVJ deceleration phase using a three-dimensional motion analysis system. Changes in knee abduction from the first to second year were compared among four subject groups (female pubertal, female postpubertal, male pubertal, and male postpubertal).

RESULTS

There were no sex differences in peak knee abduction angle or moment during DVJ between pubertal males and females (P > 0.05). However, pubertal females increased peak abduction angle from first to second year (P < 0.001), whereas males demonstrated no similar change (P = 0.90) in the matched developmental stages. After puberty, the peak abduction angle and moment were greater in females relative to males (angle: female -9.3° ± 5.7°, male -3.6° ± 4.6°, P < 0.001; moment: female -21.9 ± 13.5 N·m, male -13.0 ± 12.0 N·m, P = 0.017).

CONCLUSIONS

This study identified, through longitudinal analyses, that knee abduction angle was significantly increased in pubertal females during rapid adolescent growth, whereas males showed no similar change. In addition, knee abduction motion and moments were significantly greater for the subsequent year in young female athletes, after rapid adolescent growth, compared with males. The combination of longitudinal, sex, and maturational group differences indicates that early puberty seems to be a critical phase related to the divergence of increased anterior cruciate ligament injury risk factors.

Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport

BACKGROUND

Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non-anterior cruciate ligament-injured athletes.

HYPOTHESES

Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury.

STUDY DESIGN

Cohort study (prognosis); Level of evidence, 2.

METHODS

Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury.

RESULTS

Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81).

CONCLUSION

Altered neuromuscular control of the hip and knee during a dynamic landing task and postural stability deficits after ACLR are predictors of a second anterior cruciate ligament injury after an athlete is released to return to sport.