Cited by 3,577Knee injuries and reconstruction techniquesLower Extremity Biomechanics and PathologiesSports injuries and prevention

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Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: A Prospective Study

Hewett, Timothy E., Myer, Gregory D., Ford, Kevin R., Heidt, Robert S., Colosimo, Angelo J., McLean, Scott G., van den Bogert, Antonie J., Paterno, Mark V., Succop, Paul·2005·The American Journal of Sports Medicine

DOI 10.1177/0363546504269591

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Abstract

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 r2 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.

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Authors: Hewett, T. E., Myer, G. D., Ford, K. R., Heidt, R. S., Colosimo, A. J., McLean, S. G., van den Bogert, A. J., Paterno, M. V., & Succop, P.
Affiliations: Cincinnati Children's Hospital Medical Center (US)
Wellington Orthopaedic and Sports Medicine Center, Cincinnati, Ohio
University of Cincinnati (US)
Cleveland Clinic (US)
Department of Biomedical Engineering and Orthopaedic Research Center, Cleveland Clinic Foundation, Cleveland, Ohio
ORCID: Hewett, Timothy E.
Myer, Gregory D.
Ford, Kevin R.
Colosimo, Angelo J.
McLean, Scott G.
Paterno, Mark V.
Venue: The American Journal of Sports Medicine
Publisher: SAGE Publications
Published: 2005-04
Volume: 33
Issue: 4
Pages: 492-501
ISSN: 0363-5465 (ISSN-L)
1552-3365
DOI: 10.1177/0363546504269591
OpenAlex: W2086656914
Cited by: 3,577
References: 41
Citations by year: 2026: 193 · 2025: 217 · 2024: 238 · 2023: 185 · 2022: 188 · 2021: 289 · 2020: 243 · 2019: 245 · 2018: 225 · 2017: 197 · 2016: 202 · 2015: 192 · 2014: 169 · 2013: 154 · 2012: 155
FWCI: 53.57
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: The American Journal of Sports Medicine (publishedVersion)
PubMed (publishedVersion)
EngagedScholarship @ Cleveland State University (Cleveland State University) (submittedVersion)
Funders: National Institutes of Health
National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR049735, R101-ARO49735-01A1)
Topics: Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
Physical Sciences › Engineering › Biomedical Engineering › Lower Extremity Biomechanics and Pathologies
Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
Keywords: anterior cruciate ligament injury, female athletes, neuromuscular control, valgus loading, knee abduction moment, knee abduction angle, jump landing, injury prediction, knee joint loading, ground reaction force, high-risk sports
MeSH terms: Anterior Cruciate Ligament Injuries, Adolescent, Basketball, Biomechanical Phenomena, Epidemiologic Methods, Female, Humans, Kinesis, Knee Injuries, Knee Joint, Rotation, Rupture, Sex Factors, Soccer, Task Performance and Analysis, Weight-Bearing

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Biomechanical Measures of Neuromuscular Control and Valgus Loading of the Knee Predict Anterior Cruciate Ligament Injury Risk in Female Athletes: A Prospective Study

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