Sex Differences in Proximal Control of the Knee Joint
Open accessAbstract
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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The greater hip adduction and knee medio-lateral displacement in poor SLSs compared to good SLSs suggests that hip abductor weakness may be responsible for the sub-optimal performance.
“The fact that hip adduction and knee medio-lateral displacement was greater in poor SLSs than in good SLSs suggests that hip abductor weakness may be responsible for the sub-optimal performance. 1,23,24”
From Lower-Limb Kinematics of Single-Leg Squat Performance in Young Adults (2014) · cites this paper as [23]
Section 4.2, “Hip Contributions” (page unavailable), reports increased hip adduction alongside knee valgus in single-legged squats and discusses the potential importance of gluteus medius strength for single-leg stability. It does not compare poor with good single-leg squats or establish hip abductor weakness as the reason for poor performance; it says the strength–valgus relationship remains uncertain. (LLM, conf=0.86)
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References 167 · Cited by 127
Research works printed but not linked: 2
- [1]NCAA NCAA injury surveillance system summary [online] Available from URL: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941300/ Accessed 2010 Dec 28
- [130]Nadler SF Malanga GA De Prince M The relationship between lower extremity injury, low back pain, and hip muscle strength in male and female collegiate athletes J Sports Med 1999 10 89 97 10798789
- Authors
- Mendiguchia, J., Ford, K. R., Quatman, C. E., Alentorn-Geli, E., & Hewett, T. E.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Hewett, Timothy E.
- Venue
- Sports Medicine
- Published
- 2011-07
- Volume
- 41
- Issue
- 7
- Pages
- 541-557
- ISSN
- 0112-1642 (ISSN-L)
- PMC
- PMC4221796
- OpenAlex
- W2045732601
- Cited by
- 127
- References
- 167
- Citations by year
- 2026: 8 · 2025: 9 · 2024: 4 · 2023: 10 · 2022: 11 · 2021: 15 · 2020: 8 · 2019: 5 · 2018: 11 · 2017: 9 · 2016: 6 · 2015: 12 · 2014: 9 · 2013: 6 · 2012: 4
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01 AR05563, R01AR049735, R03AR057551, R01AR055563, R01AR056259)
- 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
- sex differences, anterior cruciate ligament injury, female athletes, knee joint control, trunk biomechanics, hip biomechanics, hip adduction, hip internal rotation, injury risk factors, injury prevention programs
- MeSH terms
- Abdomen, Anterior Cruciate Ligament Injuries, Biomechanical Phenomena, Female, Hip Joint, Humans, Knee Joint, Lumbosacral Region, Male, Musculoskeletal Physiological Phenomena, Pelvis, Risk Factors, Sex Factors
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