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211 Gender-specific differences in neuromuscular activation in the knee stabilizing muscles in adults – a systematic review
  1. Martina Steiner1,
  2. Heiner Baur1,
  3. Angela Blasimann1,2
  1. 1Bern University of Applied Sciences, Department of Health Professions, Discipline of Physiotherapy, Bern, Switzerland
  2. 2University of Antwerp, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium


Background Women have a higher injury rate for anterior cruciate ligament ruptures than men. Various indicators for this gender-specific difference are controversially dis­cussed.

Objective To find out if there is a gender-specific difference in neuromuscular activation of the knee stabilizing muscles in adult female and male subjects measured with surface electromyography (EMG).

Design Systematic literature review, registered in PROSPERO (CRD42020189504).

Setting PubMed, CINAHL, Embase, Cochrane and SPORTDiscus were searched from inception until September 2020 including e-mail alerts. The quality of included studies was assessed according to the National Heart, Lung and Blood Institute study quality as­sessment tool.

Patients (or Participants) Healthy female and male subjects (≥ 18 years of age).

Interventions (or Assessment of Risk Factors) Neuromuscular activation of the knee stabilizing muscles in different task (e.g. cutting manoeuvres) comparing female and male subjects.

Main Outcome Measurements Outcome measures describing neuromuscular activation of the knee stabilizing muscles with amplitude magnitude and time domain variables.

Results A total of 2’612 articles were identified. After deduplication, 1’802 articles were screened for title and abstract. Sixty-five articles were fully read and assessed for eligibility. Finally, a total of 15 articles, all cross-sectionally designed, were included in the qualitative synthesis. The methodological quality of the studies was mostly rated ‘fair’ (40%). A significantly higher activity of the quadriceps muscle in females was found in three studies. Two studies found significantly lower neuromuscular activity in the hamstrings in females. The remaining studies found no significant difference or even con­tradicting results.

Conclusions The controversial findings do not allow for a concluding answer to the question of a gender-specific neuromuscular activation. Further investigations with higher statistical power and a more homogeneous methodological approach (tasks and data normalization) of the included studies may help to gain better insight into any gender-specific differences in neuromuscular activation that may exist.

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