Influence of gender on hip and knee mechanics during a randomly cued cutting maneuver
Introduction
Every year, more young women compete in intercollegiate sports and more women of all ages participate in recreational sports. It has been reported that female athletes who participate in jumping and cutting sports are 4–6 times more likely to sustain a serious knee injury than male athletes participating in the same sports (Griffin et al., 2000; Hewett et al., 1999; Hutchinson et al., 1995; Ireland, 1999). Arendt and Dick (1995) analyzed NCAA basketball athletic injury rates over a 5-year period and reported that women have an anterior cruciate ligament (ACL) injury rate that is 4 times greater than their male counterparts. The majority of ACL injuries are non-contact in which there is no direct blow to the lower extremity when the injury occurs.
Based on this disproportionate incidence of injury, the current literature has investigated what has been referred to as the “gender bias” in ACL injury and has focused on a variety of potential mechanisms (Ekstrand and Gillquist, 1993; Ireland et al., 2001; Rozzi et al., 1999). These mechanisms include gender differences in structure and hormones as well as neuromuscular and biomechanical differences. Although there is an abundance of research investigating isolated structural and neuromuscular differences, there is limited research that has focused on dynamic biomechanical differences between genders. It is known that non-contact ACL injury often occurs during the deceleration of a lower extremity dynamic task, and this task is frequently some form of cutting maneuver (Boden et al., 2000). However, there has been limited investigation of lower extremity mechanics during this type of task.
To date, the biomechanical literature has included a large number of in vitro knee investigations that have addressed the loading characteristics of the ACL (Markolf et al., 1981, Markolf et al., 1995). From these in vitro investigations, a loading pattern, often referred to as the “high-risk pattern,” that places the greatest load on the ACL has been identified. Markolf et al. (1995) reported that this pattern consisted of an internal rotation tibial torque and valgus moment placed on the knee flexed between 0° and 40°.
Although this high-risk pattern has been identified under in vitro conditions, there have been limited three dimensional (3D) kinematic and kinetic investigations that have attempted to address the motions and loads applied to the knee during a dynamic task such as the cutting maneuver. Recent investigation has reported that increases in hip adduction, hip internal rotation and knee abduction are present among females during tasks such as landing and running (Ferber et al., 2003, Ford et al., 2003). However, there has been little investigation of kinematic and kinetic differences at the hip and knee between genders in performing a cutting maneuver. While two investigations have revealed gender differences in knee joint kinematics during a preplanned cutting maneuver, these researchers did not investigate gender differences in hip joint kinematics or hip and knee joint moments (Malinzak et al., 2001, McLean et al., 1999). In addition, these studies were limited to a preplanned cutting maneuver in which the subjects had prior knowledge of the cutting task. In an attempt to better reflect an ecological environment, Besier et al. (2001) utilized an unanticipated cutting maneuver which resulted in knee moments up to twice the magnitude as compared to those under a preplanned condition. However, this study was limited to a male sample population.
While the in vitro literature has suggested that a high-risk pattern may put the ACL at risk of injury, it is unclear if female collegiate athletes demonstrate greater high-risk patterns at the knee during a dynamic task such as the cutting maneuver. In addition, it is unknown if females demonstrate differences in hip mechanics as compared to males during the cutting maneuver which may result in increased loading of the knee. If this were the case, it may suggest that females are predisposed to non-contact ACL injury due to these greater high-risk patterns.
Therefore, the purpose of this study was to investigate 3D kinematics and joint moments at the hip and knee of female and male collegiate soccer athletes during a randomly cued cutting maneuver. It was hypothesized that females would exhibit greater maximum hip adduction, hip internal rotation, knee abduction and knee internal rotation angles during the first 40° of knee flexion of a randomly cued cutting maneuver as compared to males. In addition, it was hypothesized that females would exhibit greater hip abduction, hip external rotation, knee adduction and knee external rotation moments during the first 40° of knee flexion of a randomly cued cutting maneuver as compared to males.
Section snippets
Subjects
Using data from the literature (Besier et al., 2001, Malinzak et al., 2001, McLean et al., 1999), sample size was estimated for a minimal statistical power of 80% (P = 0.05). All sample size and power calculations were completed using G∗ Power Software (Erdfelder et al., 1996). Given the variation of the dependent measures that were included in this study, 12 subjects per group were deemed adequate.
Subjects consisted of 12 female (height: 1.66 m (SD, 0.05 m); mass: 62.5 kg (SD, 6.9 kg)) and 12 male
Results
Table 1 presents a summary of kinematic comparisons of variables of interest for males and females across the first 40° of knee flexion of the stance phase of a randomly cued cutting maneuver. Fig. 2 presents the ensemble 3D joint angles of the knee and hip for male and female athletes across the entire stance phase of a randomly cued cutting maneuver. There were no differences in the percent of stance which 40° of knee flexion was reached between males (27.13% ± 9.6%) and females (27.40% ± 5.5%)
Discussion
The purpose of this study was to investigate 3D hip and knee joint kinematics and moments of female and male collegiate soccer athletes during a randomly cued cutting maneuver. These lower extremity mechanics were investigated to gain insight into why female athletes incur a greater number of non-contact ACL injuries as compared to their male counterparts. It is understood that these injuries predominantly occur during either a cutting maneuver or a landing task. In vitro investigations have
Conclusions
In conclusion, aside from frontal plane hip motion, male and female collegiate soccer players demonstrated similar hip and knee joint kinematics and kinetics while performing a randomly cued cutting maneuver. This suggests that the collegiate athlete’s acquired training and exposure to sport results in more similar hip and knee joint kinematic and kinetic patterns between genders. Further investigation is necessary to continue to investigate potential biomechanical mechanisms of non-contact ACL
Acknowledgments
The authors would like to thank Lynn Crevier for her assistance with data collection and Sandy Whittlesley for his technical assistance. The International Society of Biomechanics Doctoral Dissertation Grant as well as the American College of Sports Medicine funded this work.
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