Effect of gender on lower extremity kinematics during rapid direction changes: An integrated analysis of three sports movements

Abstract

Anterior cruciate ligament (ACL) injury is a common sports injury, particularly in females. Gender differences in knee kinematics have been observed for specific movements, but there is limited information on how these findings relate to other joints and other movements. Here we present an integrated analysis of hip, knee and ankle kinematics across three movements linked to non-contact ACL injury. It was hypothesised that there are gender differences in lower extremity kinematics, which are consistent across sports movements. Ten female and ten male NCAA basketball players had three-dimensional hip, knee and ankle kinematics quantified during the stance phase of sidestep, sidejump and shuttle-run tasks. For each joint angle, initial value at contact, peak value and between-trial variability was obtained and submitted to a two-way mixed design ANOVA (gender and movement), with movement condition treated as a repeated measure. Females had higher peak knee valgus and lower peak hip and knee flexion, with the same gender differences also existing at the beginning of stance (p<0.05). Peak valgus measures were highly correlated between movements, but not to static valgus alignment. Kinematic differences demonstrated by females for the sports movements studied, and in particular knee valgus, may explain their increased risk of ACL injury. These differences appear to stem largely from subject-specific neuromuscular mechanisms across movements, suggesting that prevention via neuromuscular training is possible.