Sex differences in sagittal plane control emerge during adolescent growth: a prospective investigation
Females athletes have a higher incidence of non-contact knee joint injuries compared to their male counterparts. This may be attributable to sex-specific differences in neuromuscular control, which arise during the pubertal growth spurt. The purpose of this longitudinal study was to assess the development of landing kinematics of adolescent male and female athletes during the adolescent growth-spurt.
One hundred and eighty-four adolescent athletes (55% male, 45% female; mean age = 13 ± 0.3 years) participated. Testing was undertaken at baseline and then repeated at 6, 12, 18 and 24 months. Participants performed three drop vertical jump (DVJ) trials from a 31 cm box. Frontal and sagittal plane knee joint angles were recorded. The average measurement of the three jumps was used for analysis at each time point. To assess maturation status, participants were categorised according to their age from peak height velocity at baseline. Pre-initial contact knee flexion (pre-IC), peak knee flexion and knee valgus displacement were the dependant variables. The categorical independent variables were sex (male versus female) and time.
There was a significant sex*time interaction for pre-IC knee flexion, with males increasing knee flexion with time to a greater extent than females. There was no significant sex*time interaction for knee valgus displacement; although females displayed greater knee valgus displacement across all time points.
Adolescent male and female athletes display differing kinematic profiles across growth and development. This has clinical relevance for emphasising increased knee flexion, as well as decreasing abnormal frontal plane displacement in injury prevention programmes for adolescent females.
Level of evidence
KeywordsPuberty Sex differences Biomechanics Youth
Sinéad Holden was funded by an Irish Research Council for Science Engineering and Technology (IRCSET) Postgraduate EMBARK scholarship to carry out this research. The authors would like to thank all the schools, PE teachers, parents and participants involved for facilitating this research.
Sinéad Holden was funded by an Irish Research Council for Science Engineering and Technology (IRCSET) Postgraduate EMBARK scholarship to carry out this research.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This project was approved by University College Dublin Health Research Ethics Committee (HREC) (LS-12-147-Holden-Delahunt). Informed parental consent and participant assent was obtained from all participants.
- 2.Brophy RH, Schmitz L, Wright RW, Dunn WR, Parker RD, Andrish JT, McCarty EC, Spindler KP (2012) Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the multicenter orthopaedic outcomes network (MOON) group. Am J Sports Med 40:2517–2522CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Dingenen B, Malfait B, Vanrenterghem J, Verschueren SM, Staes FF (2014) The reliability and validity of the measurement of lateral trunk motion in two-dimensional video analysis during unipodal functional screening tests in elite female athletes. Phys Ther Sport 15:117–123CrossRefPubMedGoogle Scholar
- 8.Gokeler A, Benjaminse A, Hewett TE, Paterno MV, Ford KR, Otten E, Myer GD (2013) Feedback techniques to target functional deficits following anterior cruciate ligament reconstruction: implications for motor control and reduction of second injury risk. Sports Med 43:1065–1074CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, Van Den Bogert AJ, Paterno MV, Succop P (2005) Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med 33:492–501CrossRefPubMedGoogle Scholar
- 23.Myer GD, Wordeman SC, Sugimoto D, Bates NA, Roewer BD, Medina McKeon JM, DiCesare CA, Di Stasi SL, Barber Foss KD, Thomas SM, Hewett TE (2014) Consistency of clinical biomechanical measures between three different institutions: implications for multi-center biomechanical and epidemiological research. Int J Sports Phys Ther 9:289–301PubMedPubMedCentralGoogle Scholar
- 27.Paterno MV, Schmitt LC, Ford KR, Rauh MJ, Myer GD, Huang B, Hewett TE (2010) Biomechanical measures during landing and postural stability predict second anterior cruciate ligament injury after anterior cruciate ligament reconstruction and return to sport. Am J Sports Med 38:1968–1978CrossRefPubMedPubMedCentralGoogle Scholar