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Sex differences in sagittal plane control emerge during adolescent growth: a prospective investigation

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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

II.

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References

  1. Benjaminse A, Welling W, Otten B, Gokeler A (2015) Novel methods of instruction in ACL injury prevention programs, a systematic review. Phys Ther Sport 16:176–186

    Article  PubMed  Google Scholar 

  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 40:2517–2522

    Article  PubMed  PubMed Central  Google Scholar 

  3. DeVita P, Skelly WA (1992) Effect of landing stiffness on joint kinetics and energetics in the lower extremity. Med Sci Sports Exerc 24:108–115

    PubMed  CAS  Google Scholar 

  4. Dingenen B, Malfait B, Nijs S, Peers KH, Vereecken S, Verschueren SM, Staes FF (2015) Can two-dimensional video analysis during single-leg drop vertical jumps help identify non-contact knee injury risk? A one-year prospective study. Clin Biomech 30:781–787

    Article  Google 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 15:117–123

    Article  PubMed  Google Scholar 

  6. DiStefano LJ, Martinez JC, Crowley E, Matteau E, Kerner MS, Boling MC, Nguyen AD, Trojian TH (2015) Maturation and sex differences in neuromuscular characteristics of youth athletes. J Strength Cond Res 29:2465–2473

    Article  PubMed  Google Scholar 

  7. Ford KR, Shapiro R, Myer GD, Van Den Bogert AJ, Hewett TE (2010) Longitudinal sex differences during landing in knee abduction in young athletes. Med Sci Sports Exerc 42:1923–1931

    Article  PubMed  PubMed Central  Google 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 43:1065–1074

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gokeler A, Benjaminse A, Welling W, Alferink M, Eppinga P, Otten B (2015) The effects of attentional focus on jump performance and knee joint kinematics in patients after ACL reconstruction. Phys Ther Sport 16:114–120

    Article  PubMed  Google Scholar 

  10. Hewett TE, Myer GD, Ford KR (2004) Decrease in neuromuscular control about the knee with maturation in female athletes. J Bone Joint Surg 86:1601–1608

    Article  PubMed  Google 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 33:492–501

    Article  PubMed  Google Scholar 

  12. Hewett TE, Myer GD, Kiefer AW, Ford KR (2015) Longitudinal increases in knee abduction moments in females during adolescent growth. Med Sci Sports Exerc 47:2579–2585

    Article  PubMed  PubMed Central  Google Scholar 

  13. Holden S, Boreham C, Delahunt E (2015) Sex differences in landing biomechanics and postural stability during adolescence: a systematic review with meta-analyses. Sports Med. https://doi.org/10.1007/s40279-015-0416-6 (ePub ahead of print)

    Article  Google Scholar 

  14. Holden S, Boreham C, Doherty C, Delahunt E (2016) Two-dimensional knee valgus displacement as a predictor of patellofemoral pain in adolescent females. Scand J Med Sci Sports 27:188–194

    Article  Google Scholar 

  15. Holden S, Boreham C, Doherty C, Wang D, Delahunt E (2015) Clinical assessment of countermovement jump landing kinematics in early adolescence: Sex differences and normative values. Clin Biomech 30:469–474

    Article  Google Scholar 

  16. Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, Hewett TE, Bahr R (2007) Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med 35:359–367

    Article  PubMed  Google Scholar 

  17. Leppanen M, Pasanen K, Kujala UM, Vasankari T, Kannus P, Ayramo S, Krosshaug T, Bahr R, Avela J, Perttunen J, Parkkari J (2017) Stiff landings are associated with increased ACL injury risk in young female basketball and floorball players. Am J Sports Med 45:386–393

    Article  PubMed  Google Scholar 

  18. Malina RM, Rogol AD, Cumming SP, Coelho e Silva MJ, Figueiredo AJ (2015) Biological maturation of youth athletes: assessment and implications. Br J Sports Med 49:852–859

    Article  PubMed  Google Scholar 

  19. Moore SA, McKay HA, Macdonald H, Nettlefold L, Baxter-Jones AD, Cameron N, Brasher PM (2015) Enhancing a somatic maturity prediction model. Med Sci Sports Exerc 47:1755–1764

    Article  PubMed  Google Scholar 

  20. Munro A, Herrington L, Carolan M (2012) Reliability of 2-dimensional video assessment of frontal-plane dynamic knee valgus during common athletic screening tasks. J Sport Rehabil 21:7–11

    Article  PubMed  Google Scholar 

  21. Myer GD, Ford KR, Hewett TE (2011) New method to identify athletes at high risk of ACL injury using clinic-based measurements and freeware computer analysis. Br J Sports Med 45:238–244

    Article  PubMed  Google Scholar 

  22. Myer GD, Ford KR, Khoury J, Succop P, Hewett TE (2010) Clinical correlates to laboratory measures for use in non-contact anterior cruciate ligament injury risk prediction algorithm. Clin Biomech 25:693–699

    Article  Google 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 9:289–301

    PubMed  PubMed Central  Google Scholar 

  24. Olsen OE, Myklebust G, Engebretsen L, Bahr R (2004) Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med 32:1002–1012

    Article  PubMed  Google Scholar 

  25. Padua DA, DiStefano LJ, Beutler AI, de la Motte SJ, DiStefano MJ, Marshall SW (2015) The landing error scoring system as a screening tool for an anterior cruciate ligament injury-prevention program in elite-youth soccer athletes. J Athl Train 50:589–595

    Article  PubMed  PubMed Central  Google Scholar 

  26. Paterno MV, Rauh MJ, Schmitt LC, Ford KR, Hewett TE (2012) Incidence of contralateral and ipsilateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction and return to sport. Clin J Sports Med 22:116–121

    Article  Google 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 38:1968–1978

    Article  PubMed  PubMed Central  Google Scholar 

  28. Powers CM (2003) The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther 33:639–646

    Article  PubMed  Google Scholar 

  29. Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K (2007) A Meta-analysis of the Incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy 23:1320–1325.e1326

    Article  PubMed  Google Scholar 

  30. Quatman CE, Ford KR, Myer GD, Hewett TE (2006) Maturation leads to gender differences in landing force and vertical jump performance: a longitudinal study. Am J Sports Med 34:806–813

    Article  PubMed  Google Scholar 

  31. Rumpf MC, Cronin JB, Oliver JL, Hughes MG (2013) Vertical and leg stiffness and stretch-shortening cycle changes across maturation during maximal sprint running. Hum Mov Sci 32:668–676

    Article  PubMed  Google Scholar 

  32. Schmitz RJ, Shultz SJ, Nguyen AD (2009) Dynamic valgus alignment and functional strength in males and females during maturation. J Athl Train 44:26–32

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shea KG, Pfeiffer R, Jo HW, Curtin M, Apel PJ (2004) Anterior cruciate ligament injury in pediatric and adolescent soccer players: an analysis of insurance data. J Pediatr Orthop 24:623–628

    Article  PubMed  Google Scholar 

  34. Shultz SJ, Schmitz RJ, Benjaminse A, Collins M, Ford K, Kulas AS (2015) ACL research retreat VII: an update on anterior cruciate ligament injury risk factor identification, screening, and prevention. March 19–21, 2015; Greensboro, NC. J Athl Train. 50(10):1076–1093

    Article  Google Scholar 

  35. Sigward SM, Pollard CD, Havens KL, Powers CM (2012) Influence of sex and maturation on knee mechanics during side-step cutting. Med Sci Sports Exerc 44:1497–1503

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sigward SM, Pollard CD, Powers CM (2012) The influence of sex and maturation on landing biomechanics: implications for anterior cruciate ligament injury. Scand J Med Sci Sports 22:502–509

    Article  PubMed  CAS  Google Scholar 

  37. Slater A, Campbell A, Smith A, Straker L (2015) Greater lower limb flexion in gymnastic landings is associated with reduced landing force: a repeated measures study. Sports Biomech 14:45–56

    Article  PubMed  Google Scholar 

  38. Swanik CB (2015) Brains and Sprains: the brain’s role in noncontact anterior cruciate ligament injuries. J Athl Train 50:1100–1102

    Article  PubMed  Google Scholar 

  39. Swanik CB, Covassin T, Stearne DJ, Schatz P (2007) The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. Am J Sports Med 35:943–948

    Article  PubMed  Google Scholar 

  40. Wild CY, Munro BJ, Steele JR (2016) How young girls change their landing technique throughout the adolescent growth spurt. Am J Sports Med 44:1116–1123

    Article  PubMed  Google Scholar 

  41. Yu B, McClure SB, Onate JA, Guskiewicz KM, Kirkendall DT, Garrett WE (2005) Age and gender effects on lower extremity kinematics of youth soccer players in a stop-jump task. Am J Sports Med 33:1356–1364

    Article  PubMed  Google Scholar 

  42. Zebis MK, Andersen LL, Bencke J, Kjaer M, Aagaard P (2009) Identification of athletes at future risk of anterior cruciate ligament ruptures by neuromuscular screening. Am J Sports Med 37:1967–1973

    Article  PubMed  Google Scholar 

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Acknowledgements

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.

Funding

Sinéad Holden was funded by an Irish Research Council for Science Engineering and Technology (IRCSET) Postgraduate EMBARK scholarship to carry out this research.

Author information

Authors and Affiliations

  1. A101 School of Public Health, Physiotherapy and Sports Science, Health Sciences Centre, University College Dublin, Belfield, Dublin 4, Dublin, Ireland

    Sinead Holden, Cailbhe Doherty, Colin Boreham & Eamonn Delahunt

  2. Institute for Sport and Health, University College Dublin, Dublin, Ireland

    Colin Boreham & Eamonn Delahunt

  3. Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland

    Cailbhe Doherty

Authors
  1. Sinead Holden
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  2. Cailbhe Doherty
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  4. Eamonn Delahunt
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Correspondence to Sinead Holden.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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.

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Holden, S., Doherty, C., Boreham, C. et al. Sex differences in sagittal plane control emerge during adolescent growth: a prospective investigation. Knee Surg Sports Traumatol Arthrosc 27, 419–426 (2019). https://doi.org/10.1007/s00167-018-5069-1

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  • DOI: https://doi.org/10.1007/s00167-018-5069-1

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