Effect of Sex on Anterior Cruciate Ligament Injury-Related Biomechanics During the Cutting Maneuver in Preadolescent Athletes

Background: There are 2 movement patterns associated with an anterior cruciate ligament (ACL) injury: dynamic valgus and stiff landing. Although sex-dependent differences have been identified for adults, less is known for preadolescent athletes regarding movement patterns known to load the ACL. Hypothesis: We hypothesized that girls would demonstrate greater vertical ground reaction forces and knee valgus angles. We further hypothesized that the exercise intervention would affect girls more than boys and that this would primarily be demonstrated in less sagittal plane excursions, increased vertical ground reaction forces and knee valgus moments for girls than for boys. Study Design: Controlled laboratory study. Methods: Male and female soccer and handball players (n = 288; age range, 9-12 years) were recruited. A motion capture system synchronized to a force platform was used to record 5 trials of a cutting maneuver before and after a 5-minute fatigue intervention. Linear mixed models were constructed, and analysis of variance was used to analyze differences in outcomes associated with the sex of the athletes. Results: Boys showed greater peak knee valgus moment (0.26 vs 0.22 N.m/kg, respectively; P = .048), peak knee internal rotation moment (-0.13 vs -0.10 N.m/kg, respectively; P = .021), knee rotation excursion (-7.9 degrees vs -6.9 degrees, respectively; P = .014), and knee extension excursion (2.7 degrees vs 1.4 degrees, respectively; P < .001) compared with that in girls. A significant sex x fatigue intervention interaction (F = 7.6; P = .006) was found, which was caused by a greater increase in first peak vertical ground-reaction force (vGRF) from before to after the fatigue intervention for girls (15.3 to 16.0 N/kg) compared with boys (16.4 to 16.5 N/kg). Conclusion: Differences detected for biomechanical factors during the cutting maneuver do not point to a greater ACL injury risk for prepubescent or early pubescent girls than for boys. Nonetheless, girls go on to develop more detrimental movement patterns in adolescence than those in boys in terms of biomechanical risk factors. Clinical Relevance: Early adolescence is a good target age to learn and develop muscular control; balance, strength; flexibility; and jumping, running, and landing control. This time of physical and athletic growth may therefore be an appropriate period to influence biomechanical factors and thereby task execution and the injury risk.