Deficits in Neuromuscular Control of the Trunk Predict Knee Injury Risk

Bohdanna T. Zazulak, Timothy E. Hewett, N. Peter Reeves, Barry Goldberg and Jacek Cholewicki.

Female athletes are at significantly greater risk of anterior cruciate ligament (ACL) injury than male athletes in the same high-risk sports and it is possible that decreased trunk (core) neuromuscular control may compromise dynamic knee stability.  This study looked at whether: (1) Increased trunk displacement after sudden force release would be associated with increased knee injury risk; (2) coronal (lateral), not sagittal, plane displacement would be the strongest predictor of knee ligament injury; (3) logistic regression of factors related to core stability would accurately predict knee, ligament, and ACL injury risk; and (4) the predictive value of these models would differ between genders. Of 277 college students twenty-five athletes (11 female and 14 male) sustained knee injuries over a 3-year period. Trunk displacement was greater in athletes with knee, ligament, and ACL injuries than in uninjured athletes. Lateral displacement was the strongest predictor of ligament injury. A logistic regression model, consisting of trunk displacements, proprioception, and history of low back pain, predicted knee ligament injury with 91% sensitivity and 68% specificity. This model predicted knee, ligament, and ACL injury risk in female athletes with 84%, 89%, and 91% accuracy, but only history of low back pain was a significant predictor of knee ligament injury risk in male athletes.  The authors conclude that Factors related to core stability predicted risk of athletic knee, ligament, and ACL injuries with high sensitivity and moderate specificity in female, but not male, athletes.

The American Journal of Sports Medicine, 2007, 35, 1123-1130

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