Sex differences in muscle activation patterns associated with anterior cruciate ligament injury during landing and cutting tasks: A systematic review

Reiko Otsuki, Michael J. Del Bel, Daniel L. Benoit

Research output: Contribution to journalArticlepeer-review

Abstract

Neuromuscular control is critical for maintaining dynamic joint stability and mitigating the risk of anterior cruciate ligament (ACL) injury. Given the increased risk of ACL injury in females, sex-based differential muscle activation strategies are often associated with this risk. For example, the quadriceps-dominant muscle activation strategy sometimes observed in females has been discussed as a cause of their increased risk of ACL injury. However, there has been no synthesised knowledge on sex differences in muscle activation patterns associated with ACL injuries. Therefore, the purpose of this review was to synthesise sex differences in muscle activation patterns in movements associated with ACL injuries in both adult and adolescent populations. A systematic electronic database search was conducted. Thirty studies were included in the review. Females demonstrated higher pre- and post-landing activation of the quadriceps and lower activation of the hamstrings in 15 studies. Females also had higher quadriceps-to-hamstring co-contraction ratios during pre- and post-landing phases compared to their male counterparts in 4 of 9 studies that considered co-contraction. While some studies supported the quadriceps-dominant activation strategies in females, no consensus can be drawn due to methodological inconsistencies and limitations. Also, despite the importance of ACL injury prevention in children and adolescents, the evidence on sex difference in muscle activation patterns in this population is insufficient to draw meaningful conclusions.

Original languageEnglish
Article number102583
JournalJournal of Electromyography and Kinesiology
Volume60
DOIs
Publication statusPublished - 2021 Oct
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 Elsevier Ltd

Free keywords

  • Electromyography
  • Knee injuries
  • Neuromuscular control
  • Quadriceps

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