Effects of the menstrual cycle on lower-limb biomechanics, neuromuscular control, and anterior cruciate ligament injury risk: a systematic review

Background Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes. Hypothesis Prescreened female athletes with subsequent anterior cruciate ligament injury will demonstrate decreased neuromuscular control and increased valgus joint loading, predicting anterior cruciate ligament injury risk. Study Design Cohort study; Level of evidence, 2. Methods There were 205 female athletes in the high-risk sports of soccer, basketball, and volleyball prospectively measured for neuromuscular control using 3-dimensional kinematics (joint angles) and joint loads using kinetics (joint moments) during a jump-landing task. Analysis of variance as well as linear and logistic regression were used to isolate predictors of risk in athletes who subsequently ruptured the anterior cruciate ligament. Results Nine athletes had a confirmed anterior cruciate ligament rupture; these 9 had significantly different knee posture and loading compared to the 196 who did not have anterior cruciate ligament rupture. Knee abduction angle (P <. 05) at landing was 8° greater in anterior cruciate ligament-injured than in uninjured athletes. Anterior cruciate ligament-injured athletes had a 2.5 times greater knee abduction moment (P <. 001) and 20% higher ground reaction force (P <. 05), whereas stance time was 16% shorter; hence, increased motion, force, and moments occurred more quickly. Knee abduction moment predicted anterior cruciate ligament injury status with 73% specificity and 78% sensitivity; dynamic valgus measures showed a predictive r2 of 0.88. Conclusion Knee motion and knee loading during a landing task are predictors of anterior cruciate ligament injury risk in female athletes. Clinical Relevance Female athletes with increased dynamic valgus and high abduction loads are at increased risk of anterior cruciate ligament injury. The methods developed may be used to monitor neuromuscular control of the knee joint and may help develop simpler measures of neuromuscular control that can be used to direct female athletes to more effective, targeted interventions.

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Effects of the Menstrual Cycle on Anterior Cruciate Ligament Injury Risk

The American Journal of Sports Medicine ◽

10.1177/0363546506295699 ◽

2007 ◽

Vol 35 (4) ◽

pp. 659-668 ◽

Cited By ~ 114

Author(s):

Timothy E. Hewett ◽

Bohdanna T. Zazulak ◽

Gregory D. Myer

Keyword(s):

Anterior Cruciate Ligament ◽

Menstrual Cycle ◽

Anterior Cruciate Ligament Injury ◽

Injury Risk ◽

Cruciate Ligament ◽

Ligament Injury ◽

Anterior Cruciate

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The Menstrual Cycle and Anterior Cruciate Ligament Injury Risk

Sports Medicine ◽

10.2165/11538570-000000000-00000 ◽

2011 ◽

Vol 41 (2) ◽

pp. 91-101 ◽

Cited By ~ 20

Author(s):

Jason D. Vescovi

Keyword(s):

Anterior Cruciate Ligament ◽

Menstrual Cycle ◽

Anterior Cruciate Ligament Injury ◽

Injury Risk ◽

Cruciate Ligament ◽

Ligament Injury ◽

Anterior Cruciate

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Which assessments are used to analyze neuromuscular control by electromyography after an anterior cruciate ligament injury to determine readiness to return to sports? A systematic review

BMC Sports Science Medicine and Rehabilitation ◽

10.1186/s13102-021-00370-5 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Angela Blasimann ◽

Irene Koenig ◽

Isabel Baert ◽

Heiner Baur ◽

Dirk Vissers

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Injury ◽

Cruciate Ligament ◽

Neuromuscular Control ◽

Acl Injury ◽

Risk Of Bias ◽

Ligament Injury ◽

Return To Sports ◽

Anterior Cruciate

Abstract Background Adequate neuromuscular control of the knee could be one element to prevent secondary injuries after an anterior cruciate ligament (ACL) injury. To assess neuromuscular control in terms of time, amplitude and activity, electromyography (EMG) is used. However, it is unclear which assessments using EMG could be used for a safe return to sports (RTS). Therefore, we aimed to summarize EMG-related assessments for neuromuscular control of the knee in adult patients after an ACL injury to decide upon readiness for RTS. Methods This systematic review followed guidelines of Preferred Reporting of Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane recommendations. MEDLINE/PubMed, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database (PEDro), SPORTDiscus and the Web of Science were searched from inception to March 2019 and updated in November 2020. Studies identifying electromyographic assessments for neuromuscular control during dynamic tasks in adult, physically active patients with an anterior cruciate ligament injury were eligible and qualitatively synthesized. Two independent reviewers used a modified Downs and Black checklist to assess risk of bias of included studies. Results From initially 1388 hits, 38 mainly cross-sectional, case-controlled studies were included for qualitative analysis. Most studies provided EMG outcomes of thigh muscles during jumping, running or squatting. Outcomes measures described neuromuscular control of the knee in domains of time, amplitude or activity. Risk of bias was medium to high due to an unclear description of participants and prior interventions, confounding factors and incompletely reported results. Conclusions Despite a wide range of EMG outcome measures for neuromuscular control, none was used to decide upon return to sports in these patients. Additional studies are needed to define readiness towards RTS by assessing neuromuscular control in adult ACL patients with EMG. Further research should aim at finding reliable and valid, EMG-related variables to be used as diagnostic tool for neuromuscular control. Moreover, future studies should aim at more homogenous groups including adequately matched healthy subjects, evaluate gender separately and use sport-specific tasks. Registration The protocol for this systematic review was indexed beforehand in the International Prospective Register of Systematic Reviews (PROSPERO) and registered as CRD42019122188.

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