Association between lower extremity posture at contact and peak knee valgus moment during sidestepping: implications for ACL injury

BACKGROUND. Knee valgus load during sports movement is viewed as an important predictor of non-contact anterior cruciate ligament injury risk, particularly in females. Formulating movement strategies that can reduce valgus loading during these movements therefore appears pertinent to reducing anterior cruciate ligament injury rates. With this in mind, the current study examined the relationship between peak valgus moment and lower extremity postures at impact during a sidestep cutting task. METHODS. Ten male and ten female NCAA athletes had initial contact three-dimensional hip, knee and ankle angles and subsequent knee valgus moment quantified during the execution of (n=10 trials) sidesteps. Peak valgus data were normalized to mass and height and tested for the main effect of gender (ANOVA, P<0.05). Intra-subject correlations between the eight initial joint angles and the normalized valgus moment were then conducted across the ten sidestepping trials. The ensuing slopes of regression were submitted to a two-sample t-test to determine whether mean slope values were significantly different from zero and for the main effect of gender (P<0.05). FINDINGS. Females had significantly larger normalized knee valgus moments than males. A greater peak valgus moment was associated with larger initial hip flexion and internal rotation, and with larger initial knee valgus angle. Peak knee valgus moment was more sensitive to initial hip internal rotation and knee valgus position in females. INTERPRETATION. Training of neuromuscular control at the hip joint may reduce the likelihood of anterior cruciate ligament injury via a valgus loading mechanism during sidestepping, especially in females.