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First published on April 27, 2007, doi:10.1177/0363546507301585
This version was published on July 1, 2007
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The American Journal of Sports Medicine 35:1123-1130 (2007)
© 2007 American Orthopaedic Society for Sports Medicine

Deficits in Neuromuscular Control of the Trunk Predict Knee Injury Risk

A Prospective Biomechanical-Epidemiologic Study

Bohdanna T. Zazulak, DPT, MS, OCS{dagger},{ddagger},§,*, Timothy E. Hewett, PhD, FACSM||,¶, N. Peter Reeves, MSc§,#, Barry Goldberg, MD** and Jacek Cholewicki, PhD#,§

From {dagger} Department of Rehabilitation Services, Yale-New Haven Hospital, New Haven, Connecticut, {ddagger} Department of Physical Therapy, Quinnipiac University, New Haven, Connecticut, the § Department of Orthopaedics & Rehabilitation, Biomechanics Research Laboratory, Yale University School of Medicine, New Haven, Connecticut, the || Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children’s Hospital Research Foundation, Cincinnati, Ohio, the Departments of Pediatrics, Orthopaedic Surgery, Biomedical Engineering, and Rehabilitation Sciences, University of Cincinnati College of Medicine, Cincinnati, Ohio, the #,; #Department of Biomedical Engineering, Yale University, New Haven, Connecticut, and ** Yale University Health Services, New Haven, Connecticut

* Address correspondence to Bohdanna T. Zazulak, DPT, MS, OCS, Yale Physicians Building, 800 Howard Avenue, New Haven, CT 06510 (e-mail: bohdanna.zazulak{at}ynhh.org).

Background: Female athletes are at significantly greater risk of anterior cruciate ligament (ACL) injury than male athletes in the same high-risk sports. Decreased trunk (core) neuromuscular control may compromise dynamic knee stability.

Hypotheses: (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.

Study Design: Cohort study (prognosis); Level of evidence, 2.

Methods: In this study, 277 collegiate athletes (140 female and 137 male) were prospectively tested for trunk displacement after a sudden force release. Analysis of variance and multivariate logistic regression identified predictors of risk in athletes who sustained knee injury.

Results: 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 (P < .05). Lateral displacement was the strongest predictor of ligament injury (P = .009). 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 (P = .001). 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.

Conclusions: 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.

Key Words: anterior cruciate ligament (ACL) • trunk or core stability • gender • knee injury prevention






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