title: Effect of gender and maturity on quadriceps-to-hamstring strength ratio and anterior cruciate ligament laxity.
abstract: BACKGROUND
  Exercise programs have been introduced to reduce the ACL injury risk in female athletes. The most effective age at which to start these programs is not known.
  
  
  OBJECTIVE
  Age and gender affect ligament laxity and quadriceps-to-hamstring strength ratio.
  
  
  METHODS
  Cross-sectional study; Level of evidence, 3.
  
  
  METHODS
  Fifty-three female and 70 male recreational soccer players, 10 to 18 years of age, were studied with physical examination, KT-1000 arthrometry, and manual maximum quadriceps and hamstring strength using a handheld dynamometer. The subjects were separated into 4 groups to examine maturity-related intergender differences: group G1, premenarchal girls (n = 24); group B1, boys 13 years and younger (n = 38); group G2, girls 2 or more years after menarche (n = 29); and group B2, boys 14 years and older (n = 32).
  
  
  RESULTS
  Both knees of 123 soccer players were evaluated. The mean ages for groups G1, B1, G2, and B2 were 11.50 +/- 1.69, 10.63 +/- 1.85, 15.5 +/- 1.43, and 15.59 +/- 1.24 years, respectively, and the mean laxity measurements were 8.84 +/- 2.12, 8.51 +/- 1.61, 8.85 +/- 1.86, and 7.33 +/- 1.27 mm, respectively. Laxity was significantly less for the mature boys (P = .0015) than for the immature boys, mature girls, and immature girls. With increasing maturity, significant increases in both quadriceps and hamstring muscle strength were observed for both boys and girls (P < .05). Boys demonstrated a greater percentage increase in hamstring strength with maturity (179%) compared with girls (27%) (P < .05). Mature girls (2.06) had significantly greater quadriceps-to-hamstring ratio when compared with immature girls (1.74), immature boys (1.58), and mature boys (1.48) (P < .05).
  
  
  CONCLUSIONS
  Female athletes after menarche increase their quadriceps strength greater than their hamstring strength, putting them at risk for anterior cruciate ligament injury. Anterior cruciate ligament-prevention programs based on improving dynamic control of the knee by emphasizing hamstring strengthening should be instituted for girls after menarche.
authors.affiliation: Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University, 622 West 168th Street, PH 11th Floor, New York, NY 10032, USA. csa4@columbia.edu
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ahmad
authors.forename: A Martin
authors.initials: AM
authors.lastname: Clark
authors.forename: Niels
authors.initials: N
authors.lastname: Heilmann
authors.forename: J Scott
authors.initials: JS
authors.lastname: Schoeb
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gardner
authors.forename: William N
authors.initials: WN
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D016118:Anterior Cruciate Ligament / Q000502:physiology*; D002648:Child; D019245:Compressive Strength; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000502:physiology*; D009519:New York City; D012737:Sex Factors; D013177:Sports; D011795:Surveys and Questionnaires; D013718:Tensile Strength; D013848:Thigh / Q000502:physiology*