title: Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study.
abstract: 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.
  
  
  OBJECTIVE
  (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.
  
  
  METHODS
  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.
authors.affiliation: Department of Rehabilitation Services, Yale-New Haven Hospital, New Haven, Connecticut 06510, USA. bohdanna.zazulak@ynhh.org
authors.forename: Bohdanna T
authors.initials: BT
authors.lastname: Zazulak
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Hewett
authors.forename: N Peter
authors.initials: NP
authors.lastname: Reeves
authors.forename: Barry
authors.initials: B
authors.lastname: Goldberg
authors.forename: Jacek
authors.initials: J
authors.lastname: Cholewicki
mesh_terms: D000009:Abdominal Muscles / Q000502:physiology*; D000328:Adult; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000453:epidemiology* / Q000517:prevention & control; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology*; D007718:Knee Injuries / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D009119:Muscle Contraction / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology*; D017847:Patellar Ligament / Q000293:injuries*; D011434:Proprioception; D016059:Range of Motion, Articular; D012307:Risk Factors; D012737:Sex Factors; D011795:Surveys and Questionnaires