IDENTIFYING FEMALE ATHLETES AT HIGH RISK FOR ACL INJURY

Summary

Principal Investigator: Timothy Hewett
Affiliation: Cincinnati Children's Hospital Medical Center
Country: USA
Abstract: It is now widely recognized that gender-based differences can play a major role in the predisposition to disease and injury, yet this remains an understudied phenomenon. Adolescent females who participate in jumping and pivoting sports suffer anterior cruciate ligament (ACL) injury at a 4 to 6-fold greater rate than adolescent males participating in the same sports. The reason(s) for this ACL injury disparity remain(s) obscure. Prior to puberty, male and female injury risk appears equal. Our long-term objectives are to determine how female athletes become more susceptible to non-contact ACL injury, prospectively identify those female athletes who are more susceptible to injury and to determine the underlying mechanistic cause(s) of increased risk at the biomechanical and biochemical levels and to optimize the effectiveness of treatments designed to prevent ACL injuries. Towards these goals, we propose to test the central hypothesis that the increases in lower extremity bone length and body mass that occur during puberty, without the neuromuscular performance spurt that most males demonstrate, will increase dynamic valgus, knee joint loading and injury risk in a subset of female athletes. It will also test the hypothesis that measures relating to dynamic valgus will prove predictive of ACL injury risk in high-risk female athletes. Specific Aim 1 will determine if following the onset of pubertal growth, increases in tibia and femur length and body mass, in the absence of increases in strength and recruitment of the musculature at the hip and knee that controls knee position and load, will lead to decreased neuromuscular control as measured by increased dynamic valgus in a subset of maturing female athletes. Specific Aim 2 will determine if objective biomechanical measures can predict relative ACL injury risk in female athletes. We hypothesize that a model that incorporates measures of dynamic valgus and variables that contribute to neuromuscular control of valgus (hip adduction moment) and increased knee joint load (knee abduction moment) will prove both sensitive and specific predictors of ACL injury risk in female athletes. These data should provide a foundation for approaching both the mechanistic questions underlying risk disparity, as well as increase our ability to direct high-risk athletes to effective, targeted interventions, which are proposed. Prevention of female rates from 5 times to equal males' would allow >30,000 females annually to continue the benefits of sports participation and to avoid the long-term complications of osteoarthritis, which may occur with a 10-fold greater incidence in the ACL-injured population.
Funding Period: 2004-09-21 - 2009-08-31
more information: NIH RePORT

Top Publications

  1. ncbi Longitudinal assessment of noncontact anterior cruciate ligament injury risk factors during maturation in a female athlete: a case report
    Gregory D Myer
    Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    J Athl Train 44:101-9. 2009
  2. ncbi The relationship of hamstrings and quadriceps strength to anterior cruciate ligament injury in female athletes
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    Clin J Sport Med 19:3-8. 2009
  3. ncbi The healing potential of stable juvenile osteochondritis dissecans knee lesions
    Eric J Wall
    Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    J Bone Joint Surg Am 90:2655-64. 2008
  4. ncbi Trunk and hip control neuromuscular training for the prevention of knee joint injury
    Gregory D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory Cincinnati Children s Hospital Medical Center, Cincinnati Children s Hospital, 3333 Burnet Avenue MLC 10001, Cincinnati, OH 45229, USA
    Clin Sports Med 27:425-48, ix. 2008
  5. ncbi Neuromuscular training techniques to target deficits before return to sport after anterior cruciate ligament reconstruction
    Gregory D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Research Foundation, Cincinnati, Ohio, USA
    J Strength Cond Res 22:987-1014. 2008
  6. ncbi The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    Am J Sports Med 36:1073-80. 2008
  7. ncbi A pilot study to determine the effect of trunk and hip focused neuromuscular training on hip and knee isokinetic strength
    G D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    Br J Sports Med 42:614-9. 2008
  8. ncbi A prospective functional outcome and motion analysis evaluation of the hip abductors after femur fracture and antegrade nailing
    Michael Archdeacon
    Department of Orthopaedic Surgery, University of Cincinnati Medical Center, and The Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio, USA
    J Orthop Trauma 22:3-9. 2008
  9. ncbi Reliability of landing 3D motion analysis: implications for longitudinal analyses
    Kevin R Ford
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    Med Sci Sports Exerc 39:2021-8. 2007
  10. ncbi Hamstrings to quadriceps peak torque ratios diverge between sexes with increasing isokinetic angular velocity
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center, United States
    J Sci Med Sport 11:452-9. 2008

Detail Information

Publications57

  1. ncbi Longitudinal assessment of noncontact anterior cruciate ligament injury risk factors during maturation in a female athlete: a case report
    Gregory D Myer
    Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    J Athl Train 44:101-9. 2009
    ..To present a unique case of a young pubertal female athlete who was prospectively monitored for previously identified anterior cruciate ligament (ACL) injury risk factors for 3 years before sustaining an ACL injury...
  2. ncbi The relationship of hamstrings and quadriceps strength to anterior cruciate ligament injury in female athletes
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    Clin J Sport Med 19:3-8. 2009
    ..The primary hypothesis was that there would be decreased knee flexor and increased knee extensor strength in female athletes who went on to ACL injured status (FACL) compared to uninjured female (FC) and male (MC) control subjects...
  3. ncbi The healing potential of stable juvenile osteochondritis dissecans knee lesions
    Eric J Wall
    Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    J Bone Joint Surg Am 90:2655-64. 2008
    ....
  4. ncbi Trunk and hip control neuromuscular training for the prevention of knee joint injury
    Gregory D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory Cincinnati Children s Hospital Medical Center, Cincinnati Children s Hospital, 3333 Burnet Avenue MLC 10001, Cincinnati, OH 45229, USA
    Clin Sports Med 27:425-48, ix. 2008
    ..Finally, a clinical application section will outline novel neuromuscular training techniques designed to target deficits that underlie the proposed mechanism of increased risk of knee injury in female athletes...
  5. ncbi Neuromuscular training techniques to target deficits before return to sport after anterior cruciate ligament reconstruction
    Gregory D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Research Foundation, Cincinnati, Ohio, USA
    J Strength Cond Res 22:987-1014. 2008
    ..This algorithmic approach may improve the potential for athletes to return to sport after ACL reconstruction at the optimal performance level and with minimized risk of reinjury...
  6. ncbi The effects of generalized joint laxity on risk of anterior cruciate ligament injury in young female athletes
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    Am J Sports Med 36:1073-80. 2008
    ..Women who participate in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than men...
  7. ncbi A pilot study to determine the effect of trunk and hip focused neuromuscular training on hip and knee isokinetic strength
    G D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    Br J Sports Med 42:614-9. 2008
    ..The objective was to determine the effect of trunk focused neuromuscular training (TNMT) on hip and knee strength. The hypothesis was that TNMT would increase standing isokinetic hip abduction, but not knee flexion/extension, strength...
  8. ncbi A prospective functional outcome and motion analysis evaluation of the hip abductors after femur fracture and antegrade nailing
    Michael Archdeacon
    Department of Orthopaedic Surgery, University of Cincinnati Medical Center, and The Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio, USA
    J Orthop Trauma 22:3-9. 2008
    ....
  9. ncbi Reliability of landing 3D motion analysis: implications for longitudinal analyses
    Kevin R Ford
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    Med Sci Sports Exerc 39:2021-8. 2007
    ..The purpose was to determine the reliability of three-dimensional (3D) lower-extremity kinematic and kinetic variables during landing in young athletes measured within a session and between two sessions 7 wk apart...
  10. ncbi Hamstrings to quadriceps peak torque ratios diverge between sexes with increasing isokinetic angular velocity
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center, United States
    J Sci Med Sport 11:452-9. 2008
    ..Females, unlike males, do not increase hamstrings to quadriceps torque ratios at velocities that approach those of functional activities...
  11. ncbi Predictors of sprint start speed: the effects of resistive ground-based vs. inclined treadmill training
    Gregory D Myer
    Cincinnati Children s Hospital, Medical Center Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio 45229, USA
    J Strength Cond Res 21:831-6. 2007
    ..The results of this study indicate that both incline treadmill and resistive ground-based training are effective at improving sprint start speed, although they potentially do so through differing mechanisms...
  12. ncbi Limb asymmetries in landing and jumping 2 years following anterior cruciate ligament reconstruction
    Mark V Paterno
    Cincinnati Children s Hospital Medical Center, Ohio 45229, USA
    Clin J Sport Med 17:258-62. 2007
    ..We hypothesized that females following ACLR would demonstrate side-to-side differences in landing and jumping kinetics after their return to sport (2+ years) that would not be observed in a group of healthy female controls...
  13. ncbi Video analysis of anterior cruciate ligament injury: abnormalities in hip and ankle kinematics
    Barry P Boden
    The Orthopaedic Center, 9711 Medical Center Drive, 201, Rockville, MD 20850, USA
    Am J Sports Med 37:252-9. 2009
    ..There is a paucity of information on the position of the hip and ankle during noncontact anterior cruciate ligament injury...
  14. ncbi The anterior cruciate ligament injury controversy: is "valgus collapse" a sex-specific mechanism?
    C E Quatman
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA
    Br J Sports Med 43:328-35. 2009
    ....
  15. ncbi Resistance training among young athletes: safety, efficacy and injury prevention effects
    A D Faigenbaum
    Department of Health and Exercise Science, The College of New Jersey, 2000 Pennington Road, Ewing, NJ 08628, USA
    Br J Sports Med 44:56-63. 2010
    ..Strategies for enhancing the safety of youth resistance training are discussed...
  16. ncbi Methodological report: dynamic field tests used in an NFL combine setting to identify lower-extremity functional asymmetries
    Kathryn C Hickey
    Cincinnati Children s Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA
    J Strength Cond Res 23:2500-6. 2009
    ..The MAT also provides good reliability between testing days. Both the VHP and the MAT may be useful for clinicians to identify the presence of lower-limb asymmetry and potential injury risk factors in athletic populations...
  17. ncbi Prediction and prevention of musculoskeletal injury: a paradigm shift in methodology
    C E Quatman
    The Sports Medicine Biodynamics Center and Human Performance Laboratory, 3333 Burnet Avenue, Cincinnati, OH 45206, USA
    Br J Sports Med 43:1100-7. 2009
    ....
  18. ncbi Sex differences in "weightlifting" injuries presenting to United States emergency rooms
    Carmen E Quatman
    Cincinnati Children s Hospital Medical Center, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA
    J Strength Cond Res 23:2061-7. 2009
    ..Conversely, women may be more susceptible to lower-extremity injuries resulting from accidents during resistance training...
  19. ncbi Youth versus adult "weightlifting" injuries presenting to United States emergency rooms: accidental versus nonaccidental injury mechanisms
    Gregory D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Medical Center, Cincinnati, Ohio 45229, USA
    J Strength Cond Res 23:2054-60. 2009
    ..The majority of youth resistance training injuries are the result of accidents that are potentially preventable with increased supervision and stricter safety guidelines...
  20. ncbi Relationship between hip and knee kinematics in athletic women during cutting maneuvers: a possible link to noncontact anterior cruciate ligament injury and prevention
    Lauren E Imwalle
    Cincinnati Children s Hospital Research Foundation Sports Medicine Biodynamics Center, Cincinnati, Ohio, USA
    J Strength Cond Res 23:2223-30. 2009
    ..Therefore, these women may decrease dangerous knee loads that result from increased hip adduction during dynamic tasks, thus decreasing anterior cruciate ligament injury risk...
  21. ncbi Longitudinal evaluation of Journal of Athletic Training author credentials: implications for future research engagement in athletic training
    Gregory D Myer
    Cincinnati Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    J Athl Train 44:427-33. 2009
    ....
  22. ncbi Generalized joint laxity associated with increased medial foot loading in female athletes
    Kim D Barber Foss
    Sports Medicine Biodynamics Center, Cincinnati Children s Hospital, Cincinnati, OH 45229, USA
    J Athl Train 44:356-62. 2009
    ..The relationship between generalized joint laxity and plantar pressure distribution of the foot and the potential implications for lower extremity injury have not been studied...
  23. ncbi Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 2: a review of prevention programs aimed to modify risk factors and to reduce injury rates
    Eduard Alentorn-Geli
    Artroscopia GC, Dr Ramón Cugat s Office, Hospital Quiron, Plaza Alfonso Comín 5 7, 08023 Barcelona, Spain
    Knee Surg Sports Traumatol Arthrosc 17:859-79. 2009
    ..Future research is also needed for male soccer athletes to help determine the most effective intervention to reduce the non-contact ACL injury risk factors and to prevent non-contact ACL injuries...
  24. ncbi Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors
    Eduard Alentorn-Geli
    Artroscopia G C, Hospital Quiron, Barcelona, Spain
    Knee Surg Sports Traumatol Arthrosc 17:705-29. 2009
    ..Current evidence indicates that this crucial step to prevent ACL injury is the only option to effectively prevent the sequelae of osteoarthritis associated with this traumatic injury...
  25. ncbi Video analysis of trunk and knee motion during non-contact anterior cruciate ligament injury in female athletes: lateral trunk and knee abduction motion are combined components of the injury mechanism
    T E Hewett
    Cincinnati Children s Hospital, OH, USA
    Br J Sports Med 43:417-22. 2009
    ..The combined positioning of the trunk and knee in the coronal and sagittal planes during non-contact anterior cruciate ligament (ACL) injury has not been previously reported...
  26. ncbi The effects of gender and pubertal status on generalized joint laxity in young athletes
    Carmen E Quatman
    Cincinnati Children s Hospital, Cincinnati, OH 45229, USA
    J Sci Med Sport 11:257-63. 2008
    ..Structural and physiological changes that occur during puberty such as alterations in passive joint restraints, may affect the type, severity and incidence of injuries in the maturing adolescent population...
  27. ncbi Differential neuromuscular training effects on ACL injury risk factors in"high-risk" versus "low-risk" athletes
    Gregory D Myer
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Medical Center, Cincinnati, USA
    BMC Musculoskelet Disord 8:39. 2007
    ..quot; The hypothesis was that high-risk athletes would decrease knee abduction moments while low-risk and control athletes would not show measurable changes...
  28. ncbi Deficits in neuromuscular control of the trunk predict knee injury risk: a prospective biomechanical-epidemiologic study
    Bohdanna T Zazulak
    Department of Rehabilitation Services, Yale New Haven Hospital, New Haven, Connecticut 06510, USA
    Am J Sports Med 35:1123-30. 2007
    ..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...
  29. ncbi Maturation leads to gender differences in landing force and vertical jump performance: a longitudinal study
    Carmen E Quatman
    Cincinnati Children's Hospital Research Foundation Sports Medicine Biodynamics Center, Cincinnati, OH 45229, USA
    Am J Sports Med 34:806-13. 2006
    ..The absence of similar adaptations in female athletes may be related to the increased risk of anterior cruciate ligament injury...
  30. ncbi Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention
    Timothy E Hewett
    Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    Am J Sports Med 34:490-8. 2006
    ....
  31. ncbi The effects of plyometric versus dynamic stabilization and balance training on lower extremity biomechanics
    Gregory D Myer
    Cincinnati Children s Hospital, 3333 Burnet Avenue, MLC 10001, Cincinnati, OH 45229, USA
    Am J Sports Med 34:445-55. 2006
    ..The biomechanical effects of plyometric and balance training utilized separately are unknown...
  32. ncbi A comparison of dynamic coronal plane excursion between matched male and female athletes when performing single leg landings
    Kevin R Ford
    Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati Children s Hospital Research Foundation, OH 45229, USA
    Clin Biomech (Bristol, Avon) 21:33-40. 2006
    ..The purpose of the current study was to identify gender and task differences in measures that may increase the risk of anterior cruciate ligament injury in female basketball and soccer athletes...
  33. ncbi Gender comparison of hip muscle activity during single-leg landing
    Bohdanna T Zazulak
    Yale New Haven Hospital, Department of Rehabilitation Services, New Haven, CT, USA
    J Orthop Sports Phys Ther 35:292-9. 2005
    ..Controlled laboratory study...
  34. ncbi Evaluation of a two dimensional analysis method as a screening and evaluation tool for anterior cruciate ligament injury
    S G McLean
    Department of Biomedical Engineering, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
    Br J Sports Med 39:355-62. 2005
    ..Increased knee valgus predicts the risk of anterior cruciate ligament (ACL) injury, particularly in women. Reducing injury rates thus relies on detecting and continually evaluating people with relatively large valgus motions...
  35. ncbi A review of electromyographic activation levels, timing differences, and increased anterior cruciate ligament injury incidence in female athletes
    T E Hewett
    Cincinnati Children s Hospital, Sports Medicine Biodynamics Center, Cincinnati, OH 45229, USA
    Br J Sports Med 39:347-50. 2005
    ..The purpose of this review is to summarise the evidence for altered muscular activation and timing relative to ACL injury risk in female athletes...
  36. ncbi Use of an overhead goal alters vertical jump performance and biomechanics
    Kevin R Ford
    Cincinnati Children's Hospital Research Foundation, Sports Medicine Biodynamics Center, and Human Performance Laboratory, Cincinnati, Ohio 45229, USA
    J Strength Cond Res 19:394-9. 2005
    ..These results indicate that overhead goals may be incorporated during training and testing protocols to alter lower-extremity biomechanics and can increase performance...
  37. ncbi Reducing knee and anterior cruciate ligament injuries among female athletes: a systematic review of neuromuscular training interventions
    Timothy E Hewett
    Cincinnati Children's Hospital, Sports Medicine Biodynamics Center and Human Performance Laboratory, and the Department of Pediatrics, University of Cincinnati College of Medicine, College of Allied Health Sciences, Cincinnati, Ohio 45229, USA
    J Knee Surg 18:82-8. 2005
    ..It may be that prepubertal or early pubertal female athletes may have the potential to achieve optimal biomechanical changes and the greatest chance of injury-free sports participation throughout their careers...
  38. ncbi Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center, Division of Molecular Cardiovascular Biology, Cincinatti Children s Hospital Medical Center, Cincinnati, OH 45229, USA
    Am J Sports Med 33:492-501. 2005
    ..Female athletes participating in high-risk sports suffer anterior cruciate ligament injury at a 4- to 6-fold greater rate than do male athletes...
  39. ncbi Neuromuscular training improves performance and lower-extremity biomechanics in female athletes
    Gregory D Myer
    Cincinnati Children s Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio 45229, USA
    J Strength Cond Res 19:51-60. 2005
    ..The results of this study support the hypothesis that the combination of multiple-injury prevention-training components into a comprehensive program improves measures of performance and movement biomechanics...
  40. ncbi The effects of gender on quadriceps muscle activation strategies during a maneuver that mimics a high ACL injury risk position
    Gregory D Myer
    Division of Sports Medicine and Division of Molecular Cardiovascular Biology, Sports Medicine Biodynamics Center, Human Performance Laboratory, Cincinnati Children s Hospital Research Foundation, Cincinnati OH 45229, USA
    J Electromyogr Kinesiol 15:181-9. 2005
    ..05). The results of this study suggest that females utilize neuromuscular activation strategies which may contribute to "dynamic valgus" and ACL rupture when performing high-risk maneuvers...
  41. ncbi Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, OH 45229, USA
    Am J Sports Med 34:299-311. 2006
    ..Identification of both extrinsic and intrinsic risk factors associated with the anterior cruciate ligament injury mechanism may provide direction for targeted prophylactic treatment to high-risk individuals...
  42. ncbi Gender differences in hip adduction motion and torque during a single-leg agility maneuver
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center, Division of Sports Medicine, Cincinnati Children s Hospital Medical Center, 3333 Burnet Avenue, MLC 10001, Cincinnati, Ohio 45229, USA
    J Orthop Res 24:416-21. 2006
    ..Females also exhibited significantly increased external hip adduction moments during landing 1, however, no differences were found between genders during landings 2 and 3...
  43. ncbi Effects of the menstrual cycle on anterior cruciate ligament injury risk: a systematic review
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    Am J Sports Med 35:659-68. 2007
    ..These findings may lead to potential interventions targeted toward this phase of the menstrual cycle to reduce the incidence of anterior cruciate ligament injury...
  44. ncbi A multidisciplinary approach to the evaluation, reconstruction and rehabilitation of the multi-ligament injured athlete
    Michael J Medvecky
    Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut 06510, USA
    Sports Med 37:169-87. 2007
    ....
  45. ncbi The validation of a portable force plate for measuring force-time data during jumping and landing tasks
    Mark S Walsh
    Department of Physical Education, Health and Sport Studies, Miami University, Oxford, OH 45056, USA
    J Strength Cond Res 20:730-4. 2006
    ....
  46. ncbi Viscosupplementation for knee osteoarthritis: a systematic review
    Jon G Divine
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    Clin Orthop Relat Res 455:113-22. 2007
    ....
  47. ncbi Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases
    Tron Krosshaug
    Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
    Am J Sports Med 35:359-67. 2007
    ..The mechanisms of anterior cruciate ligament injury in basketball are not well defined...
  48. ncbi The effects of the menstrual cycle on anterior knee laxity: a systematic review
    Bohdanna T Zazulak
    Departments of Orthopedics and Rehabilitation Services, Yale New-Haven Hospital, New Haven, Connecticut, USA
    Sports Med 36:847-62. 2006
    ....
  49. ncbi Preparticipation physical examination using a box drop vertical jump test in young athletes: the effects of puberty and sex
    Timothy E Hewett
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
    Clin J Sport Med 16:298-304. 2006
    ..This fact may underlie neuromuscular imbalances related to increased risk of injury in females. The hypothesis: female athletes would demonstrate mismatched landing force to power production compared with males...
  50. ncbi Rehabilitation after anterior cruciate ligament reconstruction: criteria-based progression through the return-to-sport phase
    Gregory D Myer
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, OH 45229, USA
    J Orthop Sports Phys Ther 36:385-402. 2006
    ....
  51. ncbi Plyometric exercise in the rehabilitation of athletes: physiological responses and clinical application
    Terese L Chmielewski
    Department of Physical Therapy, University of Florida, Gainesville, FL 32610, USA
    J Orthop Sports Phys Ther 36:308-19. 2006
    ....
  52. ncbi The effects of plyometric vs. dynamic stabilization and balance training on power, balance, and landing force in female athletes
    Gregory D Myer
    Cincinnati Children s Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio 45229, USA
    J Strength Cond Res 20:345-53. 2006
    ..A combination of PLYO and BAL training may further maximize the effectiveness of preseason training for female athletes...
  53. ncbi Comparison of in-shoe foot loading patterns on natural grass and synthetic turf
    Kevin R Ford
    Cincinnati Children s Hospital Research Foundation, Sports Medicine Biodynamics Center, Human Performance Laboratory, Cincinnati, OH 45229, USA
    J Sci Med Sport 9:433-40. 2006
    ..Further epidemiological investigation is warranted to determine the effects of playing surfaces on sport specific injury mechanisms...
  54. ncbi Early rehabilitation following surgical fixation of a femoral shaft fracture
    Mark V Paterno
    Sports Medicine Biodynamics Center and Division of Occupational Therapy and Physical Therapy, Cincinnati Children s Hospital Medical Center, 3333 Burnett Ave, MLC 10001, Cincinnati, OH 45229 3039, USA
    Phys Ther 86:558-72. 2006
    ..The purpose of this case report is to describe the outcome of a patient following fixation of a midshaft femur fracture and an evaluation-based, immediate-weight-bearing approach to rehabilitation...
  55. ncbi Gender differences in the kinematics of unanticipated cutting in young athletes
    Kevin R Ford
    Cincinnati Children s Hospital Research Foundation, 3333 Burnet Avenue, MLC 10001 Cincinnati, OH 45229, USA
    Med Sci Sports Exerc 37:124-9. 2005
    ..The hypotheses were that female athletes would display increased knee abduction, increased ankle eversion and decreased knee flexion during the unanticipated cutting maneuver compared with males...