Brophy, R., Silvers, S., Gonzales, T. and Mandelbaum, T. Bristish Journal of Sports Medicine; 2010, 44, 694 – 697.
http://www.ncbi.nlm.nih.gov/pubmed/20542974
Soccer is the most popular sport in the
world and soccer injuries occur most frequently in the knee, ankle and groin.
ACL tear is one of the most common injuries sustained by those participating in
the sport. It has been suggested that leg dominance might play a role in
aetiology of ACL injuries due to different muscle activation patterns seen in
kicking vs. supporting leg and therefore different demands put on lower
extremity. However there appears to be lack of research studying that. Moreover,
one must take into consideration importance of gender discrepancies where ACL tears
incidence is reported to be, at least, two times greater in females compared to
males. Authors found out lack of literature looking at the potential relationship
between leg dominance and ACL injury risk specifically in the soccer athlete.
Therefore, purpose of the study was to look at the role of leg dominance in ACL
injury risk among soccer athletes, particularly when adjusting for gender.
A total of 93 soccer players (N=41 male, 52
female) who had undergone ACL reconstruction were identified and consented to
participate in this study. The mechanism of injury was divided into two
categories: contact and non-contact. Results indicated that more than half of
the ACL injuries occurred in the dominant lower extremity (53/99). Interesting
finding was reported when to look at non – contact injuries specifically. When
the data were stratified for gender, there was a significant difference in the
distribution of non-contact injury with respect to dominance. Exactly 74.07% of
males (20/27) were injured on the dominant kicking leg compared with 32.26% (10/31)
of females.
In conclusion, when limited to a
non-contact injury mechanism, female soccer athletes are more likely to injure
the ACL in their preferred supporting leg whereas male soccer athletes tend to
injure the ACL in their preferred kicking leg. Authors proposed some explanation
to the phenomena observed. Males might be more prone to injure their kicking
leg due to the imbalance that usually exists between the quadriceps and the
hamstring in the sagittal plane and the adductor to abductor in the frontal
plane. In addition, pelvic positioning can perhaps contribute to this phenomenon.
During striking, pelvis tilts anteriorly on preswing, whereas, at the point of
initial contact with the ball, pelvis assumes posterior tilt. At this point, the
insertion for the biceps femoris musculature migrates caudally, thus alters the
length tension relationship of the biceps femoris. The quadriceps has a mechanical
advantage—and may impart a significant anterior shear force that precludes the
ACL tear. In regards why females might be more prone to sustain an ACL injury
in their supporting leg, literature presents several mechanisms including
decreased core stability, knee valgus, decreased peak knee flexion angles upon
jump – landing, decreased lateral hip control and slower contraction times. Valgus
angles at the knee are often coupled with decreased knee and hip flexion, and
pronation at the subtalar joint.
Does your clinical experience support these
findings? Do you know any other explanations for why lower – limb dominance
might play a role in aetiology of ACL injuries?
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