Anterior cruciate ligament injuries.

Increasingly, epidemiological data has shown differences in the total number of injuries and in the incidence of serious knee injuries among males and females in jumping and pivoting activities. Particularly, strong epidemiological data support increased incidence of non-contact anterior cruciate ligament injuries in females. Despite more than a decade of vigorous debate and intense study on this topic, research has yet to clearly link gender as an individual risk factor for this injury. Risk factors can be divided into intrinsic or extrinsic factors; for this review they are divided into anatomic, hormonal, and neuromuscular categories. The most intriguing of these deals with neuromuscular control of the limb. In particular, neuromuscular issues involving hip and trunk position and its muscular control have been increasingly implicated in this injury etiology. Gender differences have been found in motion patterns, positions, and muscular forces generated with various lower extremity coordinated activities. Thus, many clinicians currently advocate a strengthening program that emphasizes proximal hip control mediated through gluteus and proximal hamstring activation in a close chain fashion. This, combined with skill training in landing and pivoting maneuvers, is thought to help prevent injury. We must encourage continued, structured, and focused research in this area. However, until specific predictive and protective factors are identified, training and prevention programs should continue to be implemented, assessed, and improved.