Summary

Should anterior cruciate ligament prevention programs be gender-specific?

Abstract

Introduction

Anterior cruciate ligament (ACL) injuries are likely the most common severe injuries in soccer. The understanding of mechanisms of injury and risk factors for ACL injury is crucial to elaborate effective prevention programs. The design of these prevention programs should perhaps be gender-specific.

Objectives: The purpose of this study was to compare the neuromuscular tensiomyographic characteristics of the lower extremity in competitive male and female soccer players who suffered from an ACL injury through tensiomyography (TMG).

Methods

A cross-sectional, controlled, between-group, comparative study was conducted to assess the neuromuscular status of the lower extremity in competitive soccer players with ACL injury. A single cohort of 84 patients (40 males and 44 females) who had suffered an anterior cruciate ligament injury attending at the Mutualidad de Futbolistas, were recruited.

All soccer players included in this study underwent a neuromuscular assessment of both lower extremities with TMG before surgery. The methodology for TMG assessment was the same on both sides, and values were obtained by the same investigator who had experience with this procedure.

Results

In males, contraction times (Tc) of vastus medialis, vastus lateralis, rectus femoris, semitendinosus, and biceps femoris were significantly higher compared to their healthy limb. In females, contraction times (Tc) were significantly higher only in vastus lateralis and rectus femoris. No between-limbs differences in maximum displacement (Dm) were observed in males, while females showed a significant higher Dm only in vastus lateralis. Between-limb symmetry index were statistically lower (worse) in females compared to males in vastus medialis, gastrocnemius medialis and gastrocnemius lateralis.

Conclusions

After an ACL injury, male players present altered contraction times in vastus medialis, vastus lateralis, rectus femoris, semitendinosus, and biceps femoris while female players only present altered Tc in vastus lateralis and rectus femoris. No statistical differences in maximum displacement were observed in male players, while a significant increase in Dm was observed in the vastus lateralis of female players. Such results suggest the persistent atrophy of the vastus lateralis in female players compared to male players. Finally, females still presented significant between-limb asymmetries in vastus medialis and calf muscles compared to males, suggesting a muscular recovery time larger than male players.

Specific prevention programs should be developed for soccer players, taking into account the difference between genders.