The Journal of Bone and Joint Surgery (American) 84:10-16 (2002)
© 2002 The Journal of Bone and Joint Surgery, Inc.
A Gender-Related Difference in the Contribution of the Knee Musculature to Sagittal-Plane Shear Stiffness in Subjects with Similar Knee Laxity
Edward M. Wojtys, MD,
James A. Ashton-Miller, PhD and
Laura J. Huston, MS
Investigation performed at the Department of Orthopaedic Surgery,
MedSport, University of Michigan, Ann Arbor, Michigan
Edward M. Wojtys, MD
Laura J. Huston, MS
Department of Orthopaedic Surgery, MedSport, 24 Frank Lloyd Wright Drive,
Ann Arbor, MI 48106. E-mail address for E.M. Wojtys: edwojtys{at}umich.edu
James A. Ashton-Miller, PhD
Biomechanics Research Laboratory, Department of Mechanical Engineering
and Applied Mechanics, Department of Biomedical Engineering, and
Institute of Gerontology, University of Michigan, Ann Arbor, MI
48109
The authors did not receive grants or outside funding in support
of their research or preparation of this manuscript. They did not
receive payments or other benefits or a commitment or agreement
to provide such benefits from a commercial entity. No commercial
entity paid or directed, or agreed to pay or direct, any benefits
to any research fund, foundation, educational institution, or other
charitable or nonprofit organization with which the authors are
affiliated or associated.
Background: Women’s susceptibility
to injuries involving the anterior cruciate ligament remains unexplained.
Volitional contraction of the knee musculature is known to increase
the resistance of the knee to shear deformation, raising the possibility
that muscles play a part in protecting the anterior cruciate ligament
during hazardous activities. We therefore tested the hypothesis
that a volitional co-contraction of the knee muscles increases the
sagittal-plane shear stiffness (or resistance to anterior tibial
translation) of the knee more in men than in women.
Methods: Twenty-three volunteers (ten men and thirteen
women; mean age, 24.7 ± 5.4 years), all with anterior
tibial translation of 6 mm, agreed to participate in the study.
Each subject underwent a subjective evaluation of knee function
and activity level, an arthrometric measurement of passive anterior
tibial translation, and an isokinetic dynamometer strength test
at 60°/sec. A dynamic stress test was then performed to
measure anterior tibial translation while simultaneously monitoring lower-extremity
muscle response.
Results: Maximum co-contraction of the knee musculature
significantly decreased mean anterior tibial translation in both
men and women (from 7.8 mm to 2.2 mm in men and from 6.5 mm to 3.1
mm in women). The corresponding percentage increase in shear stiffness
of the knee was significantly greater (p = 0.003) in men
(379%) than in women (212%).
Conclusions: The results suggested that women have
a diminished potential for muscular protection of passive structures
of the knee in anterior tibial translation.
Clinical Relevance: Maximal muscular protection
of the anterior cruciate ligament in women may be less than that
in men. This may be one factor explaining why more women than men
are apt to sustain injuries to the anterior cruciate ligament.
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