Differences in Kinematic and Muscle Activity Between ACL Injury Risk and Healthy Players in Female Football: Influence of Change of Direction Amplitude in a Cross-Sectional Case–Control Study

<i>Background and Objectives</i>: Anterior cruciate ligament (ACL) injury rates remain high and have a significant impact on female football players. This study aims to evaluate knee kinematics and lower limb muscle activity in players at risk of ACL injury compared to healthy players th...

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Main Authors: Loreto Ferrández-Laliena, Lucía Vicente-Pina, Rocío Sánchez-Rodríguez, Graham J Chapman, Jose Heredia-Jimenez, César Hidalgo-García, José Miguel Tricás-Moreno, María Orosia Lucha-López
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Language:English
Published: MDPI AG 2025-07-01
Series:Medicina
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Online Access:https://www.mdpi.com/1648-9144/61/7/1259
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author Loreto Ferrández-Laliena
Lucía Vicente-Pina
Rocío Sánchez-Rodríguez
Graham J Chapman
Jose Heredia-Jimenez
César Hidalgo-García
José Miguel Tricás-Moreno
María Orosia Lucha-López
author_facet Loreto Ferrández-Laliena
Lucía Vicente-Pina
Rocío Sánchez-Rodríguez
Graham J Chapman
Jose Heredia-Jimenez
César Hidalgo-García
José Miguel Tricás-Moreno
María Orosia Lucha-López
author_sort Loreto Ferrández-Laliena
collection DOAJ
description <i>Background and Objectives</i>: Anterior cruciate ligament (ACL) injury rates remain high and have a significant impact on female football players. This study aims to evaluate knee kinematics and lower limb muscle activity in players at risk of ACL injury compared to healthy players through three side-cutting tests. It also investigates how the amplitude of a change in direction influences stabilization parameters. <i>Materials and Methods</i>: A cross-sectional case–control study was conducted with 16 second division female futsal players (23.93 ± 5.16 years), divided into injured (<i>n</i> = 8) and healthy groups (<i>n</i> = 8). Injured players had a history of non-contact knee injury involving valgus collapse, without undergoing surgical intervention. Three change of direction tests, namely the Change of Direction and Acceleration Test (CODAT), Go Back (GOB) test, and Turn (TURN) test, were used for evaluation. The peak and range of knee joint angles and angular velocities across three planes, along with the average rectified and peak envelope EMG signals of the Biceps Femoris (BF), Semitendinosus (ST), Vastus Medialis (VM), and Lateral Gastrocnemius (LG), were recorded during the preparation and load phases. Group differences were analyzed using two-factor mixed-model ANOVA with pairwise comparisons. Statistical significance was set at <i>p</i> < 0.05. <i>Results</i>: Injured players demonstrated lower external tibial rotation angular velocity and a greater range of motion in tibial external rotation compared to healthy players. Additionally, the injured group showed significantly higher average rectified muscle activity in VM and LG both increased by 4% during the load phase. The CODAT and TURN tests elicited higher BF and VM muscle activity, compared to the GOB test. The TURN test also showed greater extension angular velocity in the sagittal plane. <i>Conclusions</i>: The results revealed differences in knee kinematics and muscle activity between players at risk of ACL injury and healthy players, influenced by the amplitude of directional changes. Players altered transverse plane mechanics and increased VM and LG activation during LOAD may reflect a dysfunctional motor pattern, while the greater sagittal plane angular velocity and VM and BF activation from the CODAT and the TURN test highlight their higher potential to replicate ACL injury mechanisms compared to the GOB test.
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spelling doaj-art-4e3316554c724982801b5395313332ca2025-08-20T03:07:58ZengMDPI AGMedicina1010-660X1648-91442025-07-01617125910.3390/medicina61071259Differences in Kinematic and Muscle Activity Between ACL Injury Risk and Healthy Players in Female Football: Influence of Change of Direction Amplitude in a Cross-Sectional Case–Control StudyLoreto Ferrández-Laliena0Lucía Vicente-Pina1Rocío Sánchez-Rodríguez2Graham J Chapman3Jose Heredia-Jimenez4César Hidalgo-García5José Miguel Tricás-Moreno6María Orosia Lucha-López7Unidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, SpainUnidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, SpainUnidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, SpainAllied Health Research Unit, School of Health, Social Work and Sport, University of Central Lancashire, Preston PR1 2HE, UKDepartamento de Educación Física y Deportiva, Universidad de Granada, 51005 Ceuta, SpainUnidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, SpainUnidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, SpainUnidad de Investigación en Fisioterapia, Spin off Centro Clínico OMT-E Fisioterapia SLP, Universidad de Zaragoza, Domingo Miral s/n, 50009 Zaragoza, Spain<i>Background and Objectives</i>: Anterior cruciate ligament (ACL) injury rates remain high and have a significant impact on female football players. This study aims to evaluate knee kinematics and lower limb muscle activity in players at risk of ACL injury compared to healthy players through three side-cutting tests. It also investigates how the amplitude of a change in direction influences stabilization parameters. <i>Materials and Methods</i>: A cross-sectional case–control study was conducted with 16 second division female futsal players (23.93 ± 5.16 years), divided into injured (<i>n</i> = 8) and healthy groups (<i>n</i> = 8). Injured players had a history of non-contact knee injury involving valgus collapse, without undergoing surgical intervention. Three change of direction tests, namely the Change of Direction and Acceleration Test (CODAT), Go Back (GOB) test, and Turn (TURN) test, were used for evaluation. The peak and range of knee joint angles and angular velocities across three planes, along with the average rectified and peak envelope EMG signals of the Biceps Femoris (BF), Semitendinosus (ST), Vastus Medialis (VM), and Lateral Gastrocnemius (LG), were recorded during the preparation and load phases. Group differences were analyzed using two-factor mixed-model ANOVA with pairwise comparisons. Statistical significance was set at <i>p</i> < 0.05. <i>Results</i>: Injured players demonstrated lower external tibial rotation angular velocity and a greater range of motion in tibial external rotation compared to healthy players. Additionally, the injured group showed significantly higher average rectified muscle activity in VM and LG both increased by 4% during the load phase. The CODAT and TURN tests elicited higher BF and VM muscle activity, compared to the GOB test. The TURN test also showed greater extension angular velocity in the sagittal plane. <i>Conclusions</i>: The results revealed differences in knee kinematics and muscle activity between players at risk of ACL injury and healthy players, influenced by the amplitude of directional changes. Players altered transverse plane mechanics and increased VM and LG activation during LOAD may reflect a dysfunctional motor pattern, while the greater sagittal plane angular velocity and VM and BF activation from the CODAT and the TURN test highlight their higher potential to replicate ACL injury mechanisms compared to the GOB test.https://www.mdpi.com/1648-9144/61/7/1259anterior cruciate ligamentbiomechanicselectromyographyfemale footballinjury prevention
spellingShingle Loreto Ferrández-Laliena
Lucía Vicente-Pina
Rocío Sánchez-Rodríguez
Graham J Chapman
Jose Heredia-Jimenez
César Hidalgo-García
José Miguel Tricás-Moreno
María Orosia Lucha-López
Differences in Kinematic and Muscle Activity Between ACL Injury Risk and Healthy Players in Female Football: Influence of Change of Direction Amplitude in a Cross-Sectional Case–Control Study
Medicina
anterior cruciate ligament
biomechanics
electromyography
female football
injury prevention
title Differences in Kinematic and Muscle Activity Between ACL Injury Risk and Healthy Players in Female Football: Influence of Change of Direction Amplitude in a Cross-Sectional Case–Control Study
title_full Differences in Kinematic and Muscle Activity Between ACL Injury Risk and Healthy Players in Female Football: Influence of Change of Direction Amplitude in a Cross-Sectional Case–Control Study
title_fullStr Differences in Kinematic and Muscle Activity Between ACL Injury Risk and Healthy Players in Female Football: Influence of Change of Direction Amplitude in a Cross-Sectional Case–Control Study
title_full_unstemmed Differences in Kinematic and Muscle Activity Between ACL Injury Risk and Healthy Players in Female Football: Influence of Change of Direction Amplitude in a Cross-Sectional Case–Control Study
title_short Differences in Kinematic and Muscle Activity Between ACL Injury Risk and Healthy Players in Female Football: Influence of Change of Direction Amplitude in a Cross-Sectional Case–Control Study
title_sort differences in kinematic and muscle activity between acl injury risk and healthy players in female football influence of change of direction amplitude in a cross sectional case control study
topic anterior cruciate ligament
biomechanics
electromyography
female football
injury prevention
url https://www.mdpi.com/1648-9144/61/7/1259
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