Gender differences in the impact of fatigue on lower limb landing biomechanics and their association with anterior cruciate ligament (ACL) injuries: A systematic review and meta-analysis

Abstract

Background: This meta-analysis examines the impact of neuromuscular fatigue on gender differences in lower limb landing biomechanics and its correlation with ACL injury risk.

Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library up to March 2024.

Results: Fourteen studies were included, averaging a quality score of 6.79; nine were high quality. Key findings: males showed a significant increase in knee flexion angle at initial contact (effect size -1.23), but females did not (-0.25). Both genders had significant changes in hip external rotation (males: 1.35, females: 1.20). Ankle peak dorsiflexion angle increased (-1.69) with no gender differences. Peak Knee extension moment increased in males (0.76) and females (0.48) with an overall effect size of 0.64, but no change in peak abduction moment. Peak Hip extension moment was significant in males (0.58) and overall (0.51), with no changes in internal rotation or adduction moments. Peak vertical ground reaction force showed no significant changes for either gender.

Conclusions: Fatigue alters knee biomechanics in males, raising ACL injury risk, and both genders show increased hip and ankle loads post-fatigue. These results suggest the need for gender-specific fatigue management strategies to mitigate ACL injury risk and call for further research into prevention mechanisms.