Biomechanical differences across pubertal maturation stages and sexes in a single-leg drop-land and a single-leg drop-land-and-cut task

Anterior cruciate ligament (ACL) injuries account for 45% of internal knee injuries, often having prolonged recovery and substantial care costs. Higher non-contact ACL injury rates have been reported in post-pubertal females compared with males and pre-pubertal individuals, which is potentially linked with biomechanical changes associated with musculoskeletal and neuromuscular development. Up to 80% of non-contact ACL injuries occur during single-leg landing or cutting; hence, a single-leg drop-land and single-leg drop-land-and-cut task were used to investigate the effect of sex and maturation on biomechanics associated with ACL injury risk. Sixty-nine males and females at three maturation stages (Males n= 16 pre-pubertal, 11 mid-pubertal, 11 post-pubertal; Females n= 10 pre-pubertal, 9 mid-pubertal, 10 post-pubertal) were categorised using Tanner stages, peak height velocity, and the pubertal maturation observation scale. Biomechanical metrics were compared using 3D motion capture and force plate technology using a two-by-three-way ANOVA. Post-pubertal females did not exhibit biomechanics suggesting comparatively higher ACL injury risk. Pre-pubertal participants exhibited greater relative vertical ground reaction forces and knee moments that suggested a lack of resistance to potentially injurious positions, compared to the other groups. Implementing screening and injury prevention pre-puberty could help develop safer movement patterns that reduce ACL injury risk with maturation.