The effects of core proprioception on knee injury: A prospective biomechanical-epidemiological study

Bohdanna T. Zazulak, Timothy E. Hewett, N. Peter Reeves, Barry Goldberg, Jacek Cholewicki

Research output: Contribution to journalArticlepeer-review

233 Scopus citations


Background: In sports involving pivoting and landing, female athletes suffer knee injury at a greater rate than male athletes. Hypotheses: Proprioceptive deficits in control of the body's core may affect dynamic stability of the knee. Female, but not male, athletes who suffered a knee injury during a 3-year follow-up period would demonstrate decreased core proprioception at baseline testing as compared with uninjured athletes. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: Study subjects were 277 collegiate athletes (140 female, 137 male) who were prospectively tested for core proprioception by active and passive proprioceptive repositioning. Athletes were monitored for injury for 3 years. An ANOVA and multivariate logistic regression were used to test whether core proprioception was related to knee injuries in athletes. Results: Twenty-five athletes sustained knee injuries (11 women, 14 men). Deficits in active proprioceptive repositioning were observed in women with knee injuries (2.2°) and ligament/meniscal injuries (2.4°) compared with uninjured women (1.5°, P ≤.05). There were no differences in average active proprioceptive repositioning error between injured men and uninjured men (P ≥.05). Uninjured women demonstrated significantly less average error in active proprioceptive repositioning than uninjured men (1.5° vs 1.7°, P ≤.05). For each degree increase in average active proprioceptive repositioning error, a 2.9-fold increase in the odds ratio of knee injury was observed, and a 3.3-fold increase in odds ratio of ligament/meniscal injury was observed (P ≤.01). Active proprioceptive repositioning predicted knee injury status with 90% sensitivity and 56% specificity in female athletes. Conclusions: Impaired core proprioception, measured by active proprioceptive repositioning of the trunk, predicted knee injury risk in female, but not male, athletes.

Original languageEnglish (US)
Pages (from-to)368-373
Number of pages6
JournalAmerican Journal of Sports Medicine
Issue number3
StatePublished - Mar 2007


  • ACL injury
  • Gender differences
  • Injury prevention
  • Neuromuscular control
  • Proprioception

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation


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