Original paperThe effects of gender and pubertal status on generalized joint laxity in young athletes
Introduction
Epidemiological studies indicate that adolescents experience an increased rate of ligament sprains and sports injuries as they mature.1, 2 Both males and females experience ligament sprains at similar rates prior to puberty; however, after 12 years of age females demonstrate higher ligament sprain rates compared to males.3, 4 The anterior cruciate ligament (ACL) injury incidence is 2 to 8-fold higher in adolescent female athletes compared to males.5 Prior to puberty, however, there does not appear to be a significant difference in ACL injury rates between the genders.6, 7 Cumulatively, these studies indicate a potential association between changes that occur during the onset of puberty and increased ACL injury risk in female athletes.
While males and females exhibit similar changes in relative limb segment growth and development associated with puberty, there is divergence in other anatomical,8 hormonal9 and neuromuscular measures.10, 11, 12, 13 Identification of anatomical, hormonal or neuromuscular gender differences related to puberty may help to delineate the mechanisms underlying the increased risk of ACL injuries in females compared to males. One potential measure that may be related to higher risk of knee and ACL injury is increased generalized joint laxity and knee joint laxity.14, 15 Increased generalized joint laxity (hypermobility) is defined as increased joint range of motion relative to the normal population. Joint stabilization provided by both active and passive restraints help provide protection against joint injury. Ligaments are passive joint restraints, while muscles contribute to both passive and active joint restraints. Ligaments, joint capsules, joint surface contacts, passive or reflexive muscle tension and soft tissues all contribute to joint stability and end-range of motion.16 Therefore, alterations in any of these structures during puberty may compromise joint stability and could potentially lead to joint injury and loss of function.
While the effects of chronological age, race, and gender on generalized joint laxity and the prevalence of hyperlaxity are relatively well defined in a non-athletic population,17, 18, 19 the effects of pubertal status on laxity measures in an athletic population are not established in the literature. Although chronological age is a common covariate employed in gender studies, comparison of males and females by chronological age during the adolescent period may not be optimal.20 The average onset of puberty differs between the genders, with females beginning puberty at an earlier age; hence comparisons of puberty-dependent variables in males and females by age during this pubertal period may not be valid. The purpose of the present study was to examine the effects of pubertal status on generalized joint laxity in a population of male and female athletes. We hypothesized that females would show an increase in generalized joint laxity after the onset of puberty while males would not demonstrate a comparable increase.
Section snippets
Subjects
The present study employed a cross-sectional cohort experimental design. Subjects for this study were 275 female and 143 male (ages 11–18) healthy preadolescent and adolescent athletes from local middle school and high schools within the same school district. Data was collected just prior to the start of the athletes’ competitive soccer or basketball season. Informed written consent was obtained from a guardian of each subject and approved by the Institutional Review Board prior to screening.
Results
Fig. 2 displays the BHJMI joint laxity scores for the male and female athletes at the three different pubertal stages: pre-pubertal, pubertal and post-pubertal. Female athletes demonstrated a significant difference in generalized joint laxity, between pubertal groups (P = 0.042), as measured by the BHJMI. In contrast, there was not a BHJMI score difference between pubertal groups in the male athletes (P = 0.582). Specifically, females had significantly greater BHJMI scores post-pubertal (P = 0.042),
Discussion
The findings of the current study support the hypothesis that generalized joint laxity increases in female, but not male, athletes during puberty. Prior to puberty, males and females demonstrated similar BHJMI scores. The study findings indicate that following the onset of puberty, females develop greater generalized joint laxity, while no similar changes in joint laxity are observed in male athletes. This potentially leads to decreased static stability in female athletes and indicates that
Practical Implications
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Female athletes experience an increase in generalized joint laxity following the onset of puberty, while males do not demonstrate a significant change overall in laxity with puberty.
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This increase in joint laxity associated with the onset of puberty in females may be related to their concomitant increase in knee and ACL injury incidence in athletic populations.
Acknowledgements
The authors would like to acknowledge funding support from National Institutes of Health Grant R01-AR049735. We would also like to acknowledge Drs. Frank Biro and Jon Divine for their contributions. We would also like to acknowledge Tiffany Evans for her assistance with the manuscript.
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