The risk factors for the rupture of the anterior cruciate ligament of the knee: the neuromuscular state

Multiple factors act conjointly to influence the risk of injury of the anterior cruciate ligament of the knee. An understanding of neuromuscular factors remains necessary, although this does not guarantee a complete analysis of the risks of injury to the anterior cruciate ligament. Women have a greater risk of injury to the anterior cruciate ligament in comparison to men. This can be explained by an increase in the internal rotation of the hip, coupled with an increase in the external rotation of the tibia and increased muscular activation of the quadriceps (with a concomitant decrease in hamstring activity) during landing or pivotal movements. In addition, muscular fatigue of the hamstrings and a weak hamstring/quadriceps ratio could contribute to the risk of injury to the anterior cruciate ligament. Finally, a lack of relative joint laxity can also constitute a risk factor of injury to the anterior cruciate ligament in women. Other potential neuromuscular risk factors could also be highlighted. Screening for these risk factors, for example, by means of a functional jump-landing test, together with an isokinetic test, could help to recommend new prevention protocols. The aim of this review was to discuss the risk factors for the rupture of the anterior cruciate ligament of the knee.
In conclusion, thanks to an overall knowledge of all the possible risk factors (intrinsic and extrinsic, modifiable or not), sports people who are predisposed to a recurrence of rupture of the anterior cruciate ligament could be identified. However, the hypothetical neuromuscular factors reported till date (Table 1) do not offer a complete understanding of this risk.