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Sex differences of knee joint repositioning accuracy in healthy adolescents



Sex differences in the knee joint have long been known and impaired proprioceptive accuracy is an important risk factor that could be associated with knee joint injury. This study was conducted to compare the accuracy of knee repositioning between healthy male and female adolescents.

Participants and methods

A total of 64 healthy adolescents (32 males, 32 females) aging from 15 to 18 years participated in this study. Active angle repositioning test was used to assess the proprioceptive accuracy of the right knee joint at 45° knee flexion by using a Biodex system 3 pro-isokinetic dynamometer.


The statistical analysis revealed that the repositioning accuracy of the knee joint was significantly lower in female participants than in males, as the mean values of repositioning errors were 3.54±1.20 for males and 4.76±1.29 for females (P< 0.05).


Sex-based difference in the accuracy of knee joint proprioception may imply that knee proprioceptive sensitivity might potentially contribute to the high incidence of knee injury in females compared with males, particularly during adolescence.


  1. Lephart S, Riemann B, Fu F. Introduction to the sensorimotor system. In: Lephart S, Fu F, eds. Proprioception and neuromuscular control in joint stability Champaign: Human Kinetics; 2000;17–24.

    Google Scholar 

  2. Riemann B, Lephart S. The sensorimotor system, part II: the role of proprioception in motor control and functional joint stability. J Athl Train 2002; 37:80–84.

    PubMed  PubMed Central  Google Scholar 

  3. Duzgun I, Kanbur N, Baltaci G, Aydin T. Effect of Tanner stage on proprioception accuracy. J Foot Ankle Surg 2011; 50:11–15.

    Article  PubMed  Google Scholar 

  4. Williams GN, Chmielewski T, Rudolph K, Buchanan TS, Snyder-Mackler L. Dynamic knee stability: current theory and implications for clinicians and scientists. J Orthop Sports Phys Ther 2001; 31:546–566.

    CAS  Article  PubMed  Google Scholar 

  5. Hübscher M, Zech A, Pfeifer K, Hänsel F, Vogt L, Banzer W. Neuromuscular training for sports injury prevention: a systematic review. Med Sci Sports Exerc 2010; 42:413–421.

    Article  PubMed  Google Scholar 

  6. Knoop J, Steultjens MP, van der Leeden M, van der Esch M, Thorstensson CA, Roorda LD et al. Proprioception in knee osteoarthritis: a narrative review. Osteoarthritis Cartilage 2011; 19:381–388.

    CAS  Article  PubMed  Google Scholar 

  7. Baker P, Reading I, Cooper C, Coggon D. Knee disorders in the general population and their relation to occupation. Occup Environ Med 2003; 60:794–797.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Chmielewski TL, Stackhouse S, Axe MJ, Snyder-Mackler L. A prospective analysis of incidence and severity of quadriceps inhibition in a consecutive sample of 100 patients with complete acute anterior cruciate ligament rupture. J Orthop Res 2004; 22:925–930.

    Article  PubMed  Google Scholar 

  9. Rice DA, McNair PJ. Quadriceps arthrogenic muscle inhibition: neural mechanisms and treatment perspectives. Semin Arthritis Rheum 2010; 40:250–266.

    Article  PubMed  Google Scholar 

  10. Reeves ND, Maffulli N. A case highlighting the influence of knee joint effusion on muscle inhibition and size. Nat Clin Pract Rheumatol 2008; 4:153–158.

    Article  PubMed  Google Scholar 

  11. Arvidsson I, Eriksson E, Knutsson E, Arnér S. Reduction of pain inhibition on voluntary muscle activation by epidural analgesia. Orthopedics 1986; 9:1415–1419.

    CAS  PubMed  Google Scholar 

  12. Fahrer H, Rentsch HU, Gerber NJ, Beyeler C, Hess CW, Grünig B. Knee effusion and reflex inhibition of the quadriceps. A bar to effective retraining. J Bone Joint Surg Br 1988; 70:635–638.

    CAS  Article  PubMed  Google Scholar 

  13. Hurley MV. The effects of joint damage on muscle function, proprioception and rehabilitation. Man Ther 1997; 2:11–17.

    Article  PubMed  Google Scholar 

  14. Fouladi R. Sex hormones and neuromuscular control system. In: Dubey R, eds. Sex hormones Croatia: InTech; 2012;52–63.

    Google Scholar 

  15. Faber S, Eckstein F, Lukasz S, Muhlbauer R, Hohe J, Englmeier K et al. Gender differences in knee joint cartilage thickness, volume and articular surface areas: assessment with quantitative three-dimensional MR imaging. Skeletal Radiol 2001; 30:144–150.

    CAS  Article  PubMed  Google Scholar 

  16. Karakaya I, Karakaya M. Proprioception and gender. In: Kaya D, eds. Proprioception: the forgotten sixth sense USA: OMICS Group eBooks; 2014;3–12.

    Google Scholar 

  17. Jerosch J, Prymka M. Knee joint proprioception in normal volunteers and patients with anterior cruciate ligament tears taking special account of the effect of a knee bandage. Arch Orthop Trauma Surg 1996; 115:162–166.

    CAS  Article  PubMed  Google Scholar 

  18. Callaghan MJ, Selfe J, Bagley PJ, Oldham JA. The effects of patellar taping on knee joint proprioception. J Athl Train 2002; 37:19–24.

    PubMed  PubMed Central  Google Scholar 

  19. Voight ML, Hardin JA, Blackburn TA, Tippett S, Canner GC. The effects of muscle fatigue on and the relationship of arm dominance to shoulder proprioception. J Orthop Sports Phys Ther 1996; 23:348–352.

    CAS  Article  PubMed  Google Scholar 

  20. Bruce D, Marco D, Lars K, Daniel G. Proprioception & neuromuscular control in joint stability. Chapter 12. Human Kinet 2000; 127–138.

  21. Ribeiro F, Oliveira J. Effect of physical exercise and age on knee joint position sense. Arch Gerontol Geriatr 2010; 51:64–67.

    Article  PubMed  Google Scholar 

  22. Ribeiro F, Oliveira J. Factors influencing proprioception: what do they reveal? In: Klika Ved, eds. Biomechanics in applications. Croatia: InTech; 2011;125–135.

    Google Scholar 

  23. Liu SH, Al-Shaikh RA, Panossian V, Finerman GA, Lane JM. Estrogen affects the cellular metabolism of the anterior cruciate ligament. A potential explanation for female athletic injury. Am J Sports Med 1997; 25:704–709.

    CAS  PubMed  Google Scholar 

  24. Boden BP, Griffin LY, Garrett WEJr. Etiology and prevention of noncontact ACL injury. Phys Sportsmed 2000; 28:53–60.

    CAS  Article  PubMed  Google Scholar 

  25. Hashemi J, Chandrashekar N, Mansouri H, Slauterbeck JR, Hardy DM. The human anterior cruciate ligament: sex differences in ultrastructure and correlation with biomechanical properties. J Orthop Res 2008; 26:945–950.

    Article  PubMed  Google Scholar 

  26. Varadarajan KM, Gill TJ, Freiberg AA, Rubash HE, Li G. Gender differences in trochlear groove orientation and rotational kinematics of human knees. J Orthop Res 2009; 27:871–878.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex-based differences in the tensile properties of the human anterior cruciate ligament. J Biomech 2006; 39:2943–2950.

    Article  PubMed  Google Scholar 

  28. Faber SC, Eckstein F, Lukasz S, Mühlbauer R, Hohe J, Englmeier KH. Reiser M Gender differences in knee joint cartilage thickness, volume and articular surface areas: assessment with quantitative three-dimensional MR imaging. Skeletal Radiol 2001; 30:144–150.

    CAS  Article  PubMed  Google Scholar 

  29. Nagai T, Sell TC, Abt JP, Lephart SM. Reliability, precision, and gender differences in knee internal/external rotation proprioception measurements. Phys Ther Sport 2012; 13:233–237.

    Article  PubMed  Google Scholar 

  30. Schmidt L, Depper L, Kerkhoff G. Effects of age, sex and arm on the precision of arm position sense-left-arm superiority in healthy righthanders. Front Hum Neurosci 2013; 7:915.

    PubMed  PubMed Central  Google Scholar 

  31. Vafadar AK, Côté JN, Archambault PS. Sex differences in the shoulder joint position sense acuity: a cross-sectional study. BMC Musculoskelet Disord 2015; 16:273.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Artz N, Adams M, Dolan P. Sensorimotor function of the cervical spine in healthy volunteers. Clin Biomech 2015; 30:260–268.

    Article  Google Scholar 

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Correspondence to Rania N. Karkousha PhD.

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Karkousha, R.N. Sex differences of knee joint repositioning accuracy in healthy adolescents. Bull Fac Phys Ther 21, 56–60 (2016).

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  • Biodex isokinetic system
  • healthy participants
  • knee joint
  • proprioception
  • sex