Biomechanical risk factors for ACL injury during a high-intensity exergame differ between the sexes based on exercise type.

Incidence rates in anterior cruciate ligament injuries, which are linked to multiple factors, are higher in females than in males. Modifiable contributors to the difference in risk are biomechanical factors such as knee valgus and knee rotation or neuromuscular control. Despite considerable research efforts, re-rupture rates are still high necessitating the need for improved risk reduction and rehabilitation programs. Incorporating exergaming, physically active serious games including a dual-task, has high potential to address this need. However, the execution of dual-tasks leads to altered movement patterns. Consequently, a comprehensive understanding of these movement patterns and their sex-specific differences is essential to subsequently tailor the training approach. The aim of this study was to explore biomechanical differences between males and females when performing a high-intensive exergame. Using three-dimensional motion capture (Vicon) during a 25-min exergame (Sphery Racer, ExerCube), kinematics were measured in 18 healthy athletes (9 male, 9 female). Knee valgus, knee internal rotation, and hip flexion angles during 10-30° knee flexion, were compared between the sexes and in each of the nine different exercises. Touches, and punches showed significant sex differences for knee internal rotation angle (main effect of sex F(1,16) = 6.14, p = .025). Depending on the exercise and side, the difference in estimated means between males and females in touches and punches ranged from 4.6-7.8°, with females showing higher values. Therefore, females display distinct movement patterns linked to anterior cruciate ligament injury, indicating that these movements should be carefully integrated into routine training and late-stage post-injury rehabilitation.