Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Health, University of Tehran, Tehran, Iran.
10.32598/SJRM.15.2.3431
Abstract
Background and Aims Non-contact anterior cruciate ligament (ACL) injuries are severe and common in sports. Hip rotation range of motion (ROM) is crucial for limb control and may affect ACL injury risk, but existing evidence remains contradictory. This systematic review and meta-analysis aimed to investigate whether hip internal rotation and external rotation ROM differ between individuals with non-contact ACL injury and healthy subjects. Methods This study followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. Comprehensive search was conducted in PubMed, Scopus, Web of Science, ProQuest, ScienceDirect, Scientific Information Database (SID) and, Magiran. Data extraction and quality assessment were performed independently by two reviewers using the modified Downs and Black checklist. Standardized mean differences (SMD) were pooled using a random-effects model. Heterogeneity was assessed using I² and Cochran’s Q. Publication bias was evaluated through funnel plots and Egger’s regression tests. Sensitivity analysis was performed using the leave-one-out method. Results A total of 14 studies (1437 participants) were eligible for the internal rotation analysis and 13 studies (1113 participants) for the external rotation analysis. Meta-analysis showed no significant differences between the ACL-injured and control groups for hip internal rotation (SMD=–0.60; 95% CI, –1.40 to 0.20; P=0.14; I²=0%) or hip external rotation (SMD=–0.45; 95% CI, –1.23 to 0.33; P=0.26; I²=0%). Sensitivity analyses confirmed the stability of the findings. Egger’s test detected no publication bias for either variable (internal rotation: P=0.69; external rotation: P=0.95). Conclusion It seems that hip internal rotation and external rotation ROM alone are not independent predictors of non-contact ACL injury. However, combined rotational imbalance, particularly increased internal rotation with limited external rotation, may contribute to altered knee loading patterns in high-risk individuals. Multidimensional biomechanical assessment, rather than reliance on isolated hip ROM measures, is recommended for ACL injury screening and prevention.
Kheiroddin, F., Minoonejad, H., & Alizadeh, M. H. (2026). Association Between Hip Internal and External Rotation Range of Motion and Non-contact Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis. The Scientific Journal of Rehabilitation Medicine, 15(2), 166-183. doi: 10.32598/SJRM.15.2.3431
MLA
Fatemeh Kheiroddin; Hooman Minoonejad; Mohammad Hossein Alizadeh. "Association Between Hip Internal and External Rotation Range of Motion and Non-contact Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis". The Scientific Journal of Rehabilitation Medicine, 15, 2, 2026, 166-183. doi: 10.32598/SJRM.15.2.3431
HARVARD
Kheiroddin, F., Minoonejad, H., Alizadeh, M. H. (2026). 'Association Between Hip Internal and External Rotation Range of Motion and Non-contact Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis', The Scientific Journal of Rehabilitation Medicine, 15(2), pp. 166-183. doi: 10.32598/SJRM.15.2.3431
VANCOUVER
Kheiroddin, F., Minoonejad, H., Alizadeh, M. H. Association Between Hip Internal and External Rotation Range of Motion and Non-contact Anterior Cruciate Ligament Injury: A Systematic Review and Meta-analysis. The Scientific Journal of Rehabilitation Medicine, 2026; 15(2): 166-183. doi: 10.32598/SJRM.15.2.3431
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