Leg dominance during various cutting movements: A systematic review and meta-analysis of knee biomechanics related to anterior cruciate ligament injury.

Abstract

The rupture of the anterior cruciate ligament (ACL) is a common and serious sports injury, but reported differences in the rate of ACL rupture of the dominant versus nondominant leg are inconsistent. The present review aimed to investigate the effect of leg dominancy on biomechanical risk factors of the ACL injury during various cutting movements. A systematic literature search was conducted in six electronic databases (Google Scholar, ScienceDirect, Web of Science, PubMed, Scopus and Cochrane Library) up to 15 July 2025. Thirteen studies with 449 subjects met the inclusion criteria. In addition to analysis for the complete population, subgroup analyses were done based on level of athleticism and gender. The risk of bias score for the included studies was between 9 and 11.5. The overall meta-analysis showed no significant difference between the dominant and nondominant leg during cutting for the knee abduction moment (95% confidence interval [CI] = -0.137, 0.110; p = 0.833; 12 studies), knee abduction angle (95% CI = -0.140, 0.325; p = 0.436; 13 studies) and knee flexion angle (95% CI = -0.618, 0.013; p = 0.060; 11 studies). Subgroup analysis of those variables showed a higher knee abduction moment in the nondominant leg for amateur athletes (95% CI =0.042, 0.365; p = 0.014; four studies; low effect size) and lower for semi-professionals (95% CI = -0.381, -0.027; p = 0.024; five studies; low effect size), while a lower knee flexion angle in the nondominant leg was observed for females (95% CI = -1.047, -0.105; p = 0.017; eight studies; moderate effect size) and semi-professional athletes (95% CI = -1.135, -0.185; p = 0.006; five studies; moderate effect size). Limb-specific biomechanical differences during cutting tasks change by skill level and gender, highlighting the need for tailored, population-specific injury prevention strategies. Level II.