); [PERSON]@unizares (J.M.T.-M.); 2 Research Center for Sport Physiology, Hungarian University of Sports Sciences, 1123 Budapest, Hungary; [EMAIL_ADDRESS]  
[PERSON]  
2 Research Center for Sport Physiology, Hungarian University of Sports Sciences, 1123 Budapest, Hungary; [EMAIL_ADDRESS]  
[PERSON]  
1 Unidad de Investigacion en Fisioterapia, Spin off Centro Clinco OMT-E Fisioiterapia SLP, Universidad de Zaragoza, Domingo Marisal s/n, 50009 Zaragoza, Spain; [PERSON]@unizares (L.F.-L.); 739468@unizares (R.-S.  
from 38 to 59 days lost per 1000 h [1; 3; 4; 5; 6; 7]. Therefore, only 33% to 61% of players return to the same competition level after an ACL reconstruction due to a lack of self-confidence or kinesiopbobia, and the risk of reinjury is 20-27% higher in females than in males [8; 9; 10]. The ACL injury mechanism is usually promoted by a non-contact mechanism, particularly during a change of direction task, with a 48% incidence rate due to a failure in the motion pattern [1; 5; 6]. Consequently, identifying potential biomechanical and neuromuscular risk factors has become a primary focus in the research studying the prevention of ACL injuries [3; 11; 12]. Most of this research has developed a methodology focused on the kinematic and kinetic pattern [3; 4; 5; 10; 12; 13; 14]. However, despite prevention efforts focused on kinematics and kinetic factors, gender disparity in non-contact ACL injury rates persists in football, and it is higher than in other injuries [1; 2; 15; 16]. Additionally, recent studies suggest that solely focusing on kinematic and kinetic mechanisms for prevention may not be sufficient [17]. Thus, the last evidence promotes the study of the risk factors associated with the neuromuscular function, suggesting that they might be more sensitive for injury prediction in elite trained players [11; 18]. Neuromuscular function evaluation is frequently conducted by calculating the maximal voluntary isometric contraction because it ensures the highest central nervous system recruitment of motor units [8; 10; 19; 20]. Nevertheless, after an ACL injury, it has been shown that neural alterations occur [21; 22]. Specifically, previous ACL-injured people have a lesser ability to generate descending action potentials from the motor cortex, lower motor output, and higher activation of the brain areas responsible for motor processing [22]. Moreover, [PERSON] et al. [21] demonstrated alterations in quadriceps (Q) and hamstrings (H) motor unit action potentials in both injured and uninjured limbs of previous ACL-injured subjects compared to healthy controls. It seems that players who have suffered an ACL injury exhibit reduced effective strength due to inefficient contractions, as they struggle to generate more force despite heightened motor unit activation. This could explain the high rate of ACL reinjury due to the fact that in return-to-play tests for medical clearance, effective strength is evaluated, but simultaneous neuromuscular activation patterns are not analyzed [23; 24]. For that reason, following rehabilitation, the muscles inhibited by the injury and surgical intervention may not have fully recovered. The balance strength symmetry index might, therefore, be a result of compensation by the adjacent muscles [25]. Isometric H/Q ratios have been widely analyzed in ACL injury prevention programs to monitor strength imbalances. It has been considered that a co-contraction developed by H as an antagonist of anterior Q force during the stance phase in the change of direction task is necessary [26; 27]. Female players have exhibited Q dominance activation during this eccentric phase compared to males [28; 29; 30; 31]. This has also been associated with increased anterior shear forces of the tibia that can elevate ACL strain [30; 32]. Therefore, ACL acts as an antagonist of Q during the stabilization phase, restricting anterior shear associated with Q activation [32]. Moreover, the addition of high-intensity rotational forces during a sidecutting task promotes a valgus collapse position.