Female Athletes and ACL Injuries
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Over 95,000 anterior cruciate ligament (ACL) tears occur each year(2). When you stop or turn quickly, this important tissue keeps the thigh bone (femur) from slipping forward over the shin bone (tibia) (1). Interestingly, many studies have shown that female soccer, basketball, and volleyball athletes have an ACL injury rate that is two to four times higher than males (5, 6). Most scientists agree that there are several factors that cause females to suffer more ACL injuries.
One factor is the wider female pelvis(9). The wider pelvis changes the angle of the leg muscle attachments and increases the forces acting on the knee. Also, ACL injury rates are slightly increased when estrogen levels are higher during the menstrual cycle (7, 8). Additionally, women have proportionally stronger muscles in the front of their leg (quadriceps) than in the back (hamstrings) which results in a muscular imbalance and increases the ACL rupture risk (5, 6).
Even with an increased risk, women can prevent ACL injury. Strengthening of the hamstrings, developing flexibility, learning proper jumping and landing techniques, and avoiding some movements, especially straight-knee landings and one-step stop landings can all help prevent ACL injuries(3, 5, 6).
There are both surgical and non-surgical options available to repair an ACL injury(1, 2). The non-surgical option consists of physical rehabilitation and is often used by individuals that do not wish to return to their sport(2, 5). Because most people want to return to their sport, many chose a surgical repair option. There are three basic types of surgical ACL repair which all involve the use of a piece of ligament-like tissue from either the patient or from a donor (2, 5). Surgical ACL repair is successful 85-92 percent of the time and can return knee functioning to normal (2). Consultation with your physician and an orthopedic specialist will help you pick the appropriate ACL repair option for your situation.
A large factor in ACL repair success is proper rehabilitation. ACL rehabilitation focuses on strengthening the injured knee and usually starts on the day of the surgery (2). Rehabilitation lasts for three to 12 months depending upon your progress and your physician's guidance (2).
A torn ACL used to be a catastrophic injury for an athlete - often ending their athletic career. However, new knowledge regarding prevention, treatment, and rehabilitation is enabling individuals to continue to be active in the sport and lifestyle of their choice.
References:
1. American Academy of Orthopaedic Surgeons. "Knee ligament injuries". June 2000 (http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=157&topcategory=...)
2. American Academy of Orthopaedic Surgeons. "ACL Reconstruction". October 2000 (http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=216&topcategory=...)
3. American Academy of Orthopaedic Surgeons. "Preventing ACL injuries in women". June 2000 (http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=158&topcategory=...)
4. American Academy of Orthopaedic Surgeons. "Women and ACL Injuries". February 2002 (http://orthoinfo.aaos.org/fact/thr_report.cfm?thread_id=85&topcategory=k...)
5. Redican, L. Female Athletes and ACL Injuries. Women's Health Education Program. 3:6, Aug. 1999.
6. Moeller, JL, MM Lamb. Anterior Cruciate Ligament Injuries in Female Athletes: Why are women more susceptible? The Physician and Sportsmedicine. 25(4), 1997.
7. Liu, SH, RA Al-Shaikh, V Panossian, et. al. Estrogren affects the cellular metabolism of the anterior cruciate ligament. A potential explanation for female athletic injury. American Journal of Sports Medicine. 25: 1997.
8. Henning, J. Estrogen increases laxity of ACL. Unpublished Masters Thesis. Univ. of Virginia. 1998.
9. Woodland, LH, RS Francis. Parameters and comparisons of the quadriceps angle of college-aged men and women in the supine and standing positions. American Journal of Sports Medicine. 20: 1992.
10. Shelbourne KD, TJ Davis, TE Klootwyk. The relationship between intercondylar notch width of the femur and the incidence of anterior cruciate ligament tears. A prospective study. American Journal of Sports Medicine. 26: 1998.
