Anterior cruciate ligament tears in female athletes are among the most common injury seen in my office. Knee injuries in general are the highest reason for female season-ending injuries with nearly all requiring surgical treatment. Soccer and basketball are the most injury-prone sports.
Many sports, like running, swimming and cycling have little impact on the ACL, however others like soccer, basketball and volleyball rely on the ACL for knee stability. More than 70% of ACL tears do not involve contact with another player. The mechanism is typically a sudden change in direction, land from a jump or cutting move.
Sudies have shown that young women are on average 5-6 times more likely than men to sustain an ACL tear.
There is no clear cut reason as to why this occurs. There are some ideas that are currently considered:
Women have different anatomy within the knee compared with men – the notch between the medial(inside) and lateral (outside) compartments of the knee is typically more narrow and the size of the ACL is somewhat smaller, making it more prone to injury.
Women typically have a wider pelvis than men, affecting the angle of the bones at the knee resulting in different contact pressures within the joint.
Women, in general, have more laxity, or ‘stretchiness’ to their ligaments than men. Female muscle tissue is also more flexible than that in men.
Female hamstring strength may be overall lower than men, resulting in less ability to control the movement of the knee, resulting in higher stress to the ACL.
Fluctuation in estrogen levels throughout a female cycle has been postulated to contribute to ACL strength, although this has not been proven and some studies suggest it may not be true.
Tomorrow, we will look at ideas to decrease this risk and help prevent season ending injuries in young women.
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