Women’s ACL Injuries
ANTERIOR CRUCIATE LIGAMENT (ACL) INJURIES IN WOMEN
More and more athletic women and girls are injuring their knees, often seriously. Why?
One reason is that more females are participating in more serious sports than ever before. Soccer, volleyball, and basketball (as well as other sports) are great examples. As overall sports participation among males remains level, more women of all ages are playing and competing in sports. Years ago, girls sports were only in high school, but now girls are beginning to compete at younger ages and continuing to play well beyond the school years. Look around—you will see more and more women playing competitive sports on adult coed and women’s teams into their forties and beyond! The shear number of female athletes means that more will get injured. Unfortunately, that is a fact of sports and of life.
Obviously, some sports are more dangerous than others. However, there is growing evidence that women are more likely to suffer a knee injury such as an ACL tear than men playing the same sport! It may not seem fair, but it does appear to be true. There are a few reasons that this happens, and also a few things that can be done to decrease the risk.
One reason for this increased risk of serious knee injuries among women athletes (compared to male athletes) is the difference in alignment of the leg in women. The female pelvis is usually broader than the male pelvis, which creates a more “knock-kneed” alignment of the knee (called “valgus”). This alignment is thought to put more stress on the ACL during twisting activities like cutting, changing direction, jumping for a header, or turning on a ball. Also, the area of the knee where the ACL resides (called “the notch” because it is a cave or notch in the femur bone) tends to be narrower in females than in males. The bone can actually cut through the ligament if the knee hyperextends, so a notch with more room is less likely to do this! Also, there estrogen seems to be associated with increased knee looseness (“laxity”), but it is not yet known if this predisposes toward tearing the ACL.
One other reason sports medicine doctors believe that ACL tears are more frequent in women is due to differences in strength and balance, called “proprioception”. Some of this is thought to be that as children boys have tended to be more physically active than girls. Of course, this is changing, but for many adults this was true when they were children. The good news is that this can be changed as teens and adults via “proprioception” programs that involve sprints, jumping drills, plyometrics, and agility drills. Maximizing your speed and agility improves your sports performance, plus it lowers your risk of serious knee injury!
So, while all athletes in agility sports such as soccer, basketball, etc. have a risk of tearing their ACL, this risk is higher in females. Some of the risk factors can not be changed, but some can! So, take advantage of agility training programs (whether you are male or female) to minimize your risk.
Note that gender plays a role in graft choice for ACL reconstruction. The bottom line is that in women ACL grafts tend to stretch out more than in men. This is most pronounced in hamstring and donor tendon (allograft) grafts, especially in teenage girls. So, in competitive female athletes I typically recommend using a patella tendon graft in order to provide a more stable knee.