Women, girls at significantly higher risk for ACL tears
By Peter Loescher, MD
One of the great developments in athletics over the last 20 years in this country has been the increasing participation of women and girls in all kinds of sports.
Prior to 1984, women were barred from competing in the Olympic marathon because it was believed that such distances were unhealthy for the female body to endure.
Since, we have come a long way. But in the world of sports medicine, some concerning trends have emerged as women compete at higher and higher levels of sport, with increasing skill, speed and strength.
One of the most startling trends is the rate at which women tear the anterior cruciate ligament (ACL) in their knees.
Especially in sprinting and cutting and change of direction sports such as soccer and basketball, females are up to eight times more likely to tear an ACL compared to males competing in the same activity.
In medical research, an eightfold discrepancy between the genders for any condition is cause for alarm. Many theories have been proposed by medical researchers to explain this discrepancy, including:
- Females are smaller and thus have smaller ACLs
- The notch in the knee that the ACL passes through (the intercondylar notch) is narrower and sharper in females
- The angle at which the thigh bone enters the knee joint in women is not as well designed for running and jumping compared with men
- Women in general are more flexible, with looser ligaments, tendons and muscles
- Monthly hormonal fluctuation may relax ligaments prior to menstruation
- Muscles are important stabilizers of all joints, and females in general have smaller and less developed muscles than males
- Females, when tested, also consistently have weaker hamstring muscles (back of thigh) relative to their quadriceps (front of thigh) as compared with males, causing an imbalance
- Women, in general, play sports in a more upright position than men. The less flexed the knee is, the greater the risk of ACL tear, especially when stopping suddenly.
When studied, none of these hypotheses alone could explain the high rate of ACL tears in women compared to men. But taken together, they may begin to tell the story.
Analysis shows that 70 percent of ACL tears in females occur in non-contact injuries. These injuries seem to come primarily from four types of movements: sudden deceleration while running; a sharp pivot, plant and cut (change of direction); a one-step stop with knee extended (not bent); and landing a jump with the knee extended.
The good news for women, however, is that there are steps they can take to reduce their risk of an ACL tear.
A revealing study done in Cincinnati in 1995 demonstrated that when a group of 1,263 female high school athletes were put through a comprehensive six-week strengthening, balance and stretching program designed to protect the ACL, the incidence of ACL injuries decreased nearly fourfold in this group relative to their untrained peers. Another similar study demonstrated a fivefold decrease in ACL injury in a smaller study group.
This data argues strongly that dynamic balance training, core strengthening, hamstring strengthening and specific training on proper jumping, landing, running and cutting techniques, should become standard off-season and preseason work for female athletes, especially those playing sports such as soccer, basketball, lacrosse, rugby, field hockey and alpine skiing.
Dr. Peter Loescher is a sports medicine specialist at Gifford Medical Center’s Sharon Health Center and Sports Medicine Clinic.
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