• ACL Injuries in a Female Athlete

  • Michelle Snyder

    The Anterior Cruciate Ligament (ACL) is one of the four major ligaments which stabilize the knee. An injury to the ACL is devastating and unfortunately very common among high school athletes. 80% of ACL tears occur through non contact mechanisms such as pivoting, cutting and landing from a jump. The recovery following an .ACL repair is long and extensive. Moreover, secondary complications include meniscus involvement and long-term complications include an early onset of osteoarthritis.

    Approximately 200,000 ACL injuries occur annually in the United States. The highest incidence is in the 15-25 year-old athletes. Female athletes are more likely to sustain this injury man alarming rate. Non-contact ACL injuries are up to eight times more common in the female population. The risk factors contributing to a higher incidence of ACL injury in the female athlete have been thoroughly reviewed in the literature. Contributing factors fall into three categories: anatomical, hormonal, and biomechanical.

    Anatomically, females' hips tend to be wider and turned inward compared to males. Females also have greater genu valgum, which is also known as "knock-knees'. Females tend to have increased foot pronation compared to males, which means their feet are flat. Females also have greater mobility in their joints compared to males and more laxity in their ligaments. These differences put the ACL in a more vulnerable position. They also put more strain on the ligament and decrease stability at the knee joint.

    The next risk factor is related to hormones. Fluctuations in hormones throughout the menstrual cycle may increase risk of injury. However, research into this category is unclear and inconsistent. Further research is required to gain a better understanding of this topic. 

    The last category is biomechanics. This is an important category because it is where we can really have an impact. Compared to males, females present with decreased muscular control and improper form during sports specific movements.  While landing from a jump, females land with their knees closer together. They also land with straighter, stiffer knees. Landing in this position puts the athlete at a high risk for an ACL injury. 

    Since there has been a rise in the number of ACL injuries in female athlete, there have also been a growing number of ACL injury prevention programs. The emphasis of these programs has been on improving biomechanics and muscular control. Most programs include stretching, strengthening, plyometrics, balance, sport-specific agilities and feedback on proper technique. Prevention programs have been successful in decreasing the occurrence of ACL Injuries by 60-89%.

    One program that has been very popular and effective is the PEP Prevent Injury, Enhance Performance) Program, which was designed by the Santa Monica Orthopaedic and Sports Medicine Research Foundation. The program was developed in 2000 and has a 70-88% success rate. The program is a 20 minute training session that takes the place of the traditional warm-up 2-3 times per week. The goals of the program are to avoid high risk and vulnerable positions, increase strength, increase balance and joint awareness and increase flexibility.