ACL Injuries in Female Athletes
As any successful athlete knows, there’s no substitute for strenuous training and play. Yet, in their quest to be the best, girls suffer more anterior cruciate ligament (ACL) tears than boys who engage in the same sports.
Why do females face such a hurdle? Alex Schroeder, M.D., who is fellowship trained in arthroscopy and sports medicine and affiliated with Memorial Hermann Memorial City Medical Center, describes the answer with a simple anatomy lesson. “The angle between the quadriceps muscle and the patellar tendon – known as the Q-angle – is about 18 degrees for a woman and about 13 degrees for a man,” said the orthopedic surgeon. “The higher the number of degrees, the more knock-kneed the individual is and, theoretically, the more predisposed to having an injury. Proportionally, females have wider pelvises so there is a mechanical alignment difference, as well.”
Physiology may also figure into the equation.
“Doctors hypothesize that the likelihood of injury increases during the menstrual cycle when ligaments are more lax,” Dr. Schroeder said.
“It was once thought that females sustained greater injuries because there was not quite the same focus on training, strengthening and conditioning,” he explained. “In this day and age that’s all changed, especially at the elite level of high school, college and professional sports. Nowadays, sports for women are more accepted, encouraged and pushed than in the past. There are more instances of injuries not only because of the sheer numbers but also because female athletes play just as aggressively as men.”
Dr. Schroeder’s personal research on sports-related meniscus injuries in females shows soccer and basketball at the top of the heap.
“Soccer players tend to have more knee injuries, while basket- ball players tend to have more ACL injuries requiring surgery,” he said. “We really don’t know why, except that there’s more direct contact in soccer. In basketball, there’s the matter of players coming down, landing on another person’s foot or at an odd angle.”
So how should the issue be addressed? Dr. Schroeder believes that increasing awareness among athletes and informing their parents of potential issues can have a positive impact.
“Parents don’t readily know the risks until their child gets hurt,” he said. “They need to be told that their daughters may be more likely to incur an injury so they can be aware of problems, treatment options and outcomes. Deciding the right time to strengthen and condition – particularly quads and hamstrings – or whether or not to brace can help with preventive maintenance. We also need more research into the role of hormones, which may be controlled with medication.”