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The Risk of ACL Injuries in Female Athletes

Since the introduction of Title IX in 1972, there has been a 545% increase in the number of women playing college sports and an astonishing 990% increase in the number of women playing high school sports. From minor sports leagues to the Olympic stage, women are breaking barriers, shattering records, and making history one day at a time. And while the growing popularity of women’s sports has helped countless women achieve success both on and off the field, it has also led to a new challenge that they must overcome—a greater risk of orthopaedic injuries.

Each year, 20,000 to 80,000 female high school athletes sustain an ACL injury. While the potential to sprain, tear, or even rupture the ACL has always been a risk for those participating in high-intensity sports, female athletes are 5 times more likely to sustain a non-contact ACL injury than their male counterparts. This natural susceptibility, combined with the increasing number of women participating in sports, has contributed to the overall epidemic in ACL injuries.

Anterior Cruciate Ligament (ACL) Injuries

The anterior cruciate ligament (ACL) is a flexible band of tissue that runs diagonally in the middle of the knee, providing it with the stability that is necessary for rotational movement. When the ACL has been stretched too far, it will sprain or tear, causing knee pain and occasional instability. When the ACL completely tears, the knee won’t be able to support any weight.

Why Do Women Suffer More ACL Injuries?

There is no single or definitive reason why women are more vulnerable to ACL injuries than men. Rather, many orthopaedic experts agree that it’s a combination of both anatomical differences and biomechanical differences between men and women.

Physical Factors

Smaller Intercondylar Notch and ACL: The intercondylar notch, which is the groove in the femur where the ACL passes through, is naturally smaller in women than it is men. Of course, this means that the ACL itself is also smaller in order to accommodate the narrower passage.

Wider Pelvis: In general, women have a wider pelvis which causes the downward angle of the thigh bones to be sharper. This causes women to bend their knees towards the midline of their body, placing additional stress on the ACL.

Lax Ligaments: Women also have more elastic ligaments than their male counterparts. This greater flexibility makes the ACL more prone to being stretched and twisted.

Technical Factors

Flat-footed Landings: Studies show that women typically jump and land with the soles of their feet instead of on the balls of their feet. By landing flat-footed, the knee has to absorb most of the shock.

Running Upright: Studies show women tend to run in a more upright position than men. This gives them less control over how the knee rotates, especially during sudden movements.

Quad Dominance: Studies also show that women tend to have stronger quadriceps than hamstrings. This can cause a female athlete to rely more on her quadriceps for movement. Consequently, the knee compensates for the lack of hamstring strength by placing additional stress on the ACL.

How Can Women Lower Their Risk of ACL Tears?

Preventing ACL injuries requires a comprehensive approach focused on:

  • Improving leg muscle strength and core muscle strength
  • Improving/learning proper jumping and landing techniques
  • Improving balance and speed
  • Wearing proper footwear specific to their sport

Strengthening the muscles that support the knee (quadriceps, hamstring, hip adductor, and gluteus muscles) as well as plyometric training have been shown to be the most effective methods of lowering women’s risk of an injury.

Athletes will also want to consider an evidence-based, sport-specific training program. These programs will not only help athletes lower their risk of an injury but will also improve their performance.

What to Do When You Experience an ACL Injury

While every athlete faces the risk of a torn ACL, this is far too often a reality for women playing soccer or basketball. And even with proper prevention methods, injuries can still happen.

It’s important to not only take steps to prevent injury, but also recognize the signs and symptoms of an ACL injury. Early treatment from an orthopaedic specialist is crucial for not only reducing painful swelling but also for preventing the development of osteoarthritis. And, of course, the earlier the treatment begins the sooner an athlete can return to her sport.

If you experience an ACL injury, schedule an appointment to see an orthopaedic specialist at Beacon Orthopaedics & Sports Medicine. We also provide a walk-in clinic in Northern Kentucky for immediate orthopaedic care.