Tuesday, August 7, 2012

Female High School Athletes and ACL Tears – An Epidemic Preventing ACL Tears and Treating Them When They Occur


Research has shown a 2 to 10 time increase in ACL injuries in females compared to males.  As more girls participate in high school sports this has created an epidemic of knee injuries that limits their ability to continue their athletic career and predisposes them to arthritis and further surgery in the future.

Why Do The Injuries Occur?
Much of the blame tends to fall on anatomy.  Girls and women have an increased “Q angle” – or, what might be better understood as “knock kneed”.  This changes the forces across the knee when an athlete lands or plants their foot and increases the risks of an ACL injury.

How Can The Injuries Be Prevented?
While we can’t change anatomy, athletes can decrease the risk of injury with a training regimen that puts the knee and the body in a better position when landing occurs.  Trainers and therapists can work with female athletes to increase their core trunk strength and to limit landing with the knee in a “knock kneed” (also called valgus) position. 

One recent study showed a remarkable benefit with a warm-up and core-strengthening program as noted by the lead researcher: 
“We showed a statistically significant reduction – by almost two-thirds – in ACL injuries in (participating) female teenage soccer players in a coach-directed neuromuscular warm-up program,” said Markus Waldén, MD, PhD, …  “Interestingly, players (who complied) had a reduction in other acute knee injuries as well.”

What Happens When There is an ACL Tear?
When an ACL tear does occur it is unfortunately typically a season ending injury. The data also shows that young females are at an increased risk for additional knee surgery after an ACL surgery.  This is probably because their initial risk factors were high and their younger age allows an opportunity to play the sport or activity again that may have led to the first injury.

Bracing and physical therapy are an option for a high school female athlete with an ACL tear.  However, due to the high likelihood of recurrent episodes of further giving way episodes and additional injury to the knee, many high school girls will consider and proceed with an ACL reconstruction.

There are multiple options for ACL reconstruction methods.  The primary goal is to achieve a stable knee with a new ACL graft that is similar to the original anatomy and function.  Surgery is typically an outpatient surgery.  Physical therapy is a mainstay of the treatment following surgery and is one of the primary to keys to a good outcome.  In addition, patience is important, as additional literature reports waiting for approximately one year before returning to high-level sport activity.

Information included from AAOS, Timothy E. Hewett, PhD, and Barry P. Boden, MD.

Written by Dane Glueck, MD – St. Peters Bone and Joint Surgery

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