Knee Pain and ACL Injury in Female Athletes
Kevin G. Shea, M.D.ANTERIOR CRUCIATE LIGAMENT (ACL) INJURY IN FEMALES
Sports injury data collected over the past decade clearly indicate that female participants in jumping and cutting sports sustain non-contact ACL injuries at 3 to 6 times the rate of males. These injuries can be devastating, and these patients are at increased risk for degenerative arthritis of the knee. In many cases, these injuries prevent the athlete from returning to the same level of competition.
Numerous theories to account for the discrepancy in injury rates between male and female athletes have been proposed. Current research on female ACL injury includes investigations of anatomical, biomechanical, hormonal, and performance related variables. Many different factors have been studied, including:
1. HORMONE EFFECTS ON LIGAMENTS. Ligaments may be 'more loose' in females, because of the effects of hormones or the menstrual period.
2. ACL SIZE. The ACL is smaller in females, and therefore, weaker compared to males.
3. ANATOMIC DIFFERENCES IN THE THIGH AND HIP BONES. These differences may make women more prone to injury.
4. TRAINING/ENVIRONMENTAL DIFFERENCES. Females may start participation in sports at a later age, which may affect the development of strength.
5. MUSCLE STRENGTH. Women tend to have weaker quadriceps and thigh muscles, which can increase the risk of knee injury.
6. JUMPING/LANDING DIFFERENCES. Women tend to land and jump differently, which increases their risk of ACL injury.
Several studies have suggested that increased knee injury in female athletes is secondary to decreased muscle strength and improper jumping and landing techniques. Recently, some researchers have focused upon injury prevention conditioning programs that improve strength and jumping techniques. Hewett, et al, reported a significant reduction in the incidence of ACL injury in a group of female high school athletes after participating in a program of "jump-training" prior to the sports season.(1) Caraffa, et al, reported similar results using a program of proprioceptive training in Italian semiprofessional and amateur soccer players.(2) Theoretically, these intervention programs will help athletes avoid these significant injuries by improving strength and jump/landing techniques. Additional research on this topic is necessary.
(1) Hewett, TE, Lindenfeld, TN, Riccobene, JV, Noyes, FR (1999). The effect of neuromuscular training on the incidence of knee injury in female athletes - a prospective study. The American Journal of Sports Medicine, Vol.27(6), pp. 699-705.
(2) Caraffa, A, Cerulli, G, Projetti, M, Aisa, G, Rizzo, A (1996). Prevention of anterior cruciate ligament injuries in soccer - a prospective controlled study of proprioceptive training. Knee Surg, Sports Traumatol, Arthroscopy, Vol. 4, pp. 19-21.
If you have questions about these research programs, many of these research topics can be accessed over the internet. If you would like more information, you can review these topics at the following web sites.
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