Camille Clinton, MD
Most of us know someone who has torn his or her ACL. What we have also become aware of is that girls are much more likely to tear their ACLs than boys. This is something that has begun to receive more attention in the press as girls and women’s sports have become increasingly competitive and common. The increase in sports participation among girls and women is a great thing, but the number of knee and specifically ACL injuries is troubling.
The ACL, or anterior cruciate ligament, is one of the 4 major ligaments in your knee. It prevents the tibia, or shinbone, from moving forward too far in relation to the femur, or thigh bone. It also prevents the knee from rotating abnormally. While an ACL is not required to walk, bike, or run in a straight line it is needed for any sports or activities that require cutting and pivoting. Not only do most people have a difficult time with these activities if their ACL is torn, but they are at risk for further injuries to the knee like meniscus tears and cartilage tears. The ACL cannot heal on its own so it must be surgically reconstructed using a tendon graft.
There are multiple reasons females are more prone to ACL tears. There are anatomic factors such as the increased angle between the hips and knees (as compared to males) and a narrower notch or bony area in the knee where the ACL passes through. Finally, there are differences in the quadriceps to hamstring strength ratio in girls compared to boys and differences in how girls jump and cut. Females tend to land from a jump and cut with their knee less bent, and their knees pointed in which puts more stress on the ACL.
We are continuing to improve our methods of ACL reconstruction, but certainly the best thing is to try to prevent these injuries from occurring in the first place. While we can’t change the bone anatomy in girls and women we can work on muscular strengthening and on improved jumping and cutting mechanics. Studies have shown that doing this can decrease the rate of ACL injuries in girls. Ideally, all girls involved in competitive sports should be doing these exercises and we should start at an early age in teaching girls improved mechanics.
We have experience with these programs and instituting them for your player and/or team. A good online resource is www.aclprevent.com or www.smsmf.org.
