Female Athletes More Susceptible to ACL Tears
BY LAUREN UZDIENSKI, JUNE 2, 2008
In February, the New York Times reported on a rise in pediatric ACL cases, attributed to aggressive athletic activity, the increasingly common practice of MRI scans for injured knees and physicians' heightened familiarity with pediatric ACL tears. Now an article by Michael Sokolove that ran in the Times Magazine last month depicts female athletes as uniquely vulnerable to ACL tears, with some research showing that female athletes rupture an ACL five times as often as male athletes do.
Since the 1972 adoption of Title IX, a federal law mandating equal opportunity in sports, the number of female athletes has swelled dramatically. With it, the article asserts, rose an intense culture where women, already more susceptible to knee pain, shin splits and stress fractures, pushed themselves to play through injuries. The notion that girls could be as competitive and tough in sports as boys seemed, on some levels, in conflict with biology. Testosterone helps boys add the muscle that keeps joints stable. Women require more effort to build muscle and are more flexible, a characteristic attributable to estrogen, but that causes ligaments to be less stable as well. Women tend to be more upright when they run, which could risk their knees when changing directions or landing from jumps, and wider hips brings a correlation with being knock-kneed, which could itself be associated with ACL damage.
No one knows what causes an ACL rupture, and what makes it particularly mysterious is that it seems to happen under relatively ordinary circumstances; changing directions, for example. The injury also happens with unsettling frequency. The author calculates that of a 20-member soccer team, four of the girls will rupture an ACL during a high-school career. Though no direct cause has been identified, consensus is generally that stretching and strengthening exercises can help to prevent a tear. One program that is targeted specifically at women is PEP, though participation in warm-ups is always challenged by the fact that they tend not to be especially fun. It's probably unlikely that girls' participation in sports will decline in the coming years, so the key issue for orthopedic device manufacturers and surgeons is familiarity with the lifestyle and expectations of this unique patient population, insight that Sokolove's article and upcoming book helps to provide.
