ACL Tears And The Female Athlete
Anterior cruciate ligament (ACL) tears are a significant knee injury that requires immediate treatment and a lengthy recovery. This injury is common in contact sports or intense physical activity but is especially risky for women. Statistics show women are more likely to suffer an ACL tear than men. Women are also more likely to re-injure the same ACL or tear the ligament in the other knee. While the surgical process is the same, surgeons and medical professionals often take different long-term treatment approaches for women. Information on the unique challenges of ACL tears in women can help with long-term management and prevention.
All about ACLs
The ACL is a critical ligament in the knee that sits behind the kneecap, connecting the thigh and shin bones. The ligament crosses with the medial collateral ligament (MCL) to stabilize the joint. Both are responsible for rotational stability, preventing excess forward and sideways movement. The ACL can get damaged or torn, making movement and athletic performance near impossible without pain and instability. Most injuries are non-contact. An unnatural twist, fall, or landing awkwardly after jumping causes a tear. Sometimes, a collision between individuals can lead to the injury. Common symptoms include knee swelling, tenderness, a popping sensation, and instability. Up to 200,000 ACL tears occur yearly, with 70% being non-contact injuries.
Why should women worry about ACL tears?
The figures are skewed to women suffering ACL tears at a higher rate than men. This variance is due to anatomy. Women are more likely to have looser knee ligaments and a higher range of motion than men. The knee is more likely to overextend during physical activity and experience tears. The wider pelvis of women changes the general function of the bones in the lower body. These anatomical differences place more pressure on soft tissues, leading to potential ACL tears. And with less muscle mass around the joint, the risk of injury increases significantly.
Is it time for surgery?
All ACL tears do not need surgery. Some can continue to function with physical therapy and other supporting treatments. Imaging tests help doctors grade the severity of the injury, with 2 and 3 the most severe. Athletes who want to return to pain-free action will opt for surgery, known as ACL reconstruction. The procedure removes the damaged ligament and installs a new tendon from a donor or another part of the patient’s body. The new ligament is held in place with surgical wire and screws through nearby bone. Women need a tailored plan as statistics show worse functional scores after reconstruction and lower return to sports than men.
A tailored surgical approach
While the procedure for males and females is the same, doctors will approach the surgery differently for women. This change can start as early as prehabilitation. Performing exercises several days before surgery can improve postoperative outcomes. Graft selection should also be tailored to the height and anatomy of the patient. Women can also benefit from minimally invasive surgery (MIS), a procedure that uses small incisions and a scope to perform reconstruction. MIS often means smaller scars, faster healing, and better outcomes.
Recovery plan perfect for women
After surgery, patients need multiple months to heal and acclimatize to the new ligament. An additional 3-6 months are necessary to recondition and return to sports. This timeframe is where women can benefit most in achieving an excellent recovery and preventing re-injury. Women tend to be quadricep dominant and weaker surrounding muscles can cause ACL injuries. Rehabilitation exercises should emphasize hamstring and glute activation to counteract quadriceps overuse. Women should also have a separate ACL prevention program that focuses on exercises that limit injury. Common examples include plyometrics, jumping and landing alignment drills, and other forms of neuromuscular training.
Back to business with the right approach
Women are justified to feel concerned about ACL tears. The natural makeup of the female knee and leg can make injuries in contact sports more likely. Re-injury is also likely without the proper training. Women with ACL tears should work with a medical team prepared to meet the unique needs of women. ACL reconstruction should keep long-term health and preservation in mind. The subsequent rehabilitation should help improve mechanics and prevent future injuries. The right approach can help women have more peace of mind.
