Increased ACL Injury Risk in Female Athletes



ACL injuries are common, costly and potentially debilitating. It is estimated that 95,000 new ACL injuries occur each year (1 in every 3000 persons). Those individuals who suffer an ACL injury and undergo surgical intervention face a lengthy rehabilitation process ranging from 6 to 36 months.

Unfortunately, surgical intervention does not ensure a return to previous activity levels. Only 75 percent of these individuals return to their previous activity levels. Moderate to severe disability is reported in individuals suffering from ACL injury during walking activities, routine activities of daily living, and sport activities. The outlook is worse for individuals who do not undergo surgical intervention following ACL injury.
 

The rate of ACL injury is greater in females than males, especially in younger individuals. As the number of females participating in competitive and recreational activity continues to increase, the number of females sustaining ACL injury can be expected to increase. Thus, ACL injury prevention programs should target females who are at greatest risk.
The majority of ACL injuries involve no contact with another athlete and these injuries are more common in females.

Approximately 70 percent of ACL injuries are non-contact in nature and almost always occur as the body undergoes rapid deceleration while performing either: 1) planting and cutting maneuvers or 2) landing from a jump. In addition, females are at 3-times greater risk for sustaining an ACL injury during non-contact mechanisms when compared to males competing in the same sport. ACL injury prevention programs should focus on preventing non-contact ACL injury, especially in females.

The associated biomechanical risk factors, in no particular order are below’

1. 
   Greater Q-Angle – the inherently wider hips in women vs. men creates an angle between the hip socket and the center of the knee, that loads the medial knee and ACL more in women.
2. Pronation (fallen arches) at the foot – any athlete, whether male or female with excessive midfoot pronation has a greater risk for ACL non-contact injuries due to the altered biomechanics.
3. Inhibited/Weak Glute Medius – a weak or inhibited glute medius will allow for excessive contralateral (opposite side) hip drop while running while allowing for greater ipsilateral (same side) internal rotation of both the hip and knee, exposing the knee to greater risk of ACL injury.
4. Quadriceps Dominance from inappropriate training protocols – all too often male and female athletes are unaware of the biomechanical changes that can occur from simply not training the posterior chain (i.e. glute max, hamstrings, low back, among others) greater than the anterior chain (i.e. quadriceps, hip flexors etc) can increase their risk of knee injuries, especially to the ACL.
5. Hormonal Differences – this is often debated difference between male and female athletes.  The question is simply;  does the inherent hormonal differences add to the greater risk of ACL injury by causing increased laxity in ligaments?

BOTTOM LINE -  All of the above associated risk factors, except for Hormonal differences between men and women, can be decreased significantly with a proper BioMechanical Assessment and Corrective Exercise program.
 
Yours in Sport,
 
Dr. A
 
Jason Amstutz DC, RTP, CCSP, CSCS                  
Synergy Chiropractic & Rehab
Strength and Conditioning Specialist                             
call 949-631-5226 for Appts

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