ACL Tears Plaguing Female Athletes

Times-Herald Record—February 27, 2011

It's not like Sara Cannillo was climbing the side of a mountain or doing 360 degree spins off her bike during the X-Games.

Cannillo, a sophomore at S.S. Seward, was simply slowly jogging up court during a basketball game with nobody around her and, when she slowed down, her right knee buckled and she tore her ACL.

ACL tears, which are debilitating knee injuries when the center part of the knee connecting the femur and tibia tears, have plagued women's athletics. In the past 10 to 15 years, doctors and researchers have found that females are 2 to 10 times more likely to suffer an ACL injury than their male counterparts.

“It's become apparent that females have significantly higher risk than males, and that's adjusted by how much time they spend playing sports,” said Dr. Robert Marx, attending orthopedic surgeon at Hospital for Special Surgery in New York City. “They are less common before puberty and more common in the junior and senior year of high school.”

Up until puberty, ACL ruptures reportedly occur at about the same rate in males and females. At the age of 12, there is a large rise in ACL injuries in females and they peak at age 16.

Reason Difficult to Pinpoint

Several studies have explored different reasons for the drastic difference between male and females when it comes to the debilitating knee injury, but have yet to pinpoint just one reason.

The most common theories are that ACL tears in women can be due to anatomical structure, genetics, estrogen levels or hormones, muscle development or physical fitness.

“The short answer is we don't know why, but it's definitely a combination of things,” Marx said. “A few reasons are that girls land in more knock-kneed positions from jumps. They have weak hips that allow the knee to crumble in that knock-knee position. They tend to be quadriceps dominant and have weak hamstrings which also affect the knee.”

Cannillo is just one example of the estimated 80 percent of ACL injuries in females that are a result of non-contact. Those typically occur during change of direction, sudden deceleration, cutting movements, awkward landings or twisting, and when an athlete plants wrong.

Two-thirds of athletes usually hear a popping sound and experience swelling immediately. Soccer and basketball are the sports most common for ACL injuries in women, followed by volleyball and lacrosse.

Rehabilitating the Knee

The rehabilitation process is long and arduous. After surgery, it typically takes six months to a year to fully recover, depending on the person. An average person takes nine months, Marx said.

Cannillo did rehab for two weeks pre-surgery and now does it three times a day since the surgery in January. Cannillo's exercises include knee bends and quad muscle workouts.

“It's definitely harder mentally,” Cannillo said of her rehab process. “It's frustrating because the exercises are hard and you can't do as much as you usually can.”

The first step of physical therapy is to return motion to the joint and surrounding muscles, and that is followed by strengthening the new ligament. The final phase is aimed to returning the athlete to doing things specific to their sport, Marx said. Basically, the athletes are relearning to do the menial things that once came easily, like walking and running.

Girls are also more likely than boys to reinjure the knee or injure the other knee, Marx said.

This story originally appeared at recordonline.com.