ACL injuries: not just for athletes (or men)

When people hear about ACL injuries, they often think of men – particularly professional athletes of high-impact sports like football or soccer.

However, ACL (anterior cruciate ligament) injuries are seven times more common in women, and simple anatomy may be to blame. ACL injuries interfere with daily life and involve a lengthy recovery. UVA orthopaedic surgeon David Diduch, MD, explains why women are more susceptible to ACL injuries and what can be done to prevent them.

Understanding the ACL

The ACL is one of four primary ligaments that stabilize the knee by holding together the thighbone, shinbone and kneecap. ACL tears occur most frequently in athletes whose sports involve running, jumping and cutting – like basketball and soccer – but anyone is at risk.

Why is the female knee more prone to injury?

1. Architecture

Women have proportionally wider hips than men, creating potential alignment problems that can aggravate the knee during activities that involve changing direction quickly, landing awkwardly from a jump or stopping suddenly. Also, the notch in the knee where the ACL is located is narrow in women, Dr. Diduch explains. The roof of that notch may catch the ACL as the knee goes into a pivot, and it may shear off the ligament.

2. Technique

Some studies suggest that females have different movement patterns than men – likely because of their structural differences. Women tend to angle their knees inward in a knock-kneed position when they land after jumping, which puts their ACL at risk of injury.

3. Hormones

At certain times in a woman’s menstrual cycle, the ligaments around the knee can be more susceptible to injury because of the way estrogen may affect the ACL’s laxity.

Avoiding injury

To avoid ACL injuries, Dr. Diduch recommends following a six-week jump-training program to strengthen the muscles and ligaments around the knee. Called plyometrics, jump-training programs consist of a series of exercises, alternated throughout the weeks, like squat jumps, wall jumps, step-ups and other movements. When performed properly, these programs have been shown to reduce the rate of ACL tears, especially in female athletes, by building strength and training the body in proper landing techniques.

Repairing a torn ACL

A torn ACL cannot heal on its own. Non-surgical options like physical therapy or leg braces may be satisfactory for elderly patients or those who lead a sedentary lifestyle. But without surgical repair, components of the knee are at high risk for further damage that could lead to late arthritis.

“ACL reconstruction is done arthroscopically, which is a minimally invasive outpatient procedure,” explains Dr. Diduch. “We make a small incision in the knee and replace the ACL with a tissue graft – preferably the patient’s own hamstring or patella tendon. Patients usually go home the same day.”

Rehabilitation begins the next day, and it takes about six months before the patient can return to a level of physical activity close to where they were before the injury. Dr. Diduch estimates the success rate for ACL reconstruction is about 90 percent in terms of getting patients back to playing sports and being active.

Take action

Dr. Diduch and his colleagues at the UVA Sports Medicine Clinic see a high volume of patients with knee injuries, including torn ACLs. But you don’t have to suffer a knee injury to consult with a specialist and get started on a six-week plyometrics program. UVA orthopaedic specialists care for patients of all ages and abilities – from recreational athletes to elite competitors, to non-athletes.

To make an appointment, call 434.243.7778. Jump-training program handouts are available at the Sports Medicine Clinic free of charge.