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Women Are At Higher Risk For Common Knee Injury

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By ERIC CORIS, M.D. Tribune correspondent

The Tampa Tribune

Published: November 29, 2008

Faith had stopped crying by the time she reached the training room. A talented young soccer player and part of the backbone of her team, she had spent the last year rehabilitating a tear of the major stabilizing ligament of the knee. Her anterior cruciate ligament (ACL) was torn in drills early in the season, a huge loss for us and for her.

She hit rehab hard, achieved goals sooner than expected, and returned faster and stronger than before the injury. Now she was hobbling in again. As she was helped into the training room by the athletic training staff, keeping weight off the right leg, my stomach sank a bit.

She apparently was participating in a match when she planted her right leg to change direction quickly. She experienced a sudden painful "pop" in the knee, felt her knee "give way," and collapsed to the turf in pain. She knew right away it was not good, having been through this before. The typical hemarthrosis, swelling due to blood build up in the knee, was developing already. The "Lachman" test (the forward shift of the shinbone on the femur as a result of tearing the ACL) confirmed that Faith had re-torn her ACL.

Ruptured or torn ACLs are among the most significant of all sports-related knee injuries. Most common in soccer and basketball, female athletes are four times more likely than male athletes who play the same sport to tear their ACLs.

With 3 million female athletes playing high school sports in the United States, the public health impact is significant. One study reported a total cost of $44 million to repair and rehabilitate the 2,200 ACL tears in one year among female athletes in the National Collegiate Athletic Association. Debate continues on why women are at higher risk than men for this particular injury, but the difference is thought to be largely related to the way the conditioned female athlete fires her thigh muscles compared to the conditioned male athlete. Differences in hormones, anatomy, alignment and other issues also likely play a role.

Unfortunately, many seasons are spent sidelined and many dreams are shattered by this "sudden stop, heard a pop." The good news is we have come a long way in treating ACL injuries. Athletes endure less-invasive surgery, recover quicker with less pain and experience improved outcomes with ACL reconstruction. The even better news is that we may be getting better at prevention. The USF Health Sports Medicine and Athletic Related Trauma Institute (SMART) is working with high school athletes in Hillsborough County to try to reduce these knee injuries by teaching girls to move safely.

Studies have shown we can change the way female athletes fire their thigh muscles, specifically recruiting the hamstrings earlier, to help protect the ACL from injury. The PEP program (Prevent injury, Enhance Performance), used by SMART staff, is one national program that has shown promise in decreasing the incidence of ACL injuries. The 20-minute training session uses exercises designed to strengthen and stretch stabilizing muscles around the knee and promote proper alignment during running, jumping and turning.

Hopefully, through prevention and early detection of injuries, better training techniques, medical research and continuing education, we can help reduce these sports and recreation-related injuries and make cases like Faith's much less likely.

Eric Coris is an associate professor in the Departments of Family Medicine and Orthopaedics and Sports Medicine, and director of the Division of Primary Care Sports Medicine at USF Health.

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