ACL injuries: What parents of female athletes need to know

When it comes to back-to-school sports injury prevention, we hear a lot about how to protect our young athletes from sports-related injuries. As a former quarterback and now team doctor for several local college and high school football teams, as well as the Chesapeake Bayhawks, I know there’s good reason for these safety precautions.

But as an orthopedic surgeon and father of a daughter, I know there’s a fact that parents of our young female athletes need to know: Female athletes are up to eight times as likely to suffer an anterior cruciate ligament (ACL) injury as male athletes.

In fact, a recent University of North Carolina School of Medicine study found a sharp 59 percent increase in the number of ACL reconstruction surgeries performed in females aged 13 to 17 in the last 13 years.

The ACL runs diagonally in the middle of each knee. It controls rotational movement and prevents the tibia from sliding out in the front of the femur. A torn ACL is a serious, potentially career-ending sports injury.

Surprisingly, more than two-thirds of ACL injuries involve little or no contact with another player. The rates of ACL injuries are higher for jumping and cutting sports. These include soccer, basketball, volleyball and lacrosse. Non-contact ACL injuries result from things like:

  • Sudden change in direction.
  • Cutting movements.
  • Landing from a jump incorrectly.
  • Pivoting with your foot firmly planted.

ACL injuries and female athletes

I start seeing these injuries appear in my office as female athletes enter puberty. In order to help prevent these injuries, it’s important to understand the hormonal changes and anatomical differences between boys and girls that develop during puberty.

Boys entering puberty are flooded with testosterone, which allows them to more easily add lean muscle mass and lose body fat. Added muscle often makes them stronger, but less flexible.

On the other hand, the increased estrogen levels that girls experience makes their ligaments lax. Girls often have better overall body flexibility compared to boys. While this increased flexibility can be a competitive advantage, it can lead to increased risk of injury if there isn’t enough muscle to keep joints in stable, safe positions.

Estrogen also has less of an effect than testosterone on lean muscle mass gains, and actually increases body fat percentage in females going through puberty. This combination of increased laxity, less lean muscle mass gains and higher body fat percentage is thought to be related to the greater rate of ACL tears in female athletes.

Is there a way to identify females at an increased risk for ACL tears? Yes, there’s a two-legged jump test that a coach, trainer or parent can give:

    • Jump off of a stair or box and land with your hips, knees and ankles in line with each other. This shows the athlete’s landing technique and whether there’s good core, hip and thigh strength.
    • If your knees buckle inward or assume a “knock knee” posture, that’s a sign of muscle weakness and shows an increased risk for ACL tear.

Athletes at risk can start jump training and other strengthening exercises to help decrease their risk of ACL tears.

Other preventative measures include:

      • Do strength training for core, hip and pelvis, and thigh muscles.
      • Start balance and stability training to increase the ability of all muscles to work in unison surrounding the hip, knee and ankle joints.
      • Learn how to safely accelerate, decelerate, jump, land and cut.
      • Begin proper training prior to the start of sports season.

Many female athlete ACL injuries can be prevented with early detection and putting into practice strength and stability training.

Redziniak_Daniel 2_fmtDaniel Redziniak, MD, is an orthopedic surgeon with Anne Arundel Medical Center  and is board-certified in sports medicine. His office at AAMG Orthopedic and Sports Medicine Specialists can be reached at 410-268-8862.

Originally published Aug. 14, 2017. Last updated July 8, 2019.

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