The number of girls and women participating in all levels of sports has risen greatly in recent years, and the way they play has changed too. Women’s sports used to be played by a slow defensive style. Today, the sports are played with speed, precision, and power. With these changes have come increased injuries, and female athletes have higher injury rates than men in many sports. Knee injuries have been rising in female sports. Anterior crutiate ligament (ACL) injuries have become the most common injury in the knee to female athletes. Females are four times more susceptible to injury then men.
The ACL is a dynamic structure whose main function is to provide primary restraint to anterior tibial subluxation. It provides secondary restraint limiting internal rotation and restraint with the knee in full extension. Along with the posterior crutiate ligament, it provides the axis for knee rotation and links rotation with flexion and extension.
The ligament is primarily made up of two bands, the anteromedial and posterolateral, and an intermediate band sometimes present. The ACL runs from the posteromedial portion of the lateral femoral condyle in an inferior, anterior, and medial orientation to an area just lateral to the medial tibial eminence. The posterolateral band is tightest when the knee is in extension, and the anteromedial band is tightest with the knee in flexion.
The majority of ACL injuries suffered during athletic participation are of the noncontact variety. Three main noncontact mechanisms have been identified planting and cutting, straight-knee landing and one-step stop landing with the knee hyperextended. Pivoting and sudden deceleration are also common mechanisms of noncontact ACL injury. Basketball, soccer, and volleyball consistently produce some of the highest ACL injury rates across various age groups. Other activities with a high rate of injury are gymnastics, martial arts, and running. In most sports, injuries occur more often in games than in practice. Many injuries have occurred during the first 30 minutes of play. One-reason physicians are seeing more ACL injuries in female patients that more women play sports, and they play more intensely. But as they continued to do more studies, they are finding that women’s higher rate of ACL is probably due to a combination of intrinsic and extrinsic factors more than to sheer increase in the number of athletes and intensity of play.
Intrinsic factors originate in the knee joint and are related to its anatomy. The intercondylar notch configuration has received a great deal of attention as a potential factor in ACL injury. Some studies have shown that athletes with smaller intercondylar notch dimensions are at greater risk for ACL injury. Reports show that notch-width indexes were less in women than in men. Another intrinsic factor is loose jointedness. Some studies have suggested that athletes who are loose jointed are at greater risk of injury than those with normal or tight joints.
Anatomic alignment differences, especially the quadriceps angle (Q-angle), have been studied as the cause of gender discrepancies in injury rate. The Q-angle is the angle formed by the intersection of a line from the anterior superior iliac spine to the center of the patella and a line from the center of the patella to the tibial tuberle. Angles up to 17 degrees are considered normal in females. Differences in pelvic structure and lower extremity alignment between men and women have been blamed for much of the ACL problem. A woman’s pelvis is wider than a man’s, creating sharper angle between the calf and thigh and putting stress on the knee. This increases the tendency of the kneecap to pull out of line and rub, causing pain.
A final intrinsic factor is an area of current study is the effect of hormones on ligamentous relaxation, which allows for pelvic changes that accommodate fetal passage through the birth canal....
Please join StudyMode to read the full document