ACL Tears in Female Athletes

Gender difference in ACL tears identified in aim to improve outcome

With female sports continuing their rise to prominence, it’s no surprise that more and more women are beginning to participate. It’s also no surprise that more participants mean more sports injuries, and the race is on to understand the particular gender-related needs of injured athletes.

A new report, published in the July issue of the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), has shed some light on the role that gender plays in the most common sports injuries and treatment outcomes. And the key points are interesting, to say the least.

We all know the key differences between the body structure of males and females: women have a narrower intercondylar notch and a smaller ACL, which makes them more prone to injury. They also have a wider pelvis, which applies more pressure to the inside of the knee, which can cause the ACL to tear. Their ligaments also tend to have more laxity than men’s, a microscopically slower response in knee-stabilizing muscles, and weaker hamstring strength.

More male sports injuries

However, the report discovered that male athletes still compromise the vast bulk of sports-related injuries (71% in all), due to greater exposure to high-risk activities. Fair enough – but this also increases the danger that the sports injury community are over-catering to the needs of male athletes, while saddling female athletes with treatment strategies that aren’t bespoke.
The study authors examined five common sports-related injuries – stress fractures, ACL tears, shoulder instability, concussion and femoroacetabular impingement – a condition in which extra bone grows along one or both bones that form the hip joint.

One particular study – which focussed on participants aged between 5 and 17 – threw up the following stats:

  • Females are more likely than males to sustain overuse injuries such as anterior knee pain, while males are at an increased risk of sustaining acute traumatic injuries such as fractures.
  • Females tended to demonstrate patterns of landing after a jump which are different from male landing patterns, and which are closely associated with ACL tears.
  • For both sexes, training programs can be used to teach at-risk athletes to modify landing patterns, in order to help prevent ACL injury.

Bespoke treatment is key

Lead study author Cordelia Carter, MD encapsulated the findings by stating; “Males and females have different risk factors for experiencing SRIs. Anatomic and physiologic characteristics such as skeletal structure, muscle mass, ligament laxity, and hormone levels differ between the sexes and may contribute to disparate injury risk.

“The best ways to avoid or treat a sports-related injury in a male may be different for a female. Understanding the sex-based differences can help orthopaedic surgeons be better equipped to care for patients with these injuries and improve their treatment outcomes.”

The moral of the story? One-size-fits-all treatments run the risk of destabilising injured female athletes, and we are still in our infancy when it comes to the role of gender in sports injury.