This is a surprisingly common refrain from parents of young female athletes, particularly soccer and basketball players. Are these girls really more likely than boys to tear their ACL? It turns out the answer is yes. The two obvious follow-up questions are: 1) Why? 2) Is there anything we can do about it?
The ACL or anterior cruciate ligament is a band of tissue that connects the femur (thigh bone) to the tibia (shin bone). When the ACL is torn, it is unable to heal on its own, leaving the knee unstable. If left untreated, many athletes will have knee problems right away. Many others will develop problems over time.
A tear of the ACL used to be a career ending injury for an athlete, but surgical advances have made return to sports following this injury routine. The recovery and return to sports typically takes about six months. Studies show, however, that the length of time it takes to recover from surgery has significant variability, and many athletes do not quite reach the same high level of performance as their pre-injury status. The rate of subsequent knee problems is higher in athletes who have had this injury, often related to other structures in the knee that were damaged. ACL reconstruction may:
- Prevent new injuries
- Prevent or delay progression of further problems
Since the early 1970s when Title IX was enacted to ensure that girls have equal opportunities in sports, it has become common for girls to grow up playing sports year round. In sports that are played by both sexes, such as soccer and basketball, the injury rate for girls appears to be around five times higher. This is particularly alarming for an injury that can lead to permanent problems.
A great deal of research has explored the reason for the difference, but no clear answer has been identified. However, some encouraging progress has been made on the issue of prevention. Recent studies suggest that specific exercises that address issues such as foot and knee position while running and landing can produce dramatic and reproducible decreases in the incidence of ACL tears in young girls. These prevention programs, often referred to as “Jump Training” are provided by physical therapists who work with athletes.
“Studies have clearly shown that abnormal movement patterns correlate with an increased rate of injury. ACL prevention training has been shown to be effective at decreasing the incidence of ACL tears.”
Orthopaedic Surgeons can take pride in the great advances in ACL treatment over the past 30 years. It has become common to see a college or high school athlete participating at a high level despite having had an ACL reconstruction in both knees, sometimes even more than once. However, as more time passes, we see that some of these athletes are developing pain and early arthritis. It is important not only to help an athlete return to sports, but also to inform them fully about the risks involved. In some cases, we may be serving our patients’ long term interests best by having them modify the demands they place on their knees.
I am always proud to see one of my patients return to sports. However, I am also proud when a young woman makes the decision to protect the long term health of her knee by deciding to focus on other interests that will allow her to play soccer in the backyard with her own daughter in 10 or 15 years.
If your daughter has torn her ACL, you will have a lot of difficult decisions to make. When should the surgery be done? What should I expect during the recovery? There is a lot of information available from friends and family as well as the internet, but not all of it is accurate or applicable to your daughter’s injury. It is important to work with a surgeon who is experienced in knee surgery and ACL reconstruction. Experienced surgeons can answer your questions, help you make the right decisions, and can give your athlete the best chance to return to an active life with a healthy knee.