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From Professional Team Physicians
Over the past several years, orthopedic and sports medicine clinics have seen an alarming number of female athletes with knee injuries, especially those to the ACL. "Since the early '90s, the predisposition of women to ACL injuries has become a very hot topic of study," says Dr. T.O. Souryal, a member of Professional Team Physicians and one of the pioneering researchers on ACL injuries. "Although we know that women proportionally suffer more ACL injuries than men, at this time, no one knows exactly why."Join Dr. Souryal as he discusses this issue and examines the possible factors that may contribute to the higher rate of ACL injuries in women.
So in sports that are mostly straight-ahead -- jogging, swimming, biking -- the ACL has virtually no function. But in the sports that involve cutting, planting and changing direction, the ACL plays a vital role.
In a follow-up study done in 1992, we discovered that women have a propensity for this type of structure and as a result were more likely to suffer injuries to the ACL. Since then, the subject of women and ACL injuries has become a hot topic. But I think there is more to it than bone structure.
Why this is so, we still don't understand. We don't know whether a narrow notch actually transects the ACL; we don't know whether a narrower notch houses a smaller ACL (an ACL that didn't have a chance to fully grow because of the bone surrounding it).
Regardless of what actually goes on in the notch, this is a simple X-ray study and it shows that those with this bony structure are at greater risk. Women have a narrower notch than men, which may sound obvious, but proportionately, it's even smaller than would be expected. Maybe this is one of the factors that predispose women to this injury.One of the other factors that may prove to have a greater role than we anticipated is that of neuromuscular coordination. Your muscles must fire at precise moments and in perfect synchronization in order to walk, run or rebound. If this precision does not occur, then instead of the muscles taking the brunt of the movement in, for instance, a sudden change of direction, the ligaments and bones absorb the impact.
For whatever reason, women do not seem to have this neuromuscular precision developed to the extent that males do. It might be hormonally mediated, because young men have testosterone and this plays a vital role in muscular development. Or it could be that boys tend to begin playing sports from the time they are very young and girls tend to start later. Whatever the reason, it's a theory although at this time it's probably the leading one.
The only other area where neuromuscular control might be a factor would be ankle sprains, but I'm confident that ankle injury rates are the same for men and women.In short, no one knows for sure why women injure their ACL at twice the rate of men. I'm sure it's multi-factorial and there are probably four or five causes. The structure of the knee is one, the wider hip angle of women may be one, the notch may be one, neuromuscular coordination may be one. If it were one of these in isolation, then we would expect men who have the same finding to have the same rate of injury, and this is not happening.
These are things in your control. Also, there are certain shoes that are a bit more dangerous than others, especially cleats. In a study on grass fields, longer cleats were far more dangerous than shorter ones. This is an issue for women playing soccer. Right now, unfortunately, there is no brace that you can slip on to prevent ACL injuries.
|Dr. T.O. Souryal , a member of Professional Team Physicians, was formerly a team physician for the Dallas Mavericks. Dr. Souryal received his medical degree from the University of Texas Health Science Center in San Antonio and completed a fellowship at Hughston Sports Medicine Clinic, Columbus, Ga. Dr. Souryal also is Medical Director at Texas Sports Medicine and is director of the Sports Injury Clinic at SMU.|