According to the American Orthopaedic Society for Sports Medicine, the rate of ACL ruptures is 2 to 8 times higher in female athletes than in male athletes.
Understanding why these injuries occur is the first step toward prevention. Dr. Christopher K. John, section chief, Carilion Clinic Sports Medicine, explains the risk factors and what young athletes, parents, and coaches can do to help reduce the risk of injury.
Q: What is an ACL?
A: The ACL, or anterior cruciate ligament, is one of 4 main ligaments in the knee. It also acts as the primary stabilizer, so when your child is cutting and changing direction as she heads toward the soccer goal, the ACL is working to stabilize her knee.
Q: What causes ACL injuries?
A: Most ACL injuries occur in sports that require a good deal of cutting, quick changes of direction, jumping, and rapid acceleration and deceleration.
The most common sports in which we see ACL tears include soccer, basketball, football, and tennis.
Q: Why are girls more susceptible to ACL injuries than boys?
A: It has a lot to do with growth and puberty. As boys enter puberty, they experience an increase in testosterone, which helps them build more lean muscle, whereas girls experience an increase in estrogen.
The increase in estrogen results in more flexible, or lax, ligaments and an increase in body fat with comparatively smaller gains in lean muscle.
This combination means that the joints are less stable and more vulnerable to injury. In addition, females naturally have wider hips, which can predispose some athletes to a more knock-kneed alignment.
Q: Is there way to identify if a young female athlete is at risk for an ACL injury?
A: If you have access to an athletic trainer through your child’s sports team, work with your trainer to pinpoint any weaknesses or poor form that could increase the risk of injury.
There is also a test called the two-legged jump test. Ask your child to jump off a stable box or stair and focus on landing with her hips, knees, and ankles aligned.
If your child’s knees buckle inward or appear knock-kneed, it could be a sign of muscle imbalance, which may indicate an increased risk for an ACL tear.
Q: Can you do anything to prevent an ACL injury?
A: The best thing a young female athlete can do is focus on neuromuscular training. Work with your child’s athletic trainer or coach to develop strength exercises that target the core, hip, pelvis, and thigh muscles.
This can also include adding balance and stability exercises that improve the ability of all the muscles surrounding the hip, knee, and ankle joints to work in unison.
Young athletes, male or female, also need to learn how to jump, land, cut, accelerate, and decelerate safely. I also encourage young athletes to stay fit year-round to keep their muscles, joints, and ligaments strong and ready for sports.
Next Steps
Check out the video below from Safe Kids Worldwide to see 7 exercises Ali Krieger of USA Women’s Soccer performs to help prevent ACL injuries.
The FIFA 11+, an injury prevention program for athletes ages 14 and up, is also great, says Dr. John.
