ACL Injuries in Females & Sport

I’m sure you will have heard the term ACL banded about in the media, especially in the world of football and rugby, but what is the ACL ?

The ACL is the anterior cruciate ligament, and is one of the main stabilising ligaments of the knee. It’s action is to prevent excessive anterior movement of the tibia on the femur. It works with the posterior cruciate ligament to stabilise the knee during dynamic movement, and also limits internal rotation of the tibia. So it prevents too much twisting at the knee joint.

Mechanism of injury

• Pressing/tackling
• Regaining balance after kicking
• Being tackled
• Twisting
• Increased valgus loading
  
  

Women's football is not generally given the same level of press coverage as their male counterparts, so the issue of ACL injuries in female footballers, is not as widely discussed. The England Lionesses win last year in the European Championships, however, has really helped to increase the spotlight on women's football and female sport in general. So, why might females be more likely to suffer from an ACL rupture?

Anatomical risk factors

The diameter of the ACL itself is smaller in females, as is the intercondylar notch of the femur so there is a narrower cresting wave for it to sit on, which could increase risk of injury. Impingement could occur in the smaller intercondylar notch combined with valgus load which could potentially result in injury.

Biomechanical Risk Factors

The increased angle of the hips means that females generally have a broader pelvis . Excessive pronation or rolling in of the tibia can be an increased risk.

Hormonal Risk Factors

Oestrogen levels are higher in the pre ovulatory phase of the menstrual cycle. ACL injury rates have been reported to be higher between days 9-14 of the menstrual cycle and least reported after day 15 (Wojyts et al 1999). This would suggest that if we are more aware of an athletes’ menstrual cycle, it can be taken into consideration during this phase of their cycle. However if we don’t record this, how would we know?
More on this in the next blog on Menstrual cycle.

Neuromuscular control risk factors

Poor co-ordination and control of movement, in particular landing control, can increase the risk of twisting, and valgus strain at the knee. Injury prevention programs have been developed that look at movement strategy and assess landing from jumping. Sports-metrics and PEP programs have been found to have a positive influence on injury reduction and athletic performance in female athletes.

Females are 5-years younger on average than males at the time of an ACL injury (Walden et al 2011). So an ACL rupture can have a huge impact on the length of a woman’s career in sport, especially given the shocking statistic that 32% of female football players, do not return to sport. Those that do return, have a higher risk of injury, particularly to the contralateral limb (Brophy & Schmidt et al 2012).

Some ACL injuries are not isolated to just the ACL, some people also tear their meniscus which may require trimming or repair. While this can often be done at the time of ACL surgery but sometimes it requires a two-stage surgery.

All of this highlights the importance of rehabilitating females in a structured, planned way, allowing them to get back to the sport they love.Their rehab programme should include landing control, twisting, strength, power, and all components of fitness so they have trust in both the injured limb, and the uninjured limb. This rehab programme takes around 9 months to give the athlete the best chance of a return to their pre-injury level. It is a long journey, but worth it in the end.

Please see our other blogs on ACL injury.

If you require any further information or are suffering from an ACL injury please don’t hesitate to get in touch. We have a new Physiotherapy for Women service - an exciting new clinic aimed at getting all women active. For more info visit our website, call 0141 616 6161 or email physioforwomen@hampdensportsclinic.com