ACL Injuries In Young Female Athletes: Causes And Epidemiology

ACL injuries in young female athletes: causes, epidemiology, prevention and rehab Siliang Zeng Introduction The world has grown tremendously in the medical field. Injuries that were once undetectable are currently easily detectable and treatable. The world has not yet reached a point where fractures and ligaments can be repaired in a matter of seconds. Recently, the world has seen a surge in the number of athletes with anterior cruciate ligament (ACL) injuries. The sad part of this discovery is that the number of young people with ACL injuries continues to increase. Mathew (2016) notes that “an estimated 200,000 ACL-related injuries occur annually in the United States, with approximately 95,000 ACP raptures.” Mathew adds that “approximately 100,000 ACL reconstructions are performed each year.” These are staggering numbers that help to showcase the risks of being an athlete. Young athletes have also had an increase in ACL-related injuries and Corner (2013) notes that “the growing number of children participating in competitive sports at an early age and exposure to more intense levels of training” as the reason for the surge. As it has been established by numerous researchers, female athletes are prone to ACL-related injuries (Corner, 2013). According to a report from Contemporary Pediatrics, the rate of getting ACL injuries is 4 to 6 times higher in female athletes compared to their male counterparts. However, ACL-related injuries are a problem and even though different ways have been proposed to help deal with the threat of ACL injuries, more athletes are having their dreams cut short. This article thus seeks to discuss the causes, epidemiology, prevention, and rehab of ACL-related injuries in the hope of creating awareness and helping young female athletes pursue their dreams. Population at Risk and Risk Factors As indicated earlier, women are currently involved in sports at a high level. However, this comes with a myriad of problems and one of them is injuries. For young female athletes, getting an ACL injury can present a big challenge as it may be threatening to their career prospects. To some, it may mean the end of a young career, to others it could mean difficulty to walk for the rest of one’s life, and to others, it could mean a normal injury like any other. There are different reasons that predispose female athletes to ACL injuries. Puberty for young girls comes with many changes. Some girls grow taller and heavier and unknowingly to them, this makes them at risk of getting an ACL injury. Wolf (2019) notes that “female athletes between 15- and 20-years old account for the largest number of ACL injuries.” Wolf (2019) notes that the biomechanics of female bodies at this age could be reason for increased probability to ACL injuries. She continues to say that this particular population is at a greater risk than any other to get ACL injuries. Loyola University Health System goes an extra point to specify that young female athletes “who play basketball and soccer are two-to-eight times more likely to suffer an ACL injury compared to male athletes.” These rates are quite high and showcase prevention mechanisms are imminent to help protect young female athletes. But, what are some of the risk factors that make young female athletes prone to ACL injuries? Risk Factors Different reasons have been put forth to help explain why young female athletes are more susceptible to ACL-related injuries than young boys. These include: * Less activation of hamstring – less activation of hamstring muscles can present a problem for young female athletes. This is because less activation means stress on the ACL and an injury could be imminent. * Female athletes have a larger degree of knee extension compared to male athletes – According to McDaniel et al. (2010), women’s knees have a “greater degree of extension (straightness) when performing certain maneuvers in running and changing directions when compared to males.” For male athletes, the knee is often relaxed and not extended while, for example, jumping. However, for female athletes, the knee is usually extended. Bencke et al. (2018) note that young female athletes increase the strain on the ACL as a result of the large force that is generated in the knee extensions as well as the angle of the knee joint. * Some female athletes have higher quadriceps-to-hamstring strength ratio – when the quadriceps muscles “in the anterior thighs are stronger in females than the hamstrings in the posterior of the females’ legs,” it becomes strenuous for the ACL and injuries can thus happen. * Hormonal differences is also another factor – young female athletes especially those already in puberty can be more prone to ACL-related injuries. During the menstrual cycle, female ligaments are often weak and this makes them prone to ACL injuries. Differential Diagnosis Different diagnostic procedures are usually performed to help determine whether a person is suffering from an ACL-related injury. Among the various diagnostic procedures for ACL injuries include: * The Lachman test – this test is considered “the most sensitive test for acute ACL rapture” (Mathew, 2016). It is usually performed when a person is lying on their back and can be done on both legs to ascertain a rapture or ACL-related injury. What usually happens in this test is that the physician bends the knee at an angle of 30 degrees and pulls the calf. Other tests that can be conducted include the pivot shift test and the anterior drawer test. * MRI – MRIs are used in the diagnostic process of many injuries. They can identify bone bruising and are quite helpful in confirming ACL injuries or tears. Life span considerations Every athlete who gets an injury wants to heal quickly and get back on the field. There are many stories of famous athletes who have surgeries and then make comebacks that shock the entire sports world. However, as many experts would advise, it is important to take more time to recover before coming back. Any form of complications to the injury could lead to more problems including permanent damage to one’s knee. Cleutt (2019) from Verywell Health notes that “because of potential risks of re-injury, however, most recommend waiting 7 to 9 months.” The life span of an ACL injury is indeed long and it is crucial to wait out the entire time before one can be cleared to get back in the field. Looking at age and its effects on the life span of the injury, Ihara and Kawano (2017) note that recovery is poorer among younger patients than adults. So, for young female athletes, it will take more time to heal and to be fully fit to get back in the field. Though there is no conclusive evidence for this, it is likely that the biomechanics of women that predisposes them to ACL injuries maybe the same issue that makes the recovery process longer. Body Function and Structure The knee is made of up four ligaments. These include the anterior crucial ligament, posterior cruciate ligament, medial collateral ligament, and the lateral collateral ligament. These are the major ligaments of the knee and each of these helps to facilitate walking, jumping, dancing, jogging, and everything that happens involving the legs. ACL injuries often occur during sporting activities and they can happen when someone makes sudden stops, lands wrongly, or changes direction abruptly. Some of the symptoms of an ACL injury include: * Severe pain. * Rapid swelling of the knee. * Feeling of instability even when standing. * Pop in the knee. * Losing one’s range of motion. Activities and Participation Patients or athletes suffering ACL injuries should take some time off from training or other strenuous activities that cause further complications on the injuries. Often, people rush to get back to what they were doing and this often leads to more severe injuries. A good example is Jerry Rice a former NFL player. In 1997, Jerry underwent surgery to help reconstruct his ACL. However, he claimed he was okay after staying on the sidelines for three and a half months. But, upon his return, he fractured his kneecap because of the physical activity he was subjecting his knee. In the end, he ended up not playing an entire season. So, it is important not to take part in activities that will enhance an injury. Every activity that strains the knee will worsen the injury. Prevention Studies show that nearly 80% of all ACL tears occur when the athlete is not in contact with another player CITATION Cor13 \l 1033 (Corner, 2013). This shows that the position of the body and especiall...