Tuesday, November 13, 2007

Knee Injury In Female Athletes


Dr. Anthony Luke, Director of UCSF Primary Care Sports Medicine, has been kind enough to share some of his expertise with us. He has agreed to join us for regular blogs on common sports related medical questions with a focus on prevention of injuries.

Do women get more knee injuries?

Unfortunately, women have higher rates of injury to the anterior cruciate ligament (ACL) in the knee. As early as the 1990’s, higher rates of injuries to the ACL in women versus men have been observed (6:1 in basketball and 2:1 in soccer). Researchers have speculated that the greater risk to women is due to various factors, since many reasons can lead to tearing the ligament when an athlete lands with an awkward twisting motion.
The leading reasons include hormonal causes, anatomical variations between men and women, and differences in neuromuscular control. Estrogen hormone receptors have been found on the surface of the ACL and researchers have tried to demonstrate whether the menstrual cycle can affect the laxity of one’s ligaments. So far, an effect has not been clearly shown. The differences in lower extremity alignment is another major area that has been suspected to play a role, particularly the greater angles at the knees due to the wider female pelvis compared to men as well as a smaller notch in the center of the knee where the ligament attaches. Again, no major significance has been noted so far. The most promising explanation for more common ACL tears in females seems to involve the athlete’s ability to balance (proprioception) and control the knee with one’s muscles (neuromuscular control). Because of anatomical and muscle strength differences between average men and women, females have less stability and upper body control which can lead to an awkward fall.

Careful work on co-ordination, balance and hamstring strength can help reduce one’s risk of an ACL tear especially for female athletes. Many professional, college and competitive high school athletes are participating in programs to prevent a season ending knee injury. Activities designed to restore both functional stability about the joint and enhance motor control skills can help prevent injury. Use of balance equipment such as wobble board and jumping exercises on one leg can improve dynamic stability.

In one study, female soccer players, ages 14 to 18, who underwent a neuromuscular training program (Preventative Injury and Enhancement Program (PEP) program) consisting of basic warm-up activities, stretching techniques for the trunk and lower extremity, strengthening exercises, plyometric activities and soccer-specific agility drills had 88% less ACL injuries in the first year and 74% less injuries in the second year. Referring the patient to a health professional familiar with similar proprioception programs may be the best measure to teach the athlete proactively reduce the chance of an ACL tear.

Anthony Luke MD, MPH Director, UCSF Primary Care Sports Medicine 1701 Divisadero St. #240 San Francisco, CA, 94115 415-353-7566

References

Bahr, R., Lian, O. (1997) A two-fold reduction in the incidence of acute ankle sprains
in volleyball
.

Caraffa, A., Cerulli, G., Projetti, M., Aisa, G., Rizzo, A. (1996) Prevention of anterior cruciate ligament injuries in soccer.

Dick RW, Arendt E. Gender specific knee injury patterns in collegiate basketball and soccer
athletes
.

Emery , C.A., Cassidy, J.D., Klassen, T.P., Rosychuk, R.J., Rowe, B.H. (2005) Effectiveness of a home-based balance-training program in reducing sports-related injuries among healthy adolescents: a cluster randomized controlled trial.

Hewett, T.E., Myer, G.D., Ford, K.R., Heidt, R.S. Jr, Colosimo, A.J., McLean, S.G., van den Bogert, A.J., Paterno, M.V., Succop, P. (2005) Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study.

Mandelbaum, B.R., Silvers, H.J., Watanabe, D.S., Knarr, J.F., Thomas, S.D., Griffin, L.Y., Kirkendall, D.T., Garrett, W. Jr. (2005) Effectiveness of a neuromuscular and proprioceptive training program in preventing anterior cruciate ligament injuries in female athletes: 2 year follow up. Am J Sport Med 33, 1003-1011.

Myklebust, G., Engebretsen, L., Braekken, I.H., Skulberg, A., Olsen, O.E., Bahr, R. (2003) Prevention of ACL injuries in female handball players: a prospective intervention study over 3 seasons. Clin J Sports Med. 13, 71-78.

6 comments:

Peter said...

Are there fewer injuries when wearing something to keep the knees warms? (I suppose this question applies to both male and female)

For example, should I wear long pants or knee warmers when riding my bike in the morning? I've been told that I shouldn't wear shorts when it's cool (40-50F) because even though the cold doesn't bother me (maybe I'm just numb?), the colder skin results in less blood flow to the knees and therefore less lubrication and I'll wear out the joint faster.

Becca said...

I was recently told that I don't have much cartilages left in one of my knees. I'm a 26 year-old female and started running only a year ago. I hate having to give it up, but now it brings me pain and I understand that it was likely the cause of the loss of cartilage. My question is, is there anything else I could do - any new surgeries or other treatments that would allow me an active lifestyle without harming my knees? What are the latest industry thoughts/trends in this area?

Dr. Luke said...

Peter,
The knee sleeve probably doesn't make a big difference just because of the warmth. Sleeves have been known to improve proprioception which is your body's ability to sense your joint, in this case the knee. With better sensation of the joint, there may be less chance for an injury like an ACL tear. Long pants should do the same.

Dr. Luke said...

becca,
You shouldn't have to give up your active lifestyle as exercise is important for everyone. Running however is one of the harder problems for the knee. Cycling, elliptical and swimming are all easier and can get you a good workout. As for the problem, it all depends on what is wrong with the cartilage and how bad it is. If there's anything that can still be done with improving your biomechanics then you should do so. This is often through good therapy and sports medicine advice. There are surgeries but they may be more to make the best of a poorer situation. There are some new cartilage procedures that can even transplant cartilage, however they are for very specific situations usually with small defects. You are young so make sure you do what it takes to stay active. Hope this helps.

Anonymous said...

Too late to post a comment? I just wanted to let everyone know that I was on crutches a long time after a full tear and the product I absolutely couldn't live without was called the Crutch Bag (www.TheCrutchBag.com) I don't know who it was, but some saint mentioned it on another site I feel compelled to thank them/return the favor.

They carry almost anything, firmly, snugly, and in the center of gravity of the crutch. Pretty ingenious and pretty cool looking. I recommend the twin pack...I used both all the time. I'm too stubborn to ask for help and this really helped me and prevented me from putting weight on my injury just to carry something from the fridge to the couch. Just wanted to let you guys know!

Thanks again and I hope this "pays it forward."

Again, I'm pretty sure the site is: www.TheCrutchBag.com

Hope that helps!

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