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What A Pain: HSS Doctor Discusses Female ACL Tears

Dr. Moira McCarthy.
Dr. Moira McCarthy. Photo Credit: Hospital for Special Surgery

STAMFORD, Conn. -- Dr. Moira McCarthy, an orthopedic surgeon with Hospital for Special Surgery explains why females are at higher risk for ACL tears and how they can protect against them.

First, let’s start with what the ACL is. The ACL is the Anterior Cruciate Ligament, one of two crossing ligaments in the middle of the knee. Basically, the ligaments are soft tissue bands that stabilize the knee. 

ACL tears commonly happen with cutting, pivoting, and jumping sports such as soccer, basketball, football, lacrosse, and volleyball. Patients usually feel or hear a pop at the time of injury; their knee will feel unstable or ‘give out’ from under them. These injuries usually occur without contact with another player or when the player is alone. 

Structurally, there is no difference between a female and male ACL. Both are made of collagen fibers, or little ropes, that stretch from the femur to the tibia in the center of the knee. Studies have shown that females have an increase in knee laxity, or stretchiness, and overall ligament laxity compared to male peers. Additionally, the menstrual cycle and the changing hormone concentrations may play a role in ligament laxity and risk of ACL injury.

Thus, females are at higher risk for ACL tears, based on several factors. First, there are the hormonal variations and the increased overall ligament laxity in females compared to males. Additionally, females have different muscle group activation and strength during jumping and landing evaluations compared to males. The lack of muscle group activation at the time of landing has been shown to increase ACL tear risk.

Female athletes can do preventative exercises to decrease the risk of an ACL tear. While several of the risk factors for females can’t be changed, muscle strength and muscle activation during certain activities can be modified through ACL prevention exercises to decrease the risk of an ACL tear. 

ACL tear recovery for the female patient is somewhat long, mostly due to letting the new ACL heal into position, remodel, and become a new ligament. This can take more than 6 months. It is important to get the muscle strength and control to return as muscles weaken rapidly after an ACL injury and surgery. Muscle control and strength can take 9-12 months to return to normal. For this reason, ACL recovery is generally between 9-12 months, depending on each patient’s overall rehabilitation.

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