The first ACL research retreat for gender bias was held in April 2001, with participants presenting their research in areas of neuromuscular, biomechanics, hormonal, and structure of the knee. Over the past 20 years, these retreats have allowed for gender based ACL knowledge, which has led to the acknowledgement that such injuries can be due to multiple risk factors. Risk factors such as anatomy, physiology and motor-control) may account for the prevalence and recurrence of ACL injuries, with a greater likelihood of the occurrence in females. This article will discuss the types of ACL injury that females are prone to and share prevention as well as treatment methods.
Categories of ACL Injury
Most ACL Injuries are non-contact in nature, in saying this, we cannot rule out the likelihood of potential ruptures from contact to the ACL, which can affect all genders.
Non-contact ACL injuries refer to instances when there is no direct blow to the knee when the injury occurs – not from the knee making contact with something, but rather as someone lands from a jump or abruptly changes direction while running, especially if it involves twisting or unstable movement. This is the most common type of ACL injury and is closely linked to the physiological makeup of the individual, as well as the differing ways in which they move and exercise. The rate of ACL injuries (namely non-contact) is three times higher in female athletes than in males (Sutton, 2013). Whilst a definitive reason cannot be absolutely determined, some factors may include differences in muscle conditioning, control, strength and anatomical build.
Contact ACL injuries can be defined as external and direct impacts that occur when an object or person collides with a body (particularly the leg/knee). When this contact happens, and the knee cannot withstand the force, an ACL injury can occur. These could occur to a myriad of circumstances including car accidents, major falls and significant collisions (on and off sport fields) etc.
Anatomy, Physiology and Motor control
The intercondylar notch, which is the groove at the bottom of the femur where it meets the knee, is larger in men than in women. When we consider the knee, alone, it’s possible that this narrower notch in women restricts the movement of the ACL, especially during twisting movements, which could be cause for injury.
On a larger scale, considering the entire human body, women typically have a wider pelvis, which makes the thigh bones angle downward more sharply than in men (See Figure 1). The greater the angle, the more pressure is applied to the inside of the knee, which in some cases can cause the ACL to tear.
Additionally, women’s ligaments tend to have more laxity than men’s. Meaning excessive or high intensity joint motion combined with increased flexibility may be a significant contributing factor in the disparity in ACL injuries between the genders.
(Figure 1. The ‘Q’ angle of Male vs. Female pelvis)
Other physiological factors
Although there are receptors for progesterone and estrogen on the ACL, there is no definitive information of whether cyclic hormonal change can cause structural change in the ACL properties (ie. the degradation of the ACL and surrounding muscles/tendons ). Recent studies have suggested that changes in estrogen levels during a woman’s menstrual cycle may affect ACL strength, predisposing women to the higher injury rate, but no such “conclusive” evidence directly links an increase in ACL injury to a predictable time in the menstrual cycle (LifeCare, 2021).
Altered neuromuscular control strategies and movement patterns, and body positioning are also believed to contribute to the increased incidence of non-contact ACL injuries for female athletes.
Evidence of a possible association between the risk for ACL injuries and lower extremity neuromuscular motor controls has been concluded. The increased knee extension, valgus moments and decreased knee flexion angle of female subjects suggest that the observed differences in knee motion patterns between men and women may be associated with alternated lower extremity neuromuscular motor control (Yu, 2002), which frequently brings them close to positions that place the ACL at risk during selected athletic tasks.
How can women prevent ACL Injury and the recurrence of existing issues?
Females who participate in high-risk sports (or any female for that matter), should consider the following injury prevention solutions to mitigate pain and support recovery.
Prevention of ACL injury
Strengthening and conditioning exercise may be accompanied by compression and bracing to aid in complete stabilisation and support of the knee and surrounding areas. These can take the form of a myriad of training practices including;
- High-intensity jumping exercises
- Developing more agile position and movement patterns, including cutting and landing techniques (aided by consultation with a licensed physiotherapist)
- Strength training, especially of the hamstring and gluteus maximus muscles
- Improving muscle strength, balance, and reaction times (use of tools such as a wobble-board may help this)
Having adequate strength in your thighs and hips is integral to providing support for your knees. Knee compression sleeves reinforce this support by providing a combination of compression and stability to these areas, by increasing blood flow to the knee which reduces the risk of injury.
Sports Knee Support
The Bauerfeind sports compression sleeves for the upper leg allow the thighs and hamstrings to receive a better supply of oxygen, perform more efficiently, and recover more quickly. Therefore, they are ideal for prevention of ACL tears as they provide effective blood circulation and aid the overall integration of muscle coordination.
Thigh Compression Sleeve (Pair)
Occurrence or Recurrence of ACL Injury
It is recommended to visit a physician to get a diagnosis of the severity of your ACL injury. Additionally, appropriate bracing and support could be recommended to mitigate the risk of injury recurrence and to strengthen the area of concern.
Ideal for mild ACL and PCL injuries, the GenuTrain S Hinged Knee Support is perfect for stability after a knee injury and preventing hyperextension during the recovery process.
GenuTrain S Hinged Knee Support
Designed as the ‘step up’ from the GenuTrain S Hinged Knee Support, the GenuTrain S Pro Hinged Knee Support is ideal for post-operative ACL and PCL injuries with range of motion restriction (aided by hinged splints to prevent buckling or twisting) of the joint for safe movement in sports and exercise.
GenuTrain S Pro Hinged Knee Support
For immediate care after an ACL/PCL rupture, the SofTec Genu is ideal for pre-operative and delayed post-operative management and aids in pain relief and swelling management in ligament injuries. The SofTec is also helpful for long-term rehabilitation and sports therapy or chronic insufficiency (which can be additional considerations after an ACL rupture)
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