Anterior Cruciate Ligament Injury in the Female Athlete

Abstract

annual meeting of the American Academy of Orthopaedic Surgeons, James Garrick and Ralph Requa presented a paper entitled "ACL Injuries in Women: Epidemiology." They found that, between 1965 and the present, 3514 MEDLINE citations were indexed under "anterior cruciate ligament," yet only 130 were indexed under prevention, and fewer than 10 focused on prevention of the injury. This special issue of the Journal of Athletic Training has several purposes: to remind readers that the epidemic of ACL injuries in female athletes continues, to identify potential risk factors that can be targeted for preventive interventions, and to recognize important research initiatives in our quest to reduce the incidence of this injury in both female and male athletes. In 1995, Elizabeth Arendt and Randall Dick published their seminal epidemiologic research in the American Journal of Sports Medicine demonstrating a higher rate of ACL injuries in college female soccer and basketball athletes in comparison with males participating in the same sports. In this issue, you will find a 5-year update of the NCAA epidemiologic research that reaffirms the higher rate of injury in female athletes. You will also find an epidemiologic review that documents a higher rate of ACL injury in physically active females participating at the college, high school, Olympic, and military levels. Both papers emphasize the importance of prevention as the cornerstone to reducing the incidence of ACL injury in the female athlete. To exemplify this emphasis on prevention, many of the articles in this issue focus on the potential risk factors for ACL injury. Extrinsic factors, which are somewhat controllable, include playing style, preparation and practice, conditioning, skill acquisition, environmental conditions, and equipment such as shoes and playing surface. Intrinsic factors include individual physical and psychosocial factors that are less controllable than the extrinsic factors. A plan for the standardized screening of the clinically measurable intrinsic anatomical risk factors, such as subtalar joint pronation, knee recurvatum, external tibial rotation, and lower extremity muscular strength, is presented. Several of the original research papers in this issue focus on the intrinsic risk factors of joint laxity, postural control, and knee biodynamics in female and male subjects. The general use of electromyography in assessing sex differences is explained, and 3 papers examine the neuromuscular factors related to muscle preactivity, fatigue, and reactive muscle firing during functional activity. Very recent research is presented that documents greater anterior laxity in conjunction with elevations in estrogen and progesterone levels during the menstrual cycle. Fluctuating hormonal levels represent one of the more obvious differences between males and females, yet the relevance of this finding to ACL injury in the female athlete has yet to be elucidated. Specialized rehabilitation programs for the female athlete who is ACL deficient or who has undergone ACL re...

Intrinsic and Extrinsic Risk Factors for Anterior Cruciate Ligament Injury in Australian Footballers

“…5 Despite the severity and cost of these injuries, fewer than 1% of citations regarding the ACL focus on injury prevention. 20…”