Chasing the enigma of female ACL injuries and the gender differences that cause them

The disparity between ACL injuries in males and females due to physical factors unique to each sex has been a recognized fact since 1996, when the first report regarding these types of differences appeared. Research has been conducted since then to evaluate the particular discrepancies between sexes, and preventative measures have been formed that have actually been effective in reducing the number of ACL injuries in females, but the exact mechanisms of the programs that prevent injuries from occurring remain something of a mystery. In order to more clearly understand the specifics of prevention programs and the particular factors that attribute to injury risk, differences in neuromuscular and biomechanical function between sexes must be entirely understood. Females are known to demonstrate greater functional valgus collapse, tend to land with less hip and knee flexion (don't bend them as much), and show earlier and stronger quadriceps activation patterns relative to the hamstrings, but it is uncertain if these factors contribute to ACL injury. Furthermore, the reasons for these differences need better analysis and explanation. With this in mind, a research retreat was held in Greensboro, NC, with some of the best experts in the field to further examine these factors and work towards a more in-depth explanation for these sex differences.

Through discussions and open forums, three distinct themes of focus were formed: 1) it was agreed that a clear definition must be devised for non-contact ACL injuries, 2) rather than continuing on with noting differences between males and females, further examination of the causes for the disparities between sexes is needed to determine if they actually contribute to increased risk of injury in physically active females. 3) Take a more integrative approach to risk factor assessment instead of examining isolated risk factors, and make detailed reports on the neuromuscular and biomechanical outcomes when examining these factors. If these three distinct points are concentrated on, a more comprehensive view of relevant risk factors for ACL injuries can be reached, and even stronger, better directed prevention programs and rehabilitation plans can be formed.

-As reported in the Sept./Oct. '08 edition of the Journal Of Athletic Training

-By Greg Gargiulo