A.C.L. Injuries Are More Common in Women

Women are more likely than men to suffer Anterior Cruciate Ligament injuries. The reasons are believed to be anatomical, biomechanical and hormonal.

The anterior cruciate ligament (ACL) is one of four main ligaments of the knee. Although it is the smallest of the four, it plays perhaps the most important role. Not only does it keep the tibia (shin bone) from pushing forward on the knee, it stabilizes the knee in rotation.
In sports that are mostly straight-ahead — jogging, swimming, biking — the ACL has virtually no function. But in the sports that involve cutting, planting and changing direction, the ACL plays a vital role.

Caroline Doty, a University of Connecticut basketball player, has torn the Anterior Cruciate ligament in her knee three times.

As reported in the New York Times, Doty was expected to run the team. Instead, Doty has rehabilitated the knee she injured last summer and has faced daily reminders why the acronym A.C.L. has become a four-letter word in women’s college basketball.

Shea Ralph, a UConn assistant and former star, has five times torn the ligament that stabilizes the knee and controls its pivoting. Michala Johnson, a freshman forward, tore an A.C.L. twice in high school, the peak years of vulnerability, experts said.

“A.C.L. injury rates sadly are staying the same across the country,” Dr. Thomas Trojian, a UConn team physician, wrote in an e-mail.

A number of possible risk factors have been identified in women: wider hips; ligament laxity at certain stages of the menstrual cycle; the smaller size of the notch through which the ligament connects to the femur in the upper leg; a tendency to land straight-legged and knock-kneed; core instability; a greater imbalance than men in the comparative strength of the hamstring to the quadriceps, or thigh muscle.

An improved surgical technique, called double bundling, uses two tendon grafts instead of one to resemble the normal A.C.L. There is a better (though not definitive) understanding today of what causes the ligament to tear, increased attention being paid to preventive techniques and a more consistent return by athletes to previous levels of activity.

Some studies indicate that cadaver tendons used to reconstruct the knees of young, active athletes are up to four times more likely to fail than tendons grafted from their own bodies, said Trojian. The reason, in part, is that athletes often feel better more quickly after a cadaver graft and are more likely to return to full activity before their bodies and the graft have reached full strength, Trojian said.

Yet players who tear the ligament seem to be significantly more vulnerable to tearing it again in the same knee or the other one. And researchers have found troubling rates of osteoarthritis 10 to 15 years after an A.C.L. is torn.

As a Miami Personal Injury Lawyer I have represented a number of individuals who suffered Anterior Cruciate Ligament (ACL) Injuries in car accidents, fall down accidents., work accidents, motorcycle accidents and bicycle accidents.

Rupture of the ACL is among the most serious of the common knee injuries and results from a variety of mechanisms.

Most patients with ACL damage complain of immediate and profound pain, exacerbated with motion, and inability to ambulate.
Most patients report a snapping or popping sensation or sound at the time of injury.
An acute knee injury heralded by a pop or snap, followed by a rapidly evolving effusion, almost always affirms a rupture of the ACL.
Disruption of the ACL may occur alone or with other knee injuries, especially a lateral meniscal injury or tear of the MCL.
ACL tears are associated with anterior blows that hyperextend the knee, excessive noncontact hyperextension of the knee, and extreme deceleration forces to the knee.

Knee pain is a complaint in as many as 20% of the general adult population, accounting for almost 3 million outpatient and emergency department visits per year. Trauma to the knee is the second most common occupational accident. The MCL is the most frequently injured ligament in the knee. ACL damage causes the highest incidence of pathologic joint instability.

In seeking monetary compensation for clients, the most common defense raised by insurance companies is that the injury was not caused by the accident in question, and the injury was degenerative rather than traumatic.

Thus, it is important to gather all prior medical records to confirm the lack of any prior knee complaints, and to make sure that the mechanism of injury is compatible with an ACL tear.