ACL tears do seem to occur more commonly in young females than males

May 11, 2008

By Alec Denes, MD Sports Orthopedic Surgeon

The feature article in this weekend’s The New York Times Magazine deals with the dramatic recent increase in injury rates among young female athletes “The Uneven Playing Field”, by Michael Sokolove.* The author focuses on injuries to the anterior cruciate ligament (ACL) of the knee in girls’ soccer, and he interviews several girls who seem to be, despite being just teenagers, dealing with chronic pain and injury in one or more of their limbs. That’s not how high school athletics is meant to be.

ACL tears do seem to occur more commonly in young females than males, according to most published research and my personal experience. There are numerous plausible reasons for this. Some of them—anatomic skeletal differences, and different hormone levels—simply cannot be reasonably altered. Other reasons, such as the mechanics of running, jumping, and pivoting that girls tend to use, can and should be changed.

I believe that the majority of sports-related injuries, ranging from minor sprains, to tendinitis, to ACL tears, are in part due to one of the following: lack of conditioning, poor core strength, or improper biomechanics. Every week I evaluate athletes of all ages, for a variety of injuries, and many are treated with a program of strengthening, conditioning or adjustment in their mechanics. Because of their rapid growth rates, children and teenagers are at especially high risk for these problems. The growth of their muscles, and their development of coordination and balance, lags significantly behind their skeletal growth, leaving them poorly conditioned to participate in regular, rigorous athletics. Furthermore, their understanding of nutrition and hydration tends to be less sophisticated than adult athletes, placing them more frequently in situations of fatigue and dehydration - - the common 4 th quarter scenario that leads to many injuries.

As a medical provider to numerous elite athletes, I’ve seen firsthand the level of discipline and training required to stay not only at peak performance levels, but also to stay injury-free. This includes strength, aerobic fitness, balance, plyometrics, proper form & technique, and nutrition. Without paying close attention to all of these aspects of athletic fitness, children who compete with adult-level intensity and regularity will always be at higher risk for both overuse and traumatic sports injuries.