One day in West Texas I went to a high school game and realized that I had performed surgery on 8 of the 10 starting female basketball players. Each had an ACL reconstruction and was wearing a brace. Was this tough luck…a bad coincidence…bad water or an epidemic?
I have spent the last 15 years trying to figure out why high school and college female athletes (more than males) are at such high risk for ACL injury. (The ACL is the major knee ligament responsible for holding the knee stiff when one plants and cuts).
Who is Most At Risk for ACL Injuries?
Last year at the University of Vermont, we completed our prospective study of local high school and college athletes on what causes ACL injuries. We identified that college female athletes are at highest risk for ACL injury. We found that female athletes are more likely to get an ACL injury if they had the combined effects of a parent who had sustained an ACL injury, increased front and backward knee laxity (loose ligaments), and increased body mass index.
For male athletes, we found that males with increases in front and backward movement of the knee, backward knee stiffness, and flat feet, were likely to incur an ACL injury.
We are very successful at getting most kids back to playing their sport and most do pretty well. Some kids even go on to the next level (college and professional) after ACL injury. But some do not.
Although ACL injury is no longer a career ending injury, it has some serious long term effects. Up to 80% of individuals tearing the ACL develop osteoarthritis by 15 years after the injury regardless if they have had surgery or not. That is humbling. The kids play painlessly today but develop arthritis too early in life.
How to Decrease ACL Injuries?
Solving this problem lies in educating the community around a math problem and partially around training athletes. The math problem is all about exposure. In simple terms if you limit the number of practices and games played, you limit the injury potential.
Kids are at risk for injuring the ACL 1 in about 1000 events. If one athletes plays in year round soccer or basketball and is on 2 or 3 teams the athletes exposure adds up to 1000 very quickly. Their number will come up sooner rather than later.
The other way to decrease injury is to participate in a known injury prevention program and to stick with it. For example FIFA 11 + has been shown to decrease ACL injury by up to 60 % and lower extremity injury by 70%. This is a simple program that takes 20 minutes to perform and takes the place of the pre practice warm up. In addition the FIFA 11 + program increases performance and decreases injury keeping the athletes on the court. Could this translate to more wins?
Come to my talk on Thursday, October 27, from 6-7:15pm and hear about ACL injury risk, prevention and surgical management. We will talk in more depth about these issues and demonstrate some of the injury prevention exercises.
Register for How to Prevent & Treat ACL Injuries. The class is FREE and open to the public.
Dr. James Slauterbeck is an orthopedic surgeon at the University of Vermont Medical Center and associate professor at the Larner College of Medicine at UVM.