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Leading Medicine Magazine, Vol 7, No 1 - 2013

T THE BIOMECHANICAL GENDER GAP ACL INJURIES IN FEMALE ATHLETES he evidence is clear: more women injure their anterior cruciate ligaments (ACLs) than men. Elkins High School soccer player Lindsey Biggart can attest to that. This past spring, Lindsey ruptured her ACL during a game. Because of the extent of her injury, Dr. Timothy Sitter, an orthopedic surgeon and sports medicine specialist with the Methodist Center for Sports Medicine in Sugar Land, performed a surgical transplant on Lindsey with an ACL from a donor. “There’s no question that I see more women in my practice than men; it’s two to one,” says Sitter, a team physician for Rodeo Houston; Dulles, Elkins, Kempner and Travis high schools in Fort Bend ISD; Stafford High School in Stafford ISD; and also the designated orthopedic surgeon for the Houston Aeros and Rodeo Houston. More often than not, women enter sports training later in life than men, which gives them different skill sets, and their training is often structured differently as well. “Women’s training programs are less rigorous, but women are competing at the same level as men,” says Sitter, who believes training programs for women should be reevaluated. Plyometrics, or “jump training,” can be an effective way for women to train or warm up before a game, refining landing techniques while strengthening muscles and reducing the impact on the joints. In terms of prevention, being physically fit and prepared for the sports you play is obvious. ACL injuries are most common in directional-change sports such as volleyball, basketball and soccer, in which players pivot and jump. The ACL is a small ligament — part of a network of tissue that attaches the femur, or upper leg bone, to the tibia, or lower leg bone — that works behind the kneecap to help keep the knee and leg bones from rotating too far. However, in female athletes, it is often vulnerable to tears that require surgical repair and intensive physical therapy; the reasons why are unclear. “Once the gender gap in ACL injury was determined, a lot of research and work was put into figuring out why,” says Dr. Winfield Campbell, an orthopedic surgeon at Methodist West Houston Hospital, who is a team physician to Rice Athletics and Rodeo Houston. “The bad news is, we still don’t know, likely because it stemmed from multiple factors.” Studies show that women are anywhere from two to nine times more likely to injure their ACLs as men, and Campbell cites five potential reasons: • General leg alignment. Women have a greater “Q angle” in the kneecap than men, increasing the risk of knee injury. • Anatomical differences. The intercondylar notch, or space inside women’s knees to which the ACL attaches, is physically smaller and narrower than men’s. • Hormonal cycle. Studies have shown an increased risk for ACL tears during ovulation, possibly due to increased tissue laxity. • Biomechanics. Men and women have different landing techniques when they jump. Women tend to land straighter and turn the knee inward, which makes the ACL more vulnerable. • Differences in neuromuscular communication. Specific training can be an effective defense against natural neuromuscular disparities among men and women. Since her ACL transplant surgery, Lindsey has recently been cleared to fully participate in her sport again. “It was a lot of work getting back,” she says, “but it feels amazing.” Her care team also kept her motivated. If she had advice to give others in her situations, she says it would be to “never give up. You have to work hard and trust your therapist, and push yourself to get back where you were.” Her mother, Michelle Biggart, says a crucial turning point in her daughter’s treatment occurred when Lindsey went in for her operation and Dr. Sitter discovered that the donor ACL was not a good fit for her. “The ACL just wasn’t right,” recounts Michelle, “and Dr. Sitter said, ‘I could’ve made it work, but I would not put it in my daughter’s leg, so I’m not going to put it in yours.’” n To learn more or to schedule an appointment with a specialist, visit methodistorthopedics.com. BY JULIANNA ARNIM Elkins High School soccer player Lindsey Biggart Dr. Timothy Sitter Leading Medicine • Volume 7, Number 1 3 9


Leading Medicine Magazine, Vol 7, No 1 - 2013
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