Unfair Odds: Girls more prone to knee injuries

The number of sports-related knee injuries sustained by young athletes has increased nearly 400 percent over the past 10 years, especially among young females, say researchers. A study presented at the meeting of the American Academy of Pediatrics also revealed teenage girls are four to six times more likely to suffer an anterior cruciate ligament (ACL) injury compared with boys participating in similar sports.

Gautam Yagnik, M.D., an orthopedic surgeon with Miami Orthopedics & Sports Medicine Institute, is seeing this trend in his practice near West Kendall Baptist Hospital and says soccer is the highest-risk sport, followed by basketball and volleyball.

Researchers suspect the increase in knee injuries may be due to the growing number of females participating in competitive sports, more intense training levels and an increased awareness and detection of these injuries, leading to more aggressive treatment.

Roger Saldana, M.D., a pediatric orthopedic surgeon with Miami Orthopedics & Sports Medicine Institute at Baptist Children’s Hospital, says year-round training also is to blame.

“In the past, kids competed in one sport for one season,” Dr. Saldana said. “Now, many of my patients compete year-round in multiple sports or in multiple leagues, with no down time. This schedule can lead to an overuse injury, and it certainly increases the risk of a traumatic injury.”

Types of Knee Injuries
The ACL is located behind the kneecap, attached at the femur, or thighbone, and the tibia, or shinbone. It stabilizes the joint when the knee twists and prevents the tibia from sliding forward. The majority of ACL tears occur without any contact with another player, while the athlete is landing from a jump, quickly changing direction or decelerating suddenly.

A torn meniscus, also referred to as torn cartilage, is another common acute knee injury among active female adolescents. The meniscus, a rubbery disc located at the outer and inner edge of the knee, helps cushion the knee. It might tear when an athlete twists, turns, slows down or collides with another player.

Patellofemoral pain syndrome, pain in the front of the knee, is the most common cause of knee pain that Dr. Saldana treats. It can be caused by overuse, injury or a kneecap that is not properly aligned, he says. The syndrome often results from activities – like running, jumping and squatting – that cause pressure or friction on the cartilage behind the kneecap.

According to Drs. Yagnik and Saldana, there are two key factors that put girls at higher risk for knee injuries – anatomic risk factors and mechanics.

Anatomic Risk Factors

Girls are built differently than boys, and the American Academy of Orthopaedic Surgeons reveals that these differences may impact mechanics. Girls’ hips grow wider after puberty, which sometimes results in a larger Q angle at the knee – a condition more commonly known as knock-knees. Compared to males, females also have a narrower notch where the ACL attaches to the femur, and this limits the space for ACL movement. And researchers continue to investigate the relationship between female hormonal changes and injury risk.

Mechanics of the Injuries

Girls also move differently than boys. Doctors studied videos of female athletes in motion and ACL injuries and identified the following improper body mechanics, published in the American Journal of Sports Medicine: Girls tend to run more upright, land with their knees buckled inward, place weight on a single leg during various movements and tilt their torso away from their center of mass.

These differences often contribute to injury. However, unlike anatomic risk factors that usually cannot be changed; the good news is these neuromuscular risk factors can potentially be modified through training. “A well-trained female athlete can have exceptional neuromuscular control,” Dr. Saldana added.

Training and Education

Doctors recommend neuromuscular strengthening exercises that focus on building strength in the leg and core muscles and improving balance and landing techniques. Exercises such as squats, lunges, planks and repetitive jumping and balancing exercises are good choices.

Dr. Yagnik, who also serves as a team physician for the Miami Dolphins and Florida Panthers, has worked with athletes, families and high school coaches to prevent injuries, and offers these tips:

• Begin specific conditioning six to eight weeks before playing high-intensity sports such as soccer, basketball and volleyball.
• Cross-train or participate in more than one sport to improve fitness and prevent overuse.
• Stretch properly before practicing or competing.
• Take a season off to allow the body to rest.

Recovery and Prognosis

Surgery to repair an ACL or meniscus tear can be complex and the recovery can be lengthy during a time when these kids are still growing, says Dr. Saldana. “They endure pain and disability during treatment, which involves surgery and 6 to 9 months of intensive rehabilitation,” he said. “We want these athletes back to their pre-injury strength and conditioning level before they return to their sport.”

There’s more bad news for young athletes who suffer a traumatic knee injury: They are at high risk of re-injury or a new injury, says Dr. Yagnik.

“I treated a high school soccer player who had surgery for a torn ACL and went through a year of rehabilitation,” he said. “Four months after returning to competitive play, she tore the ACL in her other knee.”

Adolescents with ACL injuries also have a higher risk of suffering from chronic pain and functional limitations from knee osteoarthritis when they’re older, according to a study published in the American Journal of Sports Medicine. The study reveals that more than 50 percent of ACL-injured knees will develop osteoarthritis in as few as 10 years.

“At any level, it’s important to keep our young athletes healthy,” Dr. Yagnik said. “Awareness, education and sports-injury prevention programs can go a long way toward reducing traumatic knee injuries.”

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