As the Fall sports season ramps up, so do the chances for injuries. Last month, we provided tips on getting ready for the fall sports season to prevent injuries. Still, as more women enter sports like soccer, there has been a rise in ACL injuries. This injury happens so often to women that the Washington Post and New York Times wrote about ACL injuries in women. Dr. Nicholas Sablan, one of our sports medicine experts, has worked with professional, college-level, and league athletes and offers some insights into why women may be more prone to ACL injuries than men.  

What is the ACL? 

The ACL stands for Anterior Cruciate Ligament, one of the key ligaments that helps provide stability to the knee joint. It is a strong fibrous band that connects the femur to the tibia within the center of the knee. The ACL prevents the tibia from sliding out in front of the femur and provides rotational stability to the knee. 

Theories on Why Women Are More Likely to Get an ACL Tear 

Hormonal changes may affect women athlete's chances of getting an ACL injury. According to the National Institute of Health data, the menstrual cycle can increase laxity and strength. Women constantly adapt to hormonal variations, exposing them to a higher risk of injury. Dr. Sablan mentions laxity as an issue because joint laxity is the normal amount of joint movement allowed by the joint's structures, like ligaments.  

Physical constraints of the female body may also be a factor. As women enter puberty, their knee alignment changes. Widening hips change the angle of the femur, putting more stress on the knees, and weight gain may not be distributed evenly, loading on one side of the body more. Also, changes as women go through different life events, such as pregnancy or menopause can lead to looser ligaments and weaker muscles.  

Finally, Dr. Sablan and many others believe the sheer number of women playing sports like soccer has contributed to the rise of injuries. In the 1990s, around five million women played soccer in the United States. According to US Soccer, it is estimated that over 11 million women now participate in the sport. As the popularity of playing these sports rises in women, so too does the amount of injuries.  

ACL is an end-of-the-game kind of injury 

According to data, most ACL injuries happen through non-contact, likely due to fatigue at the end of playing. According to Dr. Sablan, when the main knee stabilizers like hamstrings or quads are tired, our body will rely more on ligaments and tendons for stabilization. Combine that with the movement in sports like soccer, and injuries occur. While the only way to prevent an injury, like an ACL tear, is to not play the sport, Dr. Sablan believes that a good conditioning program focused on movement, strength training, and core building can reduce the chances of an injury.  

ACL surgery may be common, but recovery is long.  

Dr. Sablan regularly performs ACL tear surgeries. You may not know that a piece of the patient's tissue is used as a graft. The torn ligament is removed, and the graft is attached in its place to restore knee stability. While a common procedure, the recovery time is typically six - to nine months, including physical therapy. And the long term if someone has an ACL tear, they are more likely to develop other knee challenges down the road including arthritis.  

Can you play through the pain? 

With an ACL tear, there is a noticeable "pop" sound with swelling and pain. While there may be some adrenaline, most must be removed from the field for immediate medical treatment. It's important during the moments after the injury that you don't put weight on it and have it accessed by a medical professional.  

ACL tears are, unfortunately, a common knee injury, especially for female athletes. While participation in sports like soccer continues to grow, so does the incidence of ACL injuries. As Dr. Sablan explained, factors like hormones, anatomy, sheer numbers, and fatigue may contribute to the higher rate seen in women. Proper conditioning and training that accounts for women's physiology can help reduce risk. But even with precautions, ACL injuries do occur. Recognizing the signs and seeking prompt treatment can improve recovery outcomes. With diligent rehab and expert care from orthopedic specialists like Dr. Sablan, most patients can eventually return to the sports they love after ACL reconstruction. At Tidewater Orthopedics, we utilize the latest techniques and individualized approaches to help athletes overcome ACL injuries and get back to the game they love.