Sponsored by TexasbrOrthopedic Specialists, P.A.
Written by Michael L. Nguyen, M.D. Orthopedic Surgeon
Kneebrinjuries are a large problem in our female athlete population. Women are two to eight times more likely than men to sustain an injury to their anterior cruciatebrligament (ACL), one of the major ligaments of the knee that helps givebrstability to the knee. In addition, females suffer an alarming rate of kneecapbr(patella) dislocations. These injuries can leave an athlete on the sidelinesbrfor months at a time, and proper treatment of knee injuries is essential to getbrback to an active, healthy lifestyle.
ACL injuries are most common inbrathletes participating in soccer, basketball, and volleyball. This is usually abrnon-contact, twisting injury of the knee. Athletes will commonly complain thatbrthey felt a pop, the knee swelled considerably, and she was unable to continuebrparticipation. The consequences of an ACL injury are not limited to the playingbrfield. The psychological effect of missed sports participation has been shownbrto lead to lowered self-esteem, lower academic performance, and feelings ofbrsocial isolation.
There arebrmultiple anatomical and biomechanical factors that lead to increased rates ofbrACL injuries in females compared to their male counterparts. Women havebrincreased joint flexibility, smaller ACLs, wider hips, and higher estrogenbrlevels. All these factors have been shown to increase the risk of injury to thebrACL. In addition, women have different patterns of biomechanical movement whenbrjumping, landing, and pivoting compared to men.
Ifbran athlete suffers an ACL tear, there are multiple different treatment options.brWe can try an ACL stabilizing knee brace, but studies have shown that no bracebrcan give the same stability as a native ACL. Physical therapy is oftenbrimplemented to decrease pain and swelling, regain range of motion, and increasebrstrength in the leg. For the athlete looking to go back to sports, surgery isbroften the treatment chosen by the patient. We know that repairing an ACL bybrsewing it back together is not successful. Therefore surgical treatment isbralmost always taking a different tendon and recreating a new ACL. Motivatedbrathletes are usually able to get back to sports as early as 6 months afterbrsurgery.
Kneecap dislocations are one of thebrmost common reasons I see a new female patient in my clinic. These presentbrsimilarly to ACL tears with swelling, sometimes a pop, and sometimes thebrathlete will tell me she looked down and her kneecap was sitting on the outsidebrof the knee. Many times, a patient will feel the kneecap “slip out” and thenbrcome back in immediately. If the kneecap does not go back in on its own, shebrmay require urgent medical attention to get the kneecap back in place. The samebrreasons that make females more prone to ACL tears make them at risk for kneecapbrdislocations. Also, females tend to have a higher “Q-Angle,” and angle measuredbrfrom the hip to the kneecap to the bony prominence on the shin where thebrkneecap attaches to. Females with a higher Q-Angle have a higher force of pullbron their kneecap leading to an increased risk of dislocation. Fortunately, mostbrkneecap dislocations are treated nonoperatively. However if the athlete suffersbrrecurrent dislocations, surgery may be warranted. An athlete can expect to get back to sportsbrin 6-8 months after surgery.
Recently, prevention of kneebrinjuries has received much attention in the medical literature. Neuromuscularbreducation programs have shown to decrease the rate of ACL tears by up to 75%.brThese programs focus on strengthening certain muscle groups in the core, hips,brand knees. They also work on landing and pivoting mechanics, creating musclebrmemory for proper mechanics similar to practicing a golf swing. One of mybrfavorite and most effective training programs can be found here. This program should take about 20brminutes to complete and should be done as a warm-up before athletic events.
Often I am asked, “when should I bebrworried and see a doctor?” There are three main reasons that I always advise anbrathlete to seek medical attention: if they had a twisting injury and felt abrpop, if they have swelling, or if they are unable to get back to playing thebrsport they love in an early timeframe. While ACL tears and kneecap dislocationsbrare not the only knee injuries that females face, they are two of the mostbrcommon and most debilitating for the athlete. However, proper training andbrconditioning can help prevent these injuries. And if it unfortunately happens,brproper treatment can get our athletes back on the field and back to the sportsbrthey love.
We are fortunate in our community tobrhave many places to turn for orthopedic care. When seeking medical treatmentbrfor knee pain, be sure to select the physician who is most highly qualifiedbrthrough advanced training in the latest techniques and in experience. Take time to ask about medical schoolbreducation, areas of specialization, residency training, and experience withbryour particular issue.
About Dr. Michael Nguyen
Dr. MichaelbrNguyen is a board eligible orthopedic surgeon that is fellowship trained inbrsports medicine and arthroscopic injuries of the shoulder, knee and hip. Dr. Nguyen is on staff at Texas Health HarrisbrMethodist Hospital Southlake, Baylor Regional Medical Center at Grapevine andbrTexas Health Harris Methodist Hospital HEB.