Injuries In Lacrosse: ACL Tears In Female Athletes Are Four To Ten Times More Likely Due To “Anatomical Stress” On Knees, Lack Of Proper Muscle Development And Fatigue


"These findings suggest that training the central control process—the brain and reflexive responses—may be necessary to counter the fatigue induced ACL injury risk," said McLean, who also has an appointment with the U-M Bone & Joint Injury Prevention Center.

Approximately 200,000 ACL injuries are suffered each year, with about half requiring reconstructive surgery and subsequent rehabilitation, according to the American Academy of Orthopedic Surgeons.



Numerous studies and reports reveal females to be four to 10 times more likely than males to tear their ACLs.

Men typically rupture the ligament because of some external force in football or skiing, while women tend to suffer injuries in lesser-contact activities, primarily basketball, soccer and volleyball.

  • Reasons range widely for female athletes’ propensity to ACL tears. Recurring analysis since the 1980s has arrived at one basic conclusion: blame anatomy.
  • The female shape resembles that of an hourglass. With a wider pelvis and hips than male counterparts, a female athlete’s core structure lends itself to increased pressure on the lower body.
  • “The relationship of the angle from the hips back into the knee is much bigger (in women).
  • We call that the Q-angle,” said physical therapist Kevin Swanson, who in 25 years has overseen more than 1,500 rehabs from ACL reconstructive surgery. “It leads to a (greater) chance for valgus rotational injury.”
  • Valgus indicates a knock-kneed stance, which is far more common in women, while men are naturally bow-legged.
  • “As (women) run, and they get tired, their knees begin to fall in together as they land,” Lindaman said. “That increased stress as they’re landing, the knees are more at an inclined angle.”
  • The ACL crosses the posterior cruciate ligament through the tunnel-shaped intercondylar notch, which is narrower inside a female, and therefore more susceptible to “guillotine” the ACL, according to Swanson. Even menstrual cycles can wreak havoc, making ligaments more pliable and thus easier to tear.
  • Moreover, girls get taller at an earlier age than boys, adding to the wear and tear of physical sports on young bodies.
  • “Most females are skeletally mature,” he said, “whereas guys are still growing (in high school.)”
  • Beyond the subtle differences between male and female bodies, increased opportunities in women’s athletics play a role.
  • “These girls are competing at a very high level at a very young age,” Lindaman said. “Their muscles don’t have a chance to develop. As a result of that, we’re subjecting them to more risk.”
  • The majority of tears happen in competitive environments rather than practice, with Swanson adding more players are at greater risks in the second half of a basketball game – when fatigue sets in.

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