News about women and ACL knee injury

WOMENS RISK OF DEBILITATING ACL KNEE INJURY IS 4-8 TIMES THAT OF MEN: Well-known sports orthopaedist Kevin Plancher, MD on reasons, prevention and treatment

October 1, 2004 - WOMENS RISK OF DEBILITATING ACL KNEE INJURY IS 4-8 TIMES THAT OF MEN: Well-known sports orthopaedist Kevin Plancher, MD on reasons, prevention and treatment

Plancher Orthopaedics & Sports Medicine, Greenwich, CT and NY, NY, 2004 For decades it seemed the only people who suffered from Anterior Cruciate Ligament (ACL) injuries were professional football players. But the tables have turned in the past few years, and researchers are learning some surprising new truths about this painful, debilitating injury that are critical for women athletes to know.

According to Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area and official orthopaedic surgeon for the U.S. Ski and Snowboard teams, women are anywhere from four to eight times more likely to sustain a tear or rupture of the ACL than men. And while football players would be pleased to hear that more than 70% of all ACL injuries occur in non-contact sports, this news heightens the risk even further for women, who are more likely to participate in non-contact activities.

What is an ACL injury?
The Anterior Cruciate Ligament accounts for more than half of all ligamentous injuries of the knee. The ACL is the more prominent of the two ligaments that connect the femur (thigh bone) with the tibia (shin bone) beneath the kneecap. The ACL is most likely to be pulled either partially away from the bones (tear) or fully away (rupture) during sports that involve spikes in speed followed by short decelerations or turns at sharp angles like basketball, soccer, skiing, tennis and running.

Why Women?
The research community is unsure of exactly why women are at such a disproportionate risk for this type of injury, Dr. Plancher said. We believe it is a confluence of several different anatomical and hormonal factors, rather than just one single element, that increases the risk so dramatically.

For example, Dr. Plancher pointed out that because womens pelvises are wider than mens, the angle at which the femur (thigh bone) and the tibia (shin bone) meet at the knee is sharper. This creates more potential for instability in both the Anterior and Posterior Cruciate Ligaments, which cross over (cruciate) beneath the kneecap to connect the two bones. He added, The ligaments themselves are smaller, and the notch through which they pass to connect the bones is smaller, both of which may also lead to more injuries.

Whats more, recent research suggests that womens hormones may play a role in putting the ACL at increased risk. Studies have found estrogen and progesterone receptors on the ACL, Dr. Plancher noted. These hormones have been shown to make the muscles, ligaments and joints more lax and more prone to injuries during both ovulatory and menstrual cycles.

How Can Women Prevent ACL Injuries?
Dr. Plancher suggests the following preventive steps for women who participate in the kinds of sports that can lead to ACL injuries:

-Strengthen the Hamstrings Several researchers have suggested that building strength in the hamstring muscle at the back of the thigh, rather than in the quadriceps muscle at the front of the thigh, can actually take stress off the ACL.

-Practice Flexed-Knee Positioning Many ACL injuries occur when the knee is locked up, so practicing and playing sports in a flexed-knee position may reduce the risk of injury.

-Get the Latest Advice from Experts Because its such a common and growing concern, many orthopaedists and sports trainers have created detailed training programs for women athletes who want to reduce their risk of ACL injury, Dr. Plancher said.

What are the Treatment Options?
According to Dr. Plancher, the two main options for treating ACL injuries are repair and reconstruction. However, several studies have suggested that, in the long run, reconstruction is far more successful. In his own long-term study of 72 patients who underwent reconstructive surgery following an ACL injury that was rated either a C or a D preoperatively, Plancher noted: Seventy of the 72 patients (96%) knees were graded either an A or a B after the surgery, and all of the patients expressed satisfaction with the results of the reconstruction. (Journal of Bone & Joint Surgery of America, 1998 Feb;80(2):184-97)

Bio:
Kevin D. Plancher, M.D., M.S., F.A.C.S., F.A.A.O.S, is a leading orthopaedic surgeon and sports medicine expert with extensive practice in shoulder and knee injuries. Dr.Plancher is an Associate Clinical Professor in Orthopaedics at Albert Einstein College of Medicine in NY. He is on the Editorial Review Board of the American Journal of Sports Medicine, the Journal of American Academy of Orthopaedic Surgeons and a reviewer for the Arthroscopy Journal. A graduate of Georgetown University School of Medicine, Dr.Plancher received an M.S. in Physiology and an M.D. from their school of medicine (cum laude). He did his residency at Harvard's combined Orthopaedic program and a Fellowship at the Steadman-Hawkins clinic in Vail, Colorado, where he studied Shoulder and Knee Reconstruction. Dr.Plancher continued his relationship with the Clinic for the next six years as a Consultant. Dr. Plancher has been a team physician for over 15 athletic teams, including high school, college and national championship teams. Dr.Plancher is an attending physician at Beth Israel Hospital in New York City and The Stamford Hospital in Stamford, CT and has offices in Manhattan and Greenwich, Connecticut.

Dr.Plancher lectures extensively domestically and internationally on issues related to Orthopaedic procedures and injury management. During 2001, 2002, 2003 and 2004 Dr.Plancher was named among the Top Doctors in the New York Metro area and was the New York State Representative for the Council of Delegates to the American Academy of Orthopaedic surgeons. For the past six years Dr.Plancher has received the Order of Merit (Magnum Cum Laude) for distinguished Philanthropy in the Advancement of Orthopaedic Surgery by the Orthopaedic Research and Education Foundation. In 2001, he founded "The Orthopaedic Foundation for Active Lifestyles", a non-profit foundation focused on maintaining and enhancing the physical well-being of active individuals through the development and promotion of research and supporting technologies. www.plancherortho.com. Contact: Melissa Chefec, MCPR, 203-968-6625.

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