Women and Knee Injuries

Knee injuries, specifically, tears to the anterior cruciate ligament or ACL are a common occurrence in many sports. Hockey, soccer, basketball and football are all legendary sports for causing these injuries. The old 'trick' knee that your father complained about since his college days was probably a torn ACL.

The cruciate ligaments are deep in the centre of the knee joint. There are 2 cruciate ligaments, the anterior and the posterior. They are called 'cruciate' because they cross one another. Unlike most of the ligaments of the knee, they are tight when the knee is relaxed; i.e. when your knee is at a 90 degree angle, these ligaments are tight and binding against each other. This arrangement of ligamentous support provides stability when the knee is most vulnerable. At a 90 degree bend the other holding elements are more or less flaccid.

The usual cause of these tears is an abrupt change of direction in which the body moves or rotates while the foot is planted firmly on the ground. Knee trauma in contact sports such as hockey and football is more likely from direct blows, usually from the side, causing the knee to rotate and buckle inwards. This action can also tear the anterior cruciate.

Recent studies have shown that women playing sports are 4 to 6 times more likely to suffer from knee injuries than men in the same sport. So why is that? Obviously, more females are playing contact sports than ever before. Not that many years ago, women shunned sports like hockey, and although females played basketball, it was not as competitive and aggressive as it seems to be today. There are probably more adult women playing soccer then men. Even football for women, or co-ed, is not uncommon today, as is the running game called Ultimate Frisbee.

I think this is a great trend, and I hope it continues; however, there is a price to pay, and it seems that it's the gals' knees that suffer. There are various theories as to why ACL injuries are so much more common in women. Most of the popular thinking surrounds differences in male and female anatomy.

Conventional reasons such as women having less muscle, I believe, are nonsense; they also have less mass, so the ratios are similar. I also feel that hormonal changes creating ligamentous laxity are over-blown. But, I do think that the so-called 'Q-angle' theory has some merit. The Q-angle is the angle created at the knee joint by the upper leg bone, the femur. Proportionally, the female pelvis is wider than the male, and the base of support at the feet is proportionally narrower. The Q-angle in men averages 13 degrees, while in females it averages 18. This 5 degree increase in the angle where the femur meets the knee puts a lot more stress on the holding elements, particularly the cruciate ligaments.

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