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ACL Injuries in Female Athletes

What is the ACL (Anterior Cruciate Ligament)?

It is the ligament connecting the femur (thigh bone) and tibia (shin bone) inside the knee joint and provides the majority of stability in the knee. The ACL protects the knee during pivoting and shifting during running and jumping/landing. It is named cruciate for “cross” because it crosses the posterior cruciate ligament (PCL) inside the knee.

When should one suspect an ACL tear?

Usually associated with sudden knee pain & giving way from a twisting, knockkneed, or overextension-type injury. Some athletes will feel a “pop” with or without pain & usually are unable to continue to play. Knee swelling develops over next 24 hours, often rapidly. The athlete often has a feeling of “looseness”, weakness or instability in the knee.

When should an injured athlete seek medical care?

  1. Any time there is moderate or severe pain, swelling and/or the inability to bend or straighten the leg completely. 
  2. When an athlete cannot continue to play that day or has difficulty with walking, running or jumping for the next few days after the injury.
  3. When an athlete complains of “looseness” or giving way in the knee from either a new or an old injury. Any athlete with a suspected ACL injury should NOT be allowed to return to sport participation without an evaluation by a primary care sports medicine specialist or an orthopedic surgeon. Continuing to play sports with a torn ACL can lead to further injury and/or permanent damage.

Which athletes get ACL tears?

Any athlete can tear their ACL. Common ages are 15-25 years old. Female athletes are injured 7-8x more frequently than males. ACL tears occur in all sports but jumping, cutting, pivoting sports such as basketball, soccer and volleyball are highest risk.

Will tests need to be done?

Almost all suspected ACL injuries are severe enough that xrays are necessary. Sometimes additional tests such as MRI’s (magnetic resonance imaging studies) are also required.

What is the treatment?

The most successful treatment for an ACL injury is usually arthroscopic surgery. A new ligament is made to “reconstruct” the old injured ACL. The surgery is usually not performed as emergency surgery so the treatment starts with rest, ice and crutches as needed. Braces are often helpful early on and temporarily after surgery. Physical therapy is important both before and after surgery to work on bending and straightening, to decrease pain and swelling and to help walk without a limp.

Is surgery necessary?

Most ACL tears need surgery. Fortunately approximately 9/10 athletes (90%) have successful surgeries and return to their sports about 6 months. In general once recovery is complete, athletes do not have pain or weakness with running and jumping. Athletes that choose to avoid having recommended surgery can have problems with pain, weakness, giving out and can develop knee arthritis at young ages. Athletes should follow their doctor’s treatment plan to try to have the best possible recovery.

Are ACL tears preventable?

Unfortunately, many of these injuries are not preventable. However, some recommendations that might help with prevention are to teach young athletes good running, jumping, landing and squatting techniques. Parents, coaches, athletic trainers and physical therapists should continue to reinforce good sports technique at all ages. Strengthening muscles and participating in regular physical activity may also help.

Last Updated
Sports Shorts (Copyright © 2005 American Academy of Pediatrics) Conceptual design by the Ohio Chapter, American Academy of Pediatrics
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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