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| Ooops another one Bites the Dust: Increasing Incidence of ACL Injuries in young girls |
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by Mary Vacala ATC, PA-C - May 4, 2011
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“First I heard a Pop, then I felt the Pain.” Those are the famous first words that I hear when an athlete limps into my office with a swollen painful knee. The mechanism of injury is usually a result of noncontact mechanisms during landing from a jump or while making a lateral pivot. The incidence of anterior cruciate ligament (ACL) injury remains high in young athletes; however the gender disparity is alarming.
The increased incidence of ACL injuries to young women is compelling, however not new to Sports medicine professionals. Countless studies have shown that girls are six to ten times at greater risk of injuring their ACL than boys. Each year in the US alone, over 20,000 young women under the age of 20 suffer a serious knee injury related to sports participation. It has been reported that 70% of the ACL injuries occur while landing from a jump or changing direction suddenly. Researchers and medical professionals have investigated this gender disparity in ACL injury rates for years. The most compelling evidence as well as new innovative approaches to screening athletes and prevention will be discussed during this lecture.
Medical professionals have identified four highly probable critical risk factors for female athletes suffering ACL injury which include: (1) females having a decreased intercondylar notch width; (2) females being in the preovulatory phase of the menstrual cycle; (3) an increased knee valgus torque during impact on landing; and (4) a dynamic knee instability. The dynamic knee instability is thought to be a result of decreased dynamic neuromuscular control of the joint, quadriceps dominance (decreased hamstring strength and recruitment), and leg dominance (side-to-side differences in strength and coordination. Historically females athletes tend to recruit the quadriceps whereas their male counterparts will utilize the hamstrings. The ACL is more at risk when the knee is in full extension and during quadriceps recruitment.
New innovative technologies and prevention training programs have been designed to enable medical professionals and trainers the opportunity to screen athletes during preseason. This screening process will identify at risk athletes. Prevention and performance programs have been designed to facilitate athletes in developing sound mechanics in an effort to decrease the likelihood of an injury, and essentially maximize performance.
There are numerous injury prevention programs designed to reduce the risk of ACL injury in athletes. These programs attempt to alter dynamic loading through neuromuscular and proprioceptive training. Each of these programs emphasizes proper jumping/landing, and cutting, techniques to teach the athlete to properly preposition the entire body when accelerating or decelerating. This includes landing softly on the forefoot and rolling back to the rear foot, engaging knee and hip flexion and, landing on both feet. Athletes need to be trained to avoid excessive valgus of the knee and to focus on the knee over toe position when cutting.
Our clinic uses Optogait a new innovative system utilized to make precise comparisons between the performances of different patients and/or the same patient at different moments. Starting with fundamental data, the systems software makes it possible to obtain a series of parameters connected to the subject’s performance. We have designed one of the parameters of this device to assess the patients risk level for knee injury, based on several critical factors. We then use Optogait to facilitate performance analysis through various exercise techniques. The selection and progression of these exercises are designed for neuromuscular training proceeding from simple jumping drills to multi-directional landing drills. Body alignment, plyometrics, muscular efficiency, balance, proprioception, flexibility, muscle coordination, and proper power techniques are all essential to decrease the incidence of knee injuries in the female athlete. Research has shown that a six to eight week intense protocol specific program can decrease the incidence of knee injuries by eighty percent.
A prophylactic neuromuscular training program will undoubtedly have a direct benefit in decreasing the number of ACL injuries incurred by female athletes. Every female athlete under the age of 20 should be encouraged to participate in a formal prevention program to decrease the likelihood of this debilitating injury.
Mary will be presenting on this topic at the Skin, Bones, Hearts & Private Parts Conference in Orlando, September 7 - 9, 2011.
 Mary was one of the three original medical professionals selected for the 1996 Centennial Olympic Games in Atlanta. This selection took Mary to Atlanta every other Wednesday for three years during which time she did medical planning, implementation and management of all medical and performance operations for the Atlanta Committee for the Olympic Games. Mary was one of the authors of the medical management manuals for the Atlanta Committee for the Olympic Games. Mary was selected by the United States Olympic Committee for the 1993 US Olympic Festival, the 1995 World University Games in Fukuoka Japan, several Volleyball, USA Basketball team selection events and was selected by the USA Olympic Committee to serve on the US medical team in Sydney, Australia in 2000 and in Athens, Greece, in 2004. Mary is the presently the president of the Georgia Association of PAs and has served on the AAPA House of Delegates for several years. In addition to working as a clinical PA, Mary presently serves as a clinical consultant for Optogait, a performance and gait analysis system. Mary has coordinated and designed several athletic training and Physician Assistant programs throughout the country and has been influential introducing educating treatment of the Physically Challenged Patient to the PA world. She has presented the Topic at several National conferences and she authored the chapter “Treating the Physically Challenged Patient” in Bates' Guide to Physical Examination & History Taking.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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