5 things to know about non-contact ACL injuries and female athletes

Female athletes suffer non-contact ACL injuries at a rate four to six times higher than male athletes. It’s a crazy stat that’s getting even more attention as we watch the dynamic Women’s World Cup.

As a former division one athlete, as well as a sports physician and orthopedic surgeon with Allina Health Orthopedics, Dr. Aimee Klapach says there are 5 things you should know about non-contact ACL injuries and female athletes.

Who’s at greatest risk?
Female athletes as young as 12.
These injuries are most likely to impact girls and women between the ages of 12 and 30 who play or participate in a variety activities like soccer, basketball or even military drills. These injuries are non-contact! No one hits or touches her. It can happen while she’s running, jumping or pivoting.

What’s the cause?
Anatomy is a possibility.
We don’t know exactly why women are more vulnerable to this non-contact injury, but Dr. Klapach says one theory centers around anatomy. Women tend to have a higher quad to hamstring ratio, meaning the quad is stronger and bigger. The ACL stabilizes the knee, allowing us to do things like running, jumping, cutting, pivoting, accelerating and decelerating without the knee giving way. Our hamstring acts as the ACL’s backup system. When your quads are stronger than your hamstring, the ACL does too much work and becomes prone to injury.

How can you prevent injury?
Strengthen your glutes and hamstrings.
There is no clear path to preventing non-contact ACL injuries, but researchers have seen an 80% reduction of non-contact ACL injuries in programs that focus on strengthening the glutes and hamstrings.

What treatments are available?
Surgery is one option.
When you injure your ACL, you increase the risk of damage to other structures in the knee, including the meniscus. When considering treatment for an ACL injury, Dr. Klapach takes the age and health history of the patient into consideration. Typically, she recommends outpatient ACL surgery for a patient 30 years old or younger. Recovery can be anywhere from 9 to 10 months, initially. New blood vessels have to grow into the ACL the surgeon just put back in the knee. “It takes time for those to root and mature,” said Dr. Klapach.

What does post-surgery rehabilitation look like?
Patience and dedication are needed.
1. The first three months of rehab are all about range of motion and strengthening, but no shear force across the knee.

2. During months four through six, Dr. Klapach has her patients work on what she calls non-distracted cardio. “You’re just working on movement patterns. You’re starting linear or straight ahead running. Then we start agility side to side,” said Klapach.

3. For months seven through nine, “we work on sports specific non-contact movements, so if people are soccer players, we're going get a ball back on their feet,” said Klapach. “We do a lot of those acceleration and deceleration tests. Basically, nine months is the earliest that we like people to return to the sport based on their healing. The nice thing is you keep getting stronger over the next 18-24 months."

Bonus:
In addition to caring for the professional soccer players of the Minnesota United, Dr. Klapach is also a mom who understands information like this can cause families to worry about their young athletes. “I think there’s a lot of reward that outweighs the risk,” said Dr. Klapach. “You want your student athlete to have a love for the sport, and you want them to do the sort of exercises that help them decrease their risk of injury as much as possible.”

Learn more about:
Aimee Klapach MD | Orthopedic Surgeon | Allina Health
Orthopedics & Sports Medicine in Minnesota | Allina Health Orthopedics