One of the biggest nightmares of an athlete is injuring their anterior cruciate ligament (ACL). An ACL injury can sideline them for the remainder of the season, and possibly interfere with their preparedness for the following season. An ACL injury is most commonly a tear in one of the ligaments if the knee that connects the upper leg bone (femur) to the lower leg bone (tibia). The ACL is what keeps the knee stable, and there is a possibility that an injury may develop into chronic ACL deficiency. This can lead to osteoarthritis, sliding of the bone and looseness of the knee. An ACL injury can occur when the knee joint is hyperextended, twisted and bent backwards or from side to side or twisted. This can happen when you suddenly change direction or experience a blow directly to the knee. Many factors contributing to the injury include ground hardness, grass type and cleat type. Over the past few years, doctors have seen a significant number of female athletes with ACL injuries. Research shows that women are twice as likely to experience an ACL tear than men. Researches have developed several theories as to why women experience more injuries. The top theories include:

  • Anatomic Differences There are many anatomic differences between men and women, including pelvis width, Q-angle, size of the ACL and size of the intercondylar notch (where the ACL crosses the knee joint).
  • Hormonal Differences It is known that the ACL has hormone receptors for estrogen and progesterone, and it has been thought that hormone concentration could play a role in ACL injuries. (There has been come conflicting data with this research, and research continues to be conducted to support this theory.)
  • Biomechanic Differences Stability of the knee is dependent on different factors. The two most important are the static and the dynamic stabilizers of the knee. The static stabilizers are the major ligaments of the knee, including the ACL. The dynamic stabilizers of the knee are the muscles and tendons that surround the joint. Women have been found to have differences in biomechanic movements of the knee seen when pivoting, jumping, and landing – activities that often lead to an ACL injury.

The symptoms of an ACL injury usually appear suddenly, because most commonly the injury occurs during activity (such as playing sports). The injury may include hearing or feeling a popping sound in the knee, pain, swelling and feeling the knee buckle or give out. Your doctor can confirm the injury by looking for signs of instability of the knee or conducting an MRI. Once your doctor has diagnosed the severity of the injury (the ACL can tear partially or completely), it is necessary to follow the treatment prescribed, or the injury can be come a long-lasting problem. Treatment can include exercise and training rehab or surgery. The healing process can take anywhere from seven to nine months.  The goals of treatment are:

  • Make the knee stable if it is unsteady.
  • Make the knee strong enough to do all the activities you use to do.
  • Reduce your chance of damaging the knee more.

To avoid experiencing an injury to the ACL, there are several techniques athletes can use. Training drills that require balance, power and agility helps improve the neuromuscular conditioning and muscular reactions, which has shown a decrease in the risk of an ACL injury. Dr. T.O. Souryal, a member of Professional Team Physicians indicated in an interview with ESPN that flexibility, strength and endurance are crucial to protecting the knee, along with using common sense. While trying a sport you have never played before, it is important not to push yourself too hard and risk an injury. In regards to flexibility, athletes should stretch before a sporting activity, at halftime or time-outs and after the activity. Strength and endurance are important because strength gives you the power you need to run and jump during activities, and endurance gives you the ability to participate for the full activity. The doctors at Orthopaedic Associates of Michigan have worked with patients experiencing varying severities of ACL injuries. They can determine the extent of your injury and the best course of treatment. For an appointment, please call 616-459-7101.

Sources: WebMD,, ESPN,, Online Orthopaedics