Page 30 - ISAKOS 2019 Newsletter Volume 1

CURRENT CONCEPTS
Quick Report: Anterior Cruciate Ligament Rupture in Females
With regard to long-term outcomes, post-traumatic tibiofemoral knee arthritis was found to be a risk in both males and females3. However, females were more likely to undergo total knee arthroplasty at 15 years after ACL reconstruction than their male counterparts.
Prevention Programs
Primary prevention programs focus on correcting motor patterns and landing mechanics that contribute to the modifiable neuromuscular and biomechanical risk factors for ACL injuries in females. Multiple meta-analyses have been performed to determine the efficacy of these primary prevention programs in female athletes3. Michaelidis et al., in a 2013 meta-analysis that included 13 studies on primary prevention programs for female athletes, found that programs that featured a combination of strength and balance training, plyometrics, and technique analysis with feedback provided the best results, specifically for soccer and handball players; the investigators found no effective training program for basketball players. Noyes et al., in a study in which 3 training programs were found to be successful for reducing the incidence of noncontact ACL injury among female athletes, reported that 70 to 98 athletes needed to participate in the training in order to prevent 1 ACL injury and that the relative risk reduction ranged from 75% to 100%. A more recent analysis by Ramirez et al. showed that the risk of ACL tear was 1.83 times higher in females who did not participate in a neuromuscular training prevention program and 2.62 times higher for soccer athletes who did not participate. While the content of prevention programs is variable, studies have shown that the most successful programs are begun in the preseason and are continued 3 times per week for at least 8 weeks during the season to allow for adaptive change (Table III)1.
Table III Female ACL Injury Prevention Program Keys Prevention Program Keys
• Include a combination of strength and balance training, plyometrics, and agility drills
• Include technique analysis and feedback
• Include sports-specific components
• Started in preseason and continued 3 times per week for 15-20 minutes throughout season
• Maintenance program in off-season
• Screen for at-risk athletes
Conclusion
Female athletes are more at risk for ACL injuries than male athletes. Anatomical, hormonal, neuromuscular, and biomechanical risk factors may contribute to this increased risk. Primary prevention programs can be effective for reducing the risk of ACL injuries in females. Future considerations should be given to developing individualized training programs and return-to-play criteria for female athletes with modifiable risk factors. While more research is needed, the use of hormonal contraceptives may offer increased protection against ACL injury. Surgical outcomes in females are generally not equivalent to those in males, and careful consideration of unique characteristics specific to females should be considered through all phases of treatment. Understanding the mechanics behind the increased risk of ACL injuries in females is key to identifying at-risk athletes and providing the best care for patients.
References
1. Sutton KM, Bullock JM. Anterior cruciate ligament rupture: differences between males and females. J Am Acad Orthop Surg. 2013;21(1):41-50. 2. Herzberg SD, Motu’apuaka ML, Lambert W, Fu R, Brady J, Guise JM. The effect of menstrual cycle and contraceptives on ACL injuries and laxity: a systematic review and meta-analysis. Orthop J Sports Med. 2017;5(7):2325967117718781. 3. Lin CY, Casey E, Herman DC, Katz N, Tenforde AS. Sex differences in common sports injuries. PM R. 2018. 4. Shakked R, Weinberg M, Capo J, Jazrawi L, Strauss E. Autograft choice in young female patients: patella tendon versus hamstring. J Knee Surg. 2017;30(3):258-63. 5. Paterno MV, Thomas S, Hewett TE, Magnussen RA, Schmitt L. Increased risk of graft failure after ACL reconstruction in young female athletes with hamstring grafts. Orthop J Sports Med. 2017;5(7 suppl6):2325967117S00301. Published 2017 Jul 31. doi:10.1177/2325967117S00301
28 ISAKOS NEWSLETTER 2019: VOLUME I