Upload
alexis-elliott
View
225
Download
7
Tags:
Embed Size (px)
Citation preview
Anterior Cruciate Ligament in the Female Athlete
Dr. Rocco Simmerano
Athletic Trainers Meeting
June 3, 2006
Overview
EpidemiologyRelevant AnatomyMechanisms of InjuryRisk FactorsPhysical ExamDiagnostic ImagingTreatment Options
ACL Injury
Approximately 80,000 tears/year in the US50,000 reconstructions/year ($1 billion) 15-25 years old70 % sports relatedAbsolute numbers show males > females
However, in sports where both men and women compete, women are 2-8 times more likely to tear their ACL
Anatomy
Musculature Bones Ligaments Tendons Cartilage
Musculature
Quadriceps Rectus Femoris Vastus Lateralis Vastus Medialis Vastus Intermedius
Hamstrings Biceps Femoris Semimembranosis Semtitendinosis Gracilis
Gastroc-soleus complex
Ligaments
Medial (tibial) collateral ligament
Lateral (fibular) collateral ligament
Function in side to side control
Ligaments
Anterior cruciate ligament
Posterior Cruciate Ligament
Function in front to back control of the knee
Tendons
Patellar tendon Part of the extensor
mechanism Continuation of the
quadriceps
Cartilage
Menisci Secondary stabilizers Load transmission
Functions of the ACL
Prevents anterior movement of the tibia on the femur
Checks lateral rotation of the tibia in flexion
Checks extension/hyperextension of trhe knee
Mechanism of ACL Injury
ContactNon-contact
Change of direction with foot planted Deceleration Awkward landing “Out of control”
Risk Factors for ACL Injury
Environmental Equipment, Landscape, Shoes
Anatomic Lower extremity alignment, laxity, notch size
HormonalBiomechanical
Muscular strength, neuromuscular control
Environmental Risk Factors
Bracing No evidence that prophylactic bracing prevents
injury
Shoe-Surface Interaction Multifactoral, higher friction associated with
higher risk of injury
Anatomic Risk Factors
Alignment Women have higher Q
angles, more femoral anteversion, excessive tibial torsion, higher foot pronation
FEMALE MALE
Q Angle
Anatomic Risk Factors
Laxity More common in
women than men Role in injury still
unclear Notch Size
9 of 15 studies support narrow notch width as a contributing factor
In general, notch width is more narrow in women
Hormonal Risk Factors
Estrogen and Progesterone receptors found on the ACL
They can influence the mechanical properties of the ACL
Higher estrogen levels reduces the tensile strength of rabbit ACL
Hormonal Risk Factors
Studies attempting to link ACL injury with menstrual cycle are conflicting
Survery of 103 ACL injuries in NCAA womens basketball players from 1998-1999 showed injury most commonly occurred in the peri-menstrual peroid (just before or just after)
Role of oral contraceptives is still unknown
Biomechanical Risk Factors
Proprioception and neuromuscular control Hamstring and Quad balance
Women tend to have less hamstring activation than men Eccentric quad contraction
Hip extensor strength Women tend to have weaker hamstrings and glutei
which leads to more upright landings after jumps
More valgus knee angle in women increases stress on the ACL
Physical Exam
Swelling Instability
Lachman Anterior drawer Pivot shift
Magnetic Resonance Imaging
Immediate Care
RICE Rest, Ice, Compression and Elevation
CrutchesKnee Immobilizer
Quadriceps inhibition
Referral to Orthopaedist
Treatment Options
Age of patientActivity levelAssociated injuries
Meniscus Cartilage Other ligaments
Surgery vs. bracing/activity modification
Surgery
Timing—”pre”-hab Risks of arthrofibrosis
Graft choices Bone-patellar tendon-bone autograft Hamstrings autograft Allograft Prepubescent reconstruction?
Rehabilitation
Phase I—pre-op Regain quad control, optomize ROM
Phase II—0-2 weeks Wound healing, full extension, 90 deg flexion
Phase III—3-5 weeks Full ROM
Phase IV—6 weeks + Strength
Injury Prevention
Neuromuscular Training Altering pivot/cut activities Landing on bent rather than straight knee Unpublished data showed an 89% decrease in
ACl injuries in Division 1 female athletes over 2 years
Prophylactic proprioceptive training 10 fold decrease in injuries over 3 years but a
poorly matched control group
Questions?
Thank You!!!