Slauterbeck
Contributed photo | UNC Health Southeastern
SPORTS MEDICINE
Preventing knee injuries in female athletes
Early in my sports medicine career, I attended a high school girls basketball game that left a lasting impression. As I watched, I realized I had performed a knee surgery called an Anterior Cruciate Ligament reconstruction (ACL reconstruction) on eight of the ten starting players. The vivid image of eight braces on 20 knees battling it out on the court is seared into my memory.
That night, I found myself wondering: Are female knee ligament injuries…Just bad luck? A bizarre coincidence? Something in the water in that region? Or could it be a sign of a larger problem?
Over the last 30 years, I’ve dedicated my career to understanding why female athletes (especially high school and college) are at such a high risk for ACL injuries. Statistically, females have a greater incidence than males to experience this devastating ligament injury.
As a background, the anterior cruciate ligament (ACL) is a major knee stabilizer. It keeps the knee steady during high-demand movements like cutting, jumping, pivoting, or planting. Yet, despite advances in surgery and rehabilitation, ACL injuries often leave a long-lasting impact on athletes.
About 10 years ago, I led a team that conducted a study on high school and college athletes to better understand the risk factors. Here’s what we found:
• Female athletes: The predictors of ACL injury included having a parent with an ACL injury, increased knee laxity (front-and-back movement of the knee), and a higher body mass index (BMI).
• Male athletes: The predictors included increased knee stiffness, front-and-back knee movement, and flat feet.
• All athletes: A family history of ACL tears emerged as one of the strongest predictors.
These findings deepened my interest in addressing these issues not just as a sports surgeon but also as a parent of three athlete children.
The Long-Term Impact of ACL Injuries
An ACL injury isn’t just a temporary setback. While modern surgery and rehabilitation can get most athletes back on the field, there are sobering long-term consequences. In the short term, most athletes return to their sport often at the same or similar level and even a few go on to the next level.
However, up to 80 percent of individuals who tear their ACL develop osteoarthritis within 15 years, regardless of whether they had surgery. As a surgeon and father, it’s humbling to think that these young athletes who play pain-free today, may face early arthritis and its challenges early in life.
Prevention: Solving the Math Problem
Addressing the ACL epidemic starts with understanding the math. The more an athlete is exposed to high-risk situations like games, scrimmages, and intense practices, the greater their chance of injury.
Athletes face an approximate 1-in-1,000 chance of tearing their ACL during any high-intensity game or scrimmage. Therefore, a year-round soccer or basketball player, often juggling two or three teams, racks up exposure quickly. It’s not a matter of if, rather, it’s when. Think of it like old-fashioned bingo. The athlete pulls one ball out of the 1,000 in the bingo floating ball cage every contact practice or scrimmage. Today, some travel team players participate in five or even six matches on the weekend and thereby pull out six balls, inching them closer and closer to the one in 1,000 injury number.
But there’s good news: we can reduce exposure and injury risk through prevention strategies:
1. Participate in proven injury prevention programs: Programs like FIFA 11+ have been shown to reduce ACL injuries by up to 60 percent and lower extremity injuries by 70 percent. This simple, 20-minute warm-up can replace pre-practice routines, improving performance and reducing injuries.
2. Encourage cross-training and rest: Avoid year-round specialization. Incorporate low-impact sports or activities to reduce wear and tear. Take a summer family vacation. Be active and swim, bike, weight train and work on skills and drills.
3. Balance practice and game time: At times during the year, athletes can focus more on skill development and drills rather than scrimmages and games.
4. Educate coaches, parents, and athletes: Awareness is crucial, and information is powerful, especially when communities understand the risks and the solutions.
The Bottom Line
So, was it bad luck, coincidence, or something in the water? No, it’s a math problem. By understanding the numbers, identifying at-risk athletes and situations, and implementing prevention strategies, we can keep athletes on the court, field, or track longer and healthier.
As a sports surgeon, father, and advocate for athlete health, I’ve committed the next 10 years to education and prevention. Together, we can rewrite the story of ACL injuries and ensure our athletes thrive on and off the field.
James Slauterbeck, MD, is an orthopedic surgeon whose special interests include sports medicine, adolescent sports medicine, female sports medicine, and high school and college athletic injuries. He is affiliated with UNC Health Orthopedics at Southeastern Health Park and UNC Health Southeastern. Rech him at 910-738-1065.
