Anterior Cruciate Ligament

For a physical therapist or sports medicine doctor, it is a commonly heard tale of woe, “I was running to kick the ball and then I felt a ‘pop’,” or “I jumped to shoot a basket and then I felt my knee give out.” Anterior cruciate ligament injuries in young women have been steadily on the rise.


Historically, young women have been prone to anterior cruciate ligament (ACL) injuries. A 1999 study by Arendt and colleagues found that collegiate women were significantly more likely to succumb to an ACL injury compared to their male counterparts. It has been speculated that this may be due to anatomical factors such as an increased hip to knee quadriceps-angle, or hormonal factors such as estrogen that predispose them to such injuries.

ACL injuries typically occur through jumping or applying forceful torque to the knee when the foot planted, such a stopping suddenly when running or pivoting to change directions.  While there are three degrees of possible tearing, complete tears are the most common.

A group of researchers from the Gillings School of Public Health recently released the results of a study examining ACL injury related data from 2002 to 2014. In a research letter published in JAMA Pediatrics, Mackenzie Herzog and colleagues detailed their conclusions of ACL injury epidemiology.

By examining health insurance records of 148 million individuals over a 12-year span, Herzog and colleagues were able to observe trends. During this time period the overall number of ACL reconstruction surgeries rose by 22%.  Although males comprised a greater number of surgeries, females saw a greater percentage increase. The incidence of females requiring surgery rose by 34%, compared to only a 13% rise amongst males. The most frequently affected age group amongst females was 13-17 years of age.

The results of this study suggest that despite recent research into female ACL injuries, there is still much need for improvement in implementing effective education and prevention strategies in female high school and college athletics.

Herzog, M. et al. Incidence of Anterior Cruciate Ligament Reconstruction Among Adolescent  Females in the United States, 2002 Through 2014. JAMA Pediatrics.  June 12, 2017. E1-E2.

Written by Allison  P. Sevillano,  MS, PT, DPT

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