ACL Risk for Girls

Boys do not own the word tough. Girls go shoulder to shoulder, competing for the inside track. Breaking free of the pack, they strike a blaze down the field. A true streak of raw athletic ability without one thought of their physical differences – that they are more prone than boys to have ACL (anterior cruciate ligament) injuries.

“Girls, starting at the age of 10 to 12, are 4 to 6 times more susceptible to ACL injuries while playing soccer due to several factors including their neuromuscular structure and the biomechanics of how they jump and land,” said Dr. Trey Remaley of Orthopaedics and Sports Medicine at USF Health.

ACL is short for anterior cruciate ligament, a ligament or strong band of tissue that connects the thighbone (femur) to the shinbone (tibia). Although the pain of an ACL injury initially varies, a feeling of instability in the knee is common. On the field, a player will experience a “popping” or “snapping” sensation, followed by rapid swelling.

“Research indicates that embracing a prevention program (3 times a week for 25-minute sessions) that includes landing appropriately and lower body strengthening decreases risk of ACL injury,” said Dr. Amanda Tritsch of Orthopaedics and Sports Medicine at USF Health.

How an ACL injury can happen on the soccer field:

Non-contact ACL injuries

The pivot, making quick turns – A soccer player quickly changes direction to navigate through opponents or decelerates to enable a pivot or a cut across the field.  “An ACL injury is actually considered a pivot and shift injury,” Dr. Remaley said.

“The most common body position associated with an ACL injury, when changing direction, is an extended (straight) hip and knee with the trunk leaning away,” Dr.Tritsch said.

The cross – With a dynamic game changing cross, a player is at top speed and using unbelievable power to pass the ball from one side of the field to the other in a “right-to-left” motion. One foot stays fixed to the ground while the player powerfully kicks the ball across their body. ACL injuries can occur due to the strain and twist of this motion.

Going up for the ball, the hard landing – Jumping up to head (when age appropriate) or gaining control of the ball, a player might not be aware of how they land, but it’s important to avoid excessive strain and stress on a player’s knees. Their knees come together rapidly before and after jumping, which can contribute to an ACL injury. “Girls naturally land “knock-kneed” and are more vulnerable to ACL injuries,” Dr. Remaley said.

Contact ACL injuries

The slide tackle – When a defender uses this last resort tactic to stop an offender from scoring, ACL injuries can occur. A tackle from the side causes a valgus force, which causes the tibia and femur to go two different ways causing an ACL tear. “Most often, it is the player who is slide tackled who gets injured, if their leg is hit at the right spot,“ Dr. Remaley said.

The collision –  When players are competing for a ball, one player collides with another player at great velocity. If a player’s knee bends or rotates excessively in a collision, the player can incur an ACL injury.

Prevention tips on how to avoid an ACL injury:

  • Adopting FIFA’s (International Federation of Association Football) 11+ Kids program with ACL prevention exercises, which promotes better neuromuscular control of the knee to help prevent injuries. “The younger these programs are incorporated into practice and training, the better the results regarding decreasing injury,” Dr. Tritsch said.
  • Practicing a “soft” landing can help decrease the risk of injury by keeping an athlete out of the position commonly seen when a player tears their ACL. “We can train young athletes to land softly by teaching landing and changing directions with knees and hips bent, and the trunk near parallel with the shins – not too upright, and not too bent over, “ Dr. Tritsch said.
  • Incorporating muscle strength workouts for a player’s core, hips, thighs, and knees. While we sometimes focus on the muscles around the knees, the muscles around the hips play a large role in controlling how much our knees collapse in toward each other. Having a strong core and hips (exercises like planks and clam shells) can help decrease that collapse.
  • Balancing or equalizing the strength of quadriceps and hamstrings with specific exercises for girl soccer players is important. Girls tend to have much stronger quadriceps then hamstrings and this is one of the reasons girls are more at risk for ACLs.

“It’s important to know that 70% of ACL injuries are actually non-contact injuries, which means they happen from players moving in a dynamic way that causes the injury,” Dr. Remaley said.

“Prevention of an ACL injury is so important because women and girls show evidence of development of osteoarthritis within ten years of tearing their ACL. However, with proper treatment a young girl can be fully functional and return to physical activity in about a year following injury,Dr. Tritsch said.

USF Health’s Orthopaedics and Sports Medicine team is the official health care provider for the USF Women’s Soccer Team, as well as the official sports medicine team for many local high schools providing athletic training and team physician services.  We can care for all of your sports related injuries, including concussion, call (813) 396-9422 to schedule an appointment.

Written By: Kathleen Rogers