Interviews with Experts
Three incredible doctors were asked the same nine questions
concerning the topic of ACL injuries in female athletes.
This is what they had to say.
A Little About the Doctors
Doctor Matthew Prince
Doctor Matthew Prince
Doctor Matthew Prince
Dr. Prince is a board-certified orthopedic surgeon. Dr. Prince received his medical degree from Michigan State University College of Osteopathic Medicine. He completed his orthopedic surgical residency through Michigan State University and is fellowship-trained in sports medicine at the Mayo Clinic. He specializes in orthopedic surgery and orthopedic sports medicine.
Doctor Thomas Perkins
Doctor Matthew Prince
Doctor Matthew Prince
Dr. Perkins is a board-certified orthopedic surgeon. Dr. Perkins went to Oakland University for undergraduate school. He attended medical school at Michigan State University. He completed his internship and orthopedic residency through Michigan State University. He has advanced training in arthroscopic surgery and sports medicine. Dr. Perkins is a board-certified orthopedic surgeon who specializes and is fellowship-trained in minimally invasive arthroscopic and reconstructive surgery of the knee and shoulder.
Doctor Jignesh Patel
Doctor Matthew Prince
Doctor Jignesh Patel
Dr. Patel is a board-certified and fellowship-trained orthopedic surgeon. Doctor Patel received his medical degree from Lake Erie College of Osteopathic Medicine - Seton Hill. His expertise is in reconstructive surgery of the hip and knee; including minimally invasive surgery, arthroscopy, and joint replacement. He also works with orthopedic trauma, general orthopedic disorders, and sports medicine. Also, Dr. Patel is the Program Director of the Orthopedic Surgery Residency and the Chief of Orthopedic Surgery at Ohio Health/Doctors Hospital in Columbus, Ohio.
Dr. Prince
Dr. Prince feels that female athletes suffer more ACL tears than male athletes because of the female anatomy. He explains that females have a little wider hips, which makes females more prone to having a callus knee. This puts more pressure on the ACL. He also describes that people have a notch in the femur bone where the ACL goes through. This notch in females is more narrow, which, again, puts more stress on the ACL. He adds that when females jump, they tend to land more straight up, while men tend to crouch down. Due to this, more stress is put on the ACL. Lastly, he says that hormonal changes that females experience can create elasticity in the ligament, making it more prone to a tear. Dr. Prince believes that there are a few things that female athletes could do to lower their percentage of an ACL tear. He states that different ways of teaching and attending ACL injury prevention programs are important. He emphasizes that the biggest thing is learning correct jumping and landing mechanics, which can decrease the chances of a tear. He says that the age of highest risk of ACL tears is twelve to thirteen up to age eighteen. Usually, when they are most involved in cutting/pivoting sports. Once a female athlete suffers an ACL tear, he feels that their course of recovery should involve rehabilitation. Dr. Prince explains that waiting an appropriate amount of time (a minimum of nine months) before returning to sports after surgery is very important. The biggest reason behind waiting is that there is a high risk for the next twenty-four months after surgery to tear the other ACL. This is because people favor the other knee due to the loss of strength. It is key to regain strength equal to the other knee. He says that an ACL tear will have a long-term effect on a female athlete's life. Dr. Prince explains that the mental side of things is very impactful when it comes to recovering back to the same level previously. He adds that a lot of long-term knee injuries, such as a meniscus injury along with an ACL tear will impact an athlete more than just an ACL tear. A lot of the recovery has to do with other injuries done to that knee. Also, he explains that when an ACL is torn, it damages the cartilage. Unfortunately, this does not show up until decades later and it begins to break down. Moving on, he states that about ninety-five percent of the time he can determine if the patient has an ACL tear without an MRI. This is based on history and the events that have happened that have caused the injury. Also, during the non-physical exam, he can usually tell. If the events involve no contact, jumping, and cutting it could most likely be an ACL tear. Most ACL tears are due to non-contact events. Some symptoms are that the knee would be very swollen and a pop/snap was heard. The knee gets swollen when it is torn because it is filled with blood. When asked if all ACL tears are the same, he explains that the biggest thing is if there are any other injuries other than the ACL tear. As far as where the tear is located; it is common for the tear to be right in the middle of the ligament, so reconstruction is necessary. There is a small percentage of tears that occur when the ligament is pulled right off the femur bone, so it can be repaired. This case has been more common in the last few years, but usually, it tears in the middle of the ligament. Finally, he explains that the mental aspect when it comes to missing a whole year of sports is very intimidating. Missing a year of sports or a quarter of high school sports is very hard.
Dr. Perkins
Dr. Perkins feels that female athletes suffer more ACL tears than male athletes because most female athletes are not prepared muscularly or are not strong enough for the sport that they play. He explains that there is no way all ACL injuries can be taken away, but they can be prevented better through better training involving jumping and landing. This will make female athletes more prepared. This is shown in real studies. Also, more women are playing sports than ever, so that creates a higher risk for injury. He believes that ages thirteen to seventeen suffer the highest amount of ACL tears because not all of the female athletes in that age range have reached physiologic health and strength. Once a female athlete suffers an ACL tear, he feels that the best course of action is surgery and rehabilitation. He states that the statistics for non-surgical recovery are poor. After surgery, the athlete should be in rehab for three to six months, and return to sports no sooner than six months. It is best to return back to sports between nine and twelve months. There is testing to see the patient’s readiness to return back to sports, such as statistical computer testing. Dr. Perkins believes that there is a higher risk of tearing the opposite knee. There is no perfect explanation for this, but it is usually due to protecting the torn knee. He feels that an ACL tear has a life-long effect on a female athlete's life. He explains that there is data that shows that a vast majority of patients will develop arthritis in the knee at an early age. Also, an ACL tear can be traumatic and is a life-long injury. Dr. Perkins states that he can almost always determine whether a patient has an ACL tear. First, he listens to their medical history and their trauma. If it involves an awkward landing, a twist, pivot, or pop, then it usually is an ACL tear. Then, he does a provocative test, pivoting test, Lachman test, and other simple physical testing to determine the injury. Ninety-five percent of the time, he can determine if there is an ACL tear present. Most of the time, he will order an MRI to see if there is any other injury. He says that a lot of the ACL tears are due to an awkward landing, cut, or pivot. A tear of the femoral attachment is very routine. He adds that it is important for athletes and their parents to be patient when returning to sports. He explains to be safe and use bracing when returning to sports. Dr. Perkins says that there is not good evidence to see if bracing truly works, but it helps the athlete psychologically. This makes the athlete feel more confident.
Dr. Patel
Dr. Patel feels that female athletes suffer more ACL tears than male athletes because of the following four categories. First, there are anatomic differences between females and males. The femoral notch in females is narrow compared to one of a male. Also, the angle from the hip to the knee to the ankle is vagus. This angle is an “L” shape in females and a straight line in males. He explains that some studies show that these anatomic factors cause more ACL injuries, but some say that they do not. This is a controversial theory. Second, environmental factors, such as training can cause ACL tears. training with a bent knee position protects the ACL. The ACL is usually torn at an upright position. He states that ninety percent of the time, an ACL tear is caused by no contact and involves a pivot or jump. Thirdly, there are biomechanical factors. This has the most evidence to be a true factor. He explains that the ACL prevents the tibia from coming forward on the femur. He also states that the ACL is torn when the muscle is eccentrically loaded, and in females, the ACL is torn when the quadriceps are eccentrically loaded. These biomechanical loads are different than in males, but this is not known for sure. The fourth is hormonal factors. This is the most controversial factor, he feels. Dr. Patel says that some studies state that the hormonal level and cycle of females can affect the tear of an ACL, but he does not personally agree with this theory. However, this is a spoken-about factor. Statistically, females tear an ACL more than males, and that is all that is known for sure. He adds that the ACL tears in seven milliseconds. Finally, he discusses that all four of these contributing factors explain that female athletes are two to three times more susceptible to ACL injuries in sports, such as soccer or basketball. He believes that since female athletes cannot change their anatomy, they should change their training. The training should include correct ways to run, cut, and jump, along with, flexibility, and core strength. Dr. Patel says that studies show that bracing can help, but he believes that it is not practical when running, cutting, and sweating. If this training is incorporated into the athlete's skill, it could lower the percentage of female athlete ACL tears. This is all that can be done to help prevent it, he states. He feels that the highest risk age range of ACL tears in female athletes is from age ten and above, but more specifically ages sixteen to twenty-one. The highest-rated groups are the elite college level, high-level high school, or professional athletes. He adds that the Women’s World Cup has very high rates for ACL tears. Dr. Patel says that two to three out of ten female college athletes will have an ACL reconstruction. Next, Dr. Patel discusses the course of action to take when a female athlete tears an ACL. To start off, he identifies the injury and decides whether the injury is applicable for reconstructive surgery. After surgery, appropriate and effective rehab should take place for six to nine months. He states that athletes should not return to high-level sports until reaching the six-month mark. If athletes return before this mark, there is a risk of retearing the ACL. Dr. Patel believes that there is a higher percentage of tearing the reconstructed ACL and not the other ACL. The percentage is a touch higher, but not much. He says that this is because the reconstructed ACL is a graft, and the other is not. Dr. Patel feels that tearing an ACL will have a long-term effect on the athlete. He states that once a patient undergoes reconstructive ACL surgery, they will likely develop arthritis in the knee years later. When a female patient comes to see Dr. Patel, eight out of ten times, he can determine if the patient has a torn ACL through a physical exam. He performs the Lachman test and other physical testing on the patient to determine the injury. When an ACL is torn, he states that it is usually torn off the femur, not the tibia. The differences of ACL tears depend on any other ligament tears or injuries along with the ACL tear. Such as an MCL tear or a meniscus tear. Lastly, Dr. Patel shares that there are many studies on this topic, and to take them all with a grain of salt. Ultimately, we do not know the exact reason behind female athlete’s ACL tears.
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