Women’s Soccer and ACL Tears

Women’s Soccer and ACL Tears

Youth sports participation in the United States over the last twenty years has skyrocketed. Current estimates are that more than 40 million children in this country are participating in organized sports. This rise in sports participation has seen a concurrent increase in the number of athletic injuries in the pediatric and adolescent population. While current national media has focused on overuse injuries and concussions, there is an epidemic level of Anterior Cruciate Ligament (ACL) tears occurring in the young female athlete. Recent studies indicate that one girl on every varsity high school soccer team will injure her ACL each season! Girls are anywhere between 2 to 8 times more likely to tear their ACLs than their male counterparts. There are numerous reasons for this discrepancy between the sexes, and sports medicine researchers across the country have used their knowledge of these sex-based differences to develop methods to prevent or minimize these injuries.

Prior to puberty, ACL tears are uncommon and there is no reported difference in injury rates based on gender.  However, during the process of puberty, there are anatomic, neuromuscular, biomechanical and even hormonal differences between boys and girls that combine to play a role in increasing the susceptibility of female athletes to ACL tears.

While not much can be done about anatomic and hormonal factors, the neuromuscular and biomechanical differences can be modified to decrease injury risk. Neuromuscular deficits are seen in strength, coordination, and activation patterns of leg muscles that can increase the risk of ACL injury by increasing joint loads. During landing, cutting, and pivoting movements, the female athlete’s trunk or core demonstrates more motion, which can increase ground reaction forces and forces transmitted through the knee. If unaddressed, these neuromuscular deficits can persist during puberty, increasing the risk of injury to the ACL.

While, ACL tears may seem like short-term problems, they can be devastating and painful injuries that can lead to early onset arthritis. Surgery to reconstruct the ACL can force an athlete to miss between six and nine months of athletic competition. In addition, ACL injuries can end potential dreams of college scholarships and force a teenager to give up a sport that he or she grew up playing. Due to the significance of this dramatic increase in ACL injuries, the sports medicine community has instituted prevention programs on an international scale. Continuing this movement is of paramount importance if we are going to truly make an impact in the lives of these young athletes.

There have been several large-scale prevention and enhanced sports performance programs initiated in the US and abroad, two of which have drawn national attention. The first is the FIFA-11, a warm-up program that strengthens the muscles of the legs and core and improves neuromuscular control. It was implemented in Switzerland on a national level, and teams that participated in the program reduced their incidence of ACL injuries by 25%. Also noteworthy is a program called PEP (Performance Enhancement and Prevention), which was developed in Santa Monica, California to address strength and coordination deficits around the knee. Both programs take between 15-20 minutes to complete and are recommended for consistent use three times per week to help prevent injury. Further details on these programs can be found on the following websites:

FIFA 11+ Website

Santa Monica Sports Medicine Foundation

Pediatric Orthopaedics Division of NewYork-Presbyterian Morgan Stanley Children’s Hospital

It is crucial to initiate these programs for young female athletes in time for prevention to be effective. For girls participating in youth soccer, these programs should be started at the age of divergence in ACL injury rates between boys and girls, which is the onset of puberty. The exact age varies from female to female, but the beginning of breast development heralds puberty in a particular female. Incorporation of these integrative neuromuscular training programs at the onset of puberty and continuing them throughout adolescence may promote positive health outcomes, enhance sports performance, and reduce ACL tears in these young female soccer players.

The above commentary was written by Charles A. Popkin, MD, Assistant Professor of Orthopedic Surgery, Sports Medicine and Pediatric Orthopedics, Columbia University


See more New York Sports Connection articles

In August 2014 the F-MARC ‪FIFA‬ ‪Medical‬ Centre Regensburg(Germany) launched a worldwide register for anterior cruciate ligament (‪‎ACL‬) injuries in football. An anonymous questionnaire for female and male ‪soccer‬ players (amateurs and professionals) and for referees. Aim of the study is the prevention of ACL lesions in ‪football‬



Comment by ACLRegister on February 12, 2015

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