ACL Injuries in Teen Girls: A Growing Concern
Teen girls blow out their anterior cruciate ligaments, commonly known as ACLs, far more often than adult women or boys, especially in high-demand sports like soccer and basketball. Researchers at Scottish Rite for Children hope to change that.
This month, the pediatric hospital announced a $1 million grant from Dallas-based Lyda Hill Philanthropies to test whether syncing training to the menstrual cycle can prevent ACL injuries, which are sprains or tears of the knee ligament that helps stabilize the joint.
ACL tears are among the most common serious knee injuries, with an estimated 60,000 to 75,000 reconstructions performed each year in the United States. Research suggests female athletes face a two- to eightfold higher risk than males, and adolescent girls are at the highest risk: about 29 times more likely than adult women and eight times more likely than adolescent boys to suffer an ACL injury, according to Scottish Rite. Most injuries happen during high-intensity play with sharp direction changes, abrupt stops, decelerations or jumps.
Researchers at Scottish Rite for Children’s Movement Science Laboratory in Frisco.
Scottish Rite for Children
The Role of Hormones in ACL Injuries
While it’s known female athletes are prone to ACL injuries, the influence of hormones on athletic performance has been an open question. Some studies suggest estrogen can increase the “stretchiness” of tissues like the ACL. This could raise the risk of injury at certain times in the menstrual cycle; several reports point to ovulation, when estrogen peaks, as a possible hot spot.
Early data from Sophia Ulman, division director of the Movement Science Laboratory at Scottish Rite, indicates a different vulnerable period: Right after a period starts, teen girls showed a 42% increase in knee looseness, a change that could elevate ACL injury risk more than fourfold.
“Our last two years of preliminary work has highlighted how much research is still needed in this area,” Ulman said in a news release. “With this study, instead of continuing to research why female athletes experience eight times more ACL injuries than males, we are asking, ‘How do we address this problem?’”
The Study: Syncing Training to the Menstrual Cycle
The study will recruit Dallas-area high school girls, ages 14 to 19, who play basketball or soccer. During an eight-week preseason program, participants will wear smart rings to track their menstrual cycles and their neuromuscular training — drills that build muscle memory to optimize athletic movement — will be adjusted for specific phases of their cycles.
During the follicular phase, or the first 14 days of the menstrual cycle, participants will focus on strengthening exercises. From after ovulation to the end of the menstrual cycle, which is called the luteal phase, participants will focus on stability and balance.
During the eight-week program, the athletes will be tested before and after training to see whether syncing certain exercises to the menstrual cycle lowers their in-season injury risk.
A study participant demonstrates training.
Scottish Rite for Children
A Second Study: Examining Movement and Attention
In a second study, researchers will examine how an athlete moves during dual-task exercises, such as memorizing colors while landing from a jump, and how divided attention may increase the risk for injury. Studies have found when athletes aren’t focused on their movement, the greater their risk for ACL injury.
Findings from this second study will be used to refine rehab and set return-to-play benchmarks to reduce ACL re-injuries.
Conclusion
Both studies are taking place over three years and the research team is currently working with two schools, with more schools expressing interest in participating in the future, Ulman said in an email.
Dr. Henry Ellis, medical director of clinical research at Scottish Rite, said in the news release that the goal of the research “is to learn as much as we can about these injuries in hopes to provide families, coaches, athletic trainers and anyone involved in youth sports tools to prevent injuries in female athletes.”
Frequently Asked Questions
Q: What is an ACL injury?
A: An ACL injury is a sprain or tear of the knee ligament that helps stabilize the joint.
Q: Why are teen girls more prone to ACL injuries?
A: Research suggests that female athletes face a two- to eightfold higher risk of ACL injuries than males, and adolescent girls are at the highest risk due to a combination of factors, including hormones and athletic demands.
