Page 15 - Athletic Health Handbook
P. 15
the cornerstone of the sports medicine to date, certainly other sex-specific have been studied, with the majority © AMERICAN ORTHOPAEDIC SOCIETY FOR SPORTS MEDICINE, 2008, ALL RIGHTS RESERVED
profession’s approach to risk identifi- hormones could be implicated. To of them emphasizing aerobic condi-
cation and ACL injury. date, the main focus of research has tioning, plyometric training, aware-
been the negative effect of sex-specific ness of at-risk positions in landing
Classifying risk factors in the hormones on ligament or joint func- and pivoting, and balance training.
following four categories has provided tion. Current studies are investigating Although these programs have
a framework of inquiry and research: whether male sex-specific hormones shown positive results with regards to
environmental, anatomic, hormonal, positively affect joint function or reduction of knee injuries, few have
and neuromuscular. Despite the fact neuromuscular physiology. Due to the analyzed performance improvements,
that we continue to see a greater hormonal milieu of both males and and none have identified specific risk
incidence of this injury in the female females, researchers continue to study factors to alter or improve. Though
population, there remains no known the potential roles and risk factors. promising, intervention programs
explanation for the gender disparity, initiated to reduce injury risk need
nor have any risk factors been identi- Neuromuscular risk factors are further study to understand the neces-
fied. Research to date supports the studied most frequently with regard sary volume, intensity, and duration
concept of a risk equation, where to injury mechanism in noncontact specifics. The degree of program
multiple factors add to injury risk. ACL injury. Controlled laboratory retention is also unknown and likely
These risk factors are more prevalent studies at multiple centers have shown specific to the age when someone
in the female population, but not that females appear to have different learns of the intervention techniques.
exclusive to it. mechanisms than males for jump Therefore, the overall impact of ACL
landings, cutting, and pivoting prevention programs on a population
The two most researched risk maneuvers. Specifically, these studies is largely unknown.
factors to date have been hormonal illustrated less knee and hip flexion,
and neuromuscular. Hormones can increased knee valgus, less knee joint In summary, it is now accepted
affect ligament function by having a stiffness, and a higher quadriceps- that there are gender-specific differ-
direct effect on the material properties to-hamstring activity. This has been ences in the rate of noncontact ACL
of the ligament. Recent studies have coined as a quadriceps dominant/ injuries. Whatever the risk factors for
suggested that this is a less likely ligament dominant knee. the increased rate of injury, it is more
contributing mechanism to ACL likely prevalent in the female popula-
injury. Alternatively, hormones could The negative effects of some of tion but not exclusive to it nor
have an indirect effect on limb func- these neuromuscular maneuvers can mandated by gender. Identifying the
tion, mediating changes in the neuro- be lessened by specific training tech- risk factors for ACL injury may offer
muscular system. Although estrogen niques to modify dynamic muscle answers for other injuries. The goal
has been the most studied hormone activity. Multiple prevention programs of this process would be to decrease
risk of injury in sporting activities,
thereby reducing traumatic joint
injury. Though the female ACL injury
has been the most analyzed to date
with regard to gender predilection,
there are likely other injuries that fall
into a similar pattern. These could
include patellofemoral dislocations,
shoulder instability, and ankle sprains.

Continuing to encourage scholarly
pursuit of these issues, with the goal
of unraveling the associated injury
risk factors, will be invaluable to the
orthopaedic profession. The goal of
establishing prevention measures to
reduce injury risk continues to be
laudable, and one that should be in
the forefront of orthopaedic research.

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