Document Title: Anderson-AJSM-Jan01

Author: Allen F. Anderson, David C. Dome, Shiva Gautam, Mark H. Awh, Gregory W. Rennirt.

Publication: The American Journal of Sports Medicine

ISSN: 03635465

Date: January-February 2001.

(Figures included. Reference-denoting numbers appear in the same point size as document text.)

Volume: 29

Issue: 1

Pages: 58-66

Key Words: Knee, ligaments, athletes, statistical analysis, sports medicine, males, females, correlation, causal.

This article provides an interesting overview of the factors underlying the two-to-eight times higher incidence of ACL injuries in women. Their findings support the view that the sex difference in ACL tear rates is due chiefly to factors such as subtle structural/physiological and biomechanical differences, relative/proportional weaknesses of the hamstring and quadriceps muscles, and ligament size. The net result is that (even when body mass is taken into account) the female ACL is under greater stress than its male counterpart. Anderson et al. comment on the potential value of pursuing a strength-and-conditioning program at an early age.

ABSTRACT

We performed a prospective study based on the hypothesis that physiologic differences exist between men and women in strength after adjustments for body weight; that the size of the anterior cruciate ligament is proportionate to the strength of its antagonists, the quadriceps muscles; and that women have a relatively small anterior cruciate ligament, thus predisposing them to a disproportionate number of anterior cruciate ligament injuries. One hundred matched high school basketball players, 50 male and 50 female, were evaluated with anthropometric measurements, body fat analysis, muscle strength evaluation, and magnetic resonance imaging measurements of the intercondylar notch and cross-sectional area of the anterior cruciate ligament at the outlet. The male players were taller and heavier than their female counterparts, although they had 11% less body fat. Male players had statistically greater quadriceps and hamstring muscle strength than female players, even when adjustments were made for body weight. With adjustments for body weight, the size of the anterior cruciate ligament in girls was found to be statistically smaller than in boys. There was no statistically significant difference in the notch width index between the sexes. The study data support our hypothesis that sex differences in anterior cruciate ligament tear rates are caused primarily by several interrelated intrinsic factors. Most importantly, stiffness and muscular strength increase stress on the anterior cruciate ligament in female athletes. The anterior cruciate ligament, when adjustments have been made for body weight, is smaller in female athletes, and therefore, probably does not compensate for the lack of stiffness and strength.

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