In the past three years, Danna Bubalo, a University sophomore, has made three trips too many into the operating room for the same surgery.
Bubalo first tore her anterior cruciate ligament in her left knee as a senior in high school playing basketball. A year later she blew out her right knee participating in the same sport.
As if two surgeries were not enough, she went on to re-tear the ligament in her right knee the following year.
“If I had known this was going to happen, I would have lifted weights more or done more preventive exercises,” Bubalo said.
Susan Verscheure, a Ph.D. student in sports medicine at the University, said the best method for preventing ACL injuries in women is developing the hamstring muscles, which tend to be weaker than the opposing quadriceps muscles, causing strain on the ACL.
“The best time to start weight and exercise programs is probably in high school and college when women become more active with sports and are practicing every day,” Verscheure said. “Athletes should not fear getting injured, but at the same time coaches and people of all age levels should be aware of the risk.”
The ACL is located in the knee joint and attaches to the femur in the thigh and the tibia in the shin.
An injury occurs to the ACL when an athlete forcefully twists or hyperextends the ligament. Any sport with quick lateral movements can cause an ACL injury. For example, an athlete participating in sports such as basketball, football, skiing, snowboarding, tennis, soccer and volleyball have a higher susceptibility to knee injury.
When people tear their ACLs, they do not necessarily need to have surgery. However, if people opt against surgery, it could result in a decrease in activity levels.
Usually, orthopedic surgeons repair the ACL with a graft from the patellar tendon and rehabilitation takes about six months. ACL tears have been one of the leading injuries among women in the past few years.
According to an article in the February 2001 edition of “Sports Illustrated for Women,” female athletes are six times more likely to suffer from an ACL injury than males, and 1.4 million women have suffered from ACL injuries in the past decade.
Verscheure said scientists have three leading theories about the cause of ACL injuries among women: the effect of a woman’s menstrual cycle on the joints, hip-to-knee alignment and quadriceps-versus-hamstring ratios.
“None of these theories have been proven 100 percent and they are still up for debate, but scientists hope to provide answers from research soon so that they will be able to give advice on prevention methods,” Verscheure said.
Some scientists believe that the fluctuations in estrogen during different phases of the menstrual cycle can be a cause of ligament tears. Scientists have found estrogen in torn ACL grafts removed from the knee during surgery and begun research in this area. So far, they have discovered that different estrogen levels at separate points in a woman’s menstrual cycle change the laxity in the ligament.
When the ligament has less laxity, it’s at a higher risk of ACL injury because it is tighter and more prone to hyperextension.
A woman’s knee-to-hip alignment can be another cause of ACL tears.
In women, scientists call the angle between the hip and the knee joint the “Q” angle because of its inward tilt. This tilt on each side of the body is formed because a woman’s hips are wider than her knees. This results in more pressure on the ACL.
Men tend to have narrower hips, making their knees and hips aligned in a straight angle, which provides more stability. Women also have weaker hamstrings than quadriceps, which can cause ACL injuries because the hamstrings decrease sheer force on the ACL.
Men tend to have a 1-to-1 ratio between the strength in quadriceps and the hamstrings. The closer the ratio between the quadriceps and hamstrings, the less likely a person will tear the ACL.
Bubalo said she wishes she would have been more conscious of the high susceptibility to ACL tears in women.
“I think that a lot of women should be more aware, and coaches need to change the ways females work out, because our bodies are different than males’,” Bubalo said.