One twist. That’s all it takes for your knees to buckle.
Normally, this buckling is prevented by a specific set of muscle tissues that run from your thigh to the shinbone. It keeps your knee steady, helps it to pivot and stabilises the twisting movement. But what happens when these tissues get lax? There’s a ‘pop’ sensation, followed by severe pain and swelling, and in all probability, you might have to consider surgery and rest for a couple of weeks. But here’s the good thing—it’s not as terrifying as it sounds. After you have rested well and healed, you can resume your normal activities again.
The health of this specific ligament that saves you from inordinate amount of pain is called ACL, or anterior cruciate ligament. However, when this becomes lax, sudden stops, turns while running, improper landing after jumps during sports, cause a tear in the ACL. It can happen when you put your foot in one direction, and your knee is in the other. "ACL tears typically occur during activities that involve sudden stops or changes in direction, such as pivoting, landing from a jump, or quickly changing direction while running," explains Azzam Fayyad, consultant orthopaedic surgeon at Medcare Orthopaedics & Spine Hospital. "The scientific evidence suggests that ACL tears happen due to several reasons, like high-demand activities, history of previous knee injuries or who have certain anatomical factors," he says.
The scientific evidence suggests that ACL tears happen due to a combination of factors, high-demand activities, history of previous knee injuries or who have certain anatomical factors
This particular injury is far more common in sportspersons, especially women. But why so? We speak to experts and find out.
Why do women face ACL tears more than men?
It’s still a bit of a mystery as to why women are at a higher risk of ACL injuries, but doctors and experts have put forward possible reasons. It is said to boil down to the anatomical as well as hormonal differences. "In terms of percentages, research suggests that women are 2 to 10 times more likely to sustain an ACL tear compared to men, depending on the specific population and activity level," explains Fayyad.
A lot is to do with the build of a woman’s body itself and structure, says Kirti Mohan Marya, chief orthopedic at Dubai-based Life Healthcare. Quite often, women have a wider pelvis, which leads to a greater hip-to-knee angle. This puts increased stress on the ACL and affects the alignment of the lower body. Another reason is that the structure of the knee joint in women puts them at more risk for an ACL injury, as it is much looser than men’s. In simple words, women have less muscle mass around the knee than men.
Women typically have a wider pelvis, leading to a greater hip-to-knee angle, which can place increased stress on the ACL and affect lower limb alignment. This puts increased stress on the ACL and affects the alignment of the lower body.
Apart from structural differences, hormonal fluctuations also have a part to play. For starters, the hormone estrogen, which is more prevalent in women, affects ligament strength and elasticity. During the menstrual cycles, there are considerable hormonal fluctuations. The laxity of the ligament is affected, and this could lead to injury in the ACL, explains Ruhil Badiani, podiatrist at the Dubai-based Cornerstone clinic.
Estrogen, which is more prevalent in women, can affect ligament strength and elasticity. This may make the ACL more susceptible to injury during certain phases of the menstrual cycle when estrogen levels are higher.
Different movement patterns
Women put more stress on the thigh-bones than men, which leads them to be more vulnerable to an ACL tear.
In the case of women, there’s far more stress on the group of bones in the thighs, called quadriceps, which dominate movements, says Badiani. “Along with this, there is less hamstring strength, which can impact knee stability. So, as women tend to use their quadriceps more, their ACL can be affected when they change direction quickly.
“In the case of many sportswomen, the problem lies in their ‘landing’ pattern. When they finish a jump, they don’t bend their knees enough, and land in a rather collapsing pattern. Women often land with more knee valgus, which is the inward collapse of the knee. This puts additional stress on the ACL,” explains Badiani.
No proper warm-ups?
There’s a reason why coaches and gym instructors tell you to do warm-ups before you begin sports.
If you don’t take it seriously, you’re at a higher risk of an ACL injury, explains Ashfaq Konchwalla, an orthopaedic surgeon in Dubai. Stretching and warm-up exercises ensure that your muscles remain flexible and help straighten the leg.
How can ACL injuries be treated?
If you suffer an ACL injury, the first word to remember immediately after you hurt yourself is, RICE—Rest, Ice, Compression and Elevation. And then, proceed to the emergency room without much haste.
There’s not much difference in treatments for men and women; they have similar rehabilitation methods. The essential goal is to heal the leg properly and so that they can return to their normal activities. Of course, a lot of factors need to be taken into account, including severity of the injury, activity level and overall health, says Badiani. If you’re a sportsperson, try not to be too impatient and speed up the recovery process.
In all probability, you do have to undergo surgery, but don’t let that prevent you from taking this necessary step. The ACL requires reconstruction, explains Konchwalla. Surgery is the best option for those who want to pursue their sports career, he emphasises. “After the surgery, the person might need help with crutches for the first few days. They can resume normal walking in 2 to 3 weeks, and slowly continue with physical activities in 4 to 6 weeks,” he says.
Surgery is the best option for those who want to pursue their sports career. After the surgery, the person might need help with crutches for the first few days. They can resume normal walking in 2 to 3 weeks, and slowly continue with physical activities in 4 to 6 weeks
While the surgical techniques for ACL tears may not significantly differ based on gender, certain considerations may be taken into account for women. “Women tend to have smaller ACLs, which influences graft selection and fixation techniques during surgical reconstruction,” explains Marya. “The choice of graft, such as hamstring, patellar tendon, or allograft (transplant of one organ to another), depends on the surgeon's expertise and the patient's specific needs.”
The other form of treatment is conservative, where the person can opt for knee support and physiotherapy, says Konchwalla. However, this can mostly be considered for people with lower physical demands, or in their older age, as such factors make surgery less favourable. “This involves physical therapy to restore knee function, strengthen the surrounding muscles, and improve stability. A knee brace may also be used for additional support,” says Badiani. Nevertheless, non-surgical treatment may result in decreased knee stability and potentially increased risk of future knee issues, such as meniscal tears or osteoarthritis, a common form of arthritis.
'Surgery was the best decision I ever made'
She was a kickboxer.
In 2011, Qamar Sayed, a PR manager based in Dubai had to undergo surgery. "It began during a kickboxing c;ass. when I was in the middle of a workout," she says. "In the middle of throwing punches and kicks, I felt an intense pain in my knee. I fell down." At first, Sayed didn't take it too seriously, and thought it was a muscle spasm or a twisted ankle. She realised that she couldn't get up and the pain was reaching a crescendo. "It turned out that I had torn my ACL, and the doctor said surgery was the only way to recover." At first, Sayed had been hesitant, as she did physiotherapy and took painkillers. She realised finally that surgery was the best option, as her condition worsened. After surgery. she spent a month confined to the bed, and had to undergo physiotherapy for several months. However, she says surgery was the best decision she ever made.
Are the chances of a re-tear higher in women?
Warning for both men and women, if you try to rush back to sports quickly after an ACL surgery without following a proper recovery process, you’ll be damaging your ACL, again. You’ll be risking a new ACL tear, which could be far more dangerous than the first.
Both women and men face chances of ACL re-tears, and the reasons could be the same. According to Marya, the risk of a re-tear depends on various factors, including how much a person has rested, whether they overstrained themselves at sports after the surgery. The surgery technique also plays a role here. However, owing to the difference in anatomical structure, women could be at a higher risk of a re-tear.
How can it be prevented?
The basic motto is, just make sure you work out in a healthy manner. Don’t ditch your warm-ups and stretches; they’re crucial for your legs.
Here are some strategies to prevent an ACL tear:
•Strengthen the muscles around the knee by doing constant exercise.
•Learn and practice proper techniques for jumping, landing, pivoting and changing direction.
•Warm up and stretch before playing sports. However, do not exercise when you are extremely fatigued. Ensure that you have enough sleep, else you risk muscle fatigue, where the muscles are unable to generate force. "It is important to pay attention to any signs of fatigue, pain, or discomfort during physical activities and take appropriate breaks or modify the intensity to prevent overexertion," warns Fayyad.
Focus on strengthening your hamstrings, glutes, core, as it can protect you from ACL injuries.
• Wear protective equipment like knee braces or protective padding.
•Get proper coaching and instruction especially with high risk sports, as they can teach you proper techniques.