ACL Tear in Female Athletes — Graft Options and Fixation Methods
DNB Orthopaedics • May 2024 • Paper IV • 10 Marks
Introduction
Anterior cruciate ligament (ACL) injury is an important sports injury, particularly in young athletes participating in pivoting and cutting sports. Female athletes demonstrate a higher incidence of non-contact ACL injury in several comparable sports.
ACL reconstruction aims to restore anteroposterior and rotational stability, permit return to sports, protect secondary stabilizers and reduce recurrent giving-way episodes.
Graft selection should be individualized according to: age, sport, activity level, graft size, skeletal maturity, donor-site morbidity, associated injuries and patient preference.
Why Are Female Athletes Important in ACL Injury?
The increased risk is multifactorial rather than attributable to a single anatomical or hormonal factor.
| Factor | Examples |
|---|---|
| Anatomical | Smaller ACL dimensions in some individuals, intercondylar notch morphology, lower-limb alignment |
| Neuromuscular | Dynamic valgus, altered landing mechanics, quadriceps-dominant patterns, reduced trunk/hip control |
| Biomechanical | Greater knee abduction moments during selected cutting/landing tasks |
| Hormonal | Possible hormonal influences have been investigated, but clinical risk is multifactorial and should not be reduced to menstrual-cycle effects alone |
Indications for ACL Reconstruction in an Athlete
- Symptomatic functional instability / recurrent giving way
- Desire to return to pivoting, cutting or…