ACL Tears: Why Are Women More Susceptible? - Dr. Mullen

Dr. Mullen:
Hi, my name is Dan Mullen. I am fellowship trained orthopedic surgeon working at the Banner Baywood Medical Center in Mesa, Arizona.

I specialize in sports medicine and I see a range of patients with a range of different problems.

I see ACL tears, arthritis, knee problem, shoulder problems and hip problems, and I take care of patients from a variety of places including Gilbert, Mesa, Tempe, Chandler, Scottsdale and the greater East Valley of Phoenix.

Women are at a higher risk of tearing the ACL or the anterior cruciate ligament as compared to men.

There’s a number of theories as to why that may be. They fall into three major categories.

Anatomic differences -- Women, of course, have a wider pelvic brim, a natural accommodation for the potential for childbirth, and that leads to an increased valgus angle at the knee which can potentially cause increased strains on the ACL and eventually potentially lead it to rupture.

A second consideration is hormonal. There are estrogen receptors, progesterone receptors in the knee and most notably on the ACL.

And there is an idea that these receptors can be involved in weakening the ACL at different times of a female’s menstrual cycle, hence precluding them to injuries at different times.

A third consideration is neuromuscular balancing and control. It’s been shown that when a woman lands from a jump or a fall, she typically activates her quadriceps mechanisms at a higher proportion in relation to the hamstrings as compared to a man.

There are jump mechanics programs to help educate women and to retrain these muscles to minimize her chances of tearing her ACL.

High heels don’t necessarily increase the risk of tearing the ACL because it’s usually a firm foot plant combined with a twist that leads to the injury.

And when they are wearing shoes other than athletic shoes it’s of low likelihood that they will tear their ACL. It’s more likely that they would tear it wearing firm athletic shoes participating in athletic maneuvers.

About Dr. Daniel J. Mullen, M.D.:
Dr. Daniel J. Mullen, M.D., specializes in reconstructive procedures of both the knee and shoulder. He did his undergraduate studies at the University of Notre Dame. He went to medical school at Temple University in Philadelphia and did his orthopaedic training in Baltimore centered out of Union Memorial Hospital. He also worked at Johns Hopkins University Hospital and the Shock Trauma Center. He did a fellowship at the Cleveland Clinic in Ohio where he was assistant team doctor for the Cleveland Browns, the Cleveland Cavaliers, and the spring training division of the Cleveland Indians. He has authored numerous articles and textbook chapters and delivered many research and teaching presentations on surgery of the knee and the shoulder on both a national and international level. He volunteers his time and resources to help the local high school athletes during their sporting seasons. He lives in Gilbert, AZ, with his wife and two boys.

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• Anterior Cruciate Ligament Injury