The passing of Title IX in 1972 has led to a rapid increase in the number of female athletes, and with this, the field of women’s sports medicine has continued to grow. As the number of female athletes increases, the role of sports medicine surgeons is to meet the needs of the female body, that vary greatly from the masculine, by improving the knowledge of the injuries, treatments, and outcomes.
The understanding of injury prevention and long-term outcomes after anterior cruciate ligament (ACL) injuries are still evolving, yet this is a promising area for future study in female athletes. The role of gender in concussions and its relationship to musculoskeletal injuries continues to be explored.
The purpose of this article is to highlight the current and relevant topics in the evaluation and management of the female athlete.
Anterior Cruciate Ligament (ACL) Injuries and Prevention
ACL injuries are up to eight times more common in female athletes than male athletes. The increasing number of female athletes and the number of ACL reconstructions performed in women has continued to rise at a rate greater than in men. Hormonal influences have been studied in their relationship to ACL injuries in women, yet the significance of this influence is unclear. The majority of ACL injuries occur without contact, during pivoting or landing motions. The most modifiable risk factor contributing to the increased risk of noncontact ACL injury in female athletes is a deficiency in neuromuscular control. Female athletes also have been shown have greater hip adduction moment and internal rotation when compared to male athletes, as well as decreased relative hamstring activation during such landing drills and decreased trunk stability.
Even though the rate of sports-related concussion is lower in women, this seems to be slowly changing – female athletes have been increasing the rates of concussion and it has been reported to be at 1.9 times greater risk for concussions in sex-comparable sports including baseball or softball, basketball, and soccer.
Evaluation and Management of Injuries in the Pregnant Athlete
Very little information exists on the evaluation and treatment of female athletes in the setting of pregnancy, yet this is a unique area within women’s sports medicine that is gaining increasing attention due to the sports participation of several elite female athletes during or after their pregnancies. Orthopedic surgeons are often unaware of the specific modifications and considerations for maternal and fetal health in the management of sports medicine injuries and can be hesitant to treat this population. Because of this, collaborations with maternal-fetal medicine specialists are paramount in the treatment of a pregnant female athlete, as well as to guide future research in this area.
As the number and type of female athletes continue to increase, your role as sports medicine surgeons is to meet the needs of this rapidly evolving field by improving your knowledge of the injuries, treatments, and outcomes that are specific to this population. The understanding of injury prevention and long-term outcomes after ACL injuries are still evolving, yet this is a clear area for future studies in female athletes. The unique element of pregnancy, which has gained increasing attention in the public and will continue to do so as women continue to be more active during all phases of their lives, leads to a greater need for multidisciplinary care. Because of this, women’s sports medicine programs that promote close collaboration with specialists who can augment our knowledge of the treatment of sports medicine conditions and promote awareness of the rapidly changing field can allow us to continually improve the level of care for female athletes.