How does an ACL tear occur?
An anterior cruciate ligament (ACL) tear most often occurs during a sudden change of direction, a pivoting motion, or upon landing from a jump. In most cases, there isn’t even any contact: the person injures themselves simply by twisting their knee (sprain).
According to statistics from the Swiss National Accident Insurance Fund (Suva), nearly 90% of anterior cruciate ligament tears occur while skiing or playing soccer. Handball, basketball, and combat sports are also responsible for a large number of cases.
Why are women at greater risk?
The risk of an ACL tear is reportedly two to six times higher in women than in men during sports activities. This finding holds true regardless of the sport, although the exact figures vary depending on the study. However, a longitudinal study conducted in Finland involving more than 45,000 young adults qualified this finding: the relative risk is higher for young women only when they engage in intensive sports training; at less than three training sessions per week, no difference was observed between the two sexes.
Several hypotheses attempt to explain this difference. Morphological characteristics may play a role: shorter ligaments, less developed musculature, a wider pelvis, anatomical differences in the knee, and greater joint laxity. This hyperlaxity, which lowers the threshold for ligament rupture, is thought to have a hormonal origin.
This hormonal theory is supported by several studies: the risk of rupture appears to vary with the menstrual cycle, increasing during the pre-ovulatory phase and at the time of ovulation (between the 9th and 14th day of a 28-day cycle), then decreasing starting on the 15th day, during the post-ovulatory phase. Oral contraceptives may have a protective effect.
ACL Tear: Is Surgery Always Necessary?
Surgery is not routinely performed following an anterior cruciate ligament (ACL) tear, whether complete or partial. It may be considered once the patient is able to walk without limping, following a treatment regimen that combines physical therapy sessions, wearing a brace, rehabilitation, and muscle strengthening.
The decision to undergo surgery is generally made at a later stage, following a thorough assessment of the individual’s situation. The desire to return to sports, physical activity goals, and the level of discomfort experienced in daily life are key factors in this decision.
How can an ACL tear be prevented?
Prevention relies on targeted exercises: proprioception training (awareness of the body’s position in space), balance training, and, above all, muscle strengthening for both women and men. Joint flexibility exercises, on the other hand, do not appear to be effective in preventing this injury.
In the United States, prevention programs in professional women’s basketball teams have reduced the incidence of knee injuries by 89%. These programs teach athletes to avoid changing direction at too sharp an angle and to replace sudden stops with a stop made in three small, successive steps. When rehabilitation or surgery are not sufficient to restore proper knee stability, wearing a knee brace can provide additional support.
Frequently Asked Questions About ACL Tears
Is surgery always necessary for an anterior cruciate ligament (ACL) tear?
No. Surgery is considered on a case-by-case basis, once normal walking has been restored through rehabilitation, taking into account the individual’s athletic goals.
Does the menstrual cycle affect the risk of an ACL tear?
Some studies suggest so: the risk appears to increase during the pre-ovulatory phase and at the time of ovulation, then decrease during the post-ovulatory phase.
Does the birth control pill protect against ACL tears?
Some data suggest that oral contraceptives have a protective effect, but this remains to be confirmed depending on the source.
Does stretching help prevent ACL tears?
No: unlike strength training and balance exercises, joint flexibility exercises do not appear to be effective in preventing this injury.
Which sports carry the highest risk of an ACL tear?
Skiing and soccer account for nearly 90% of cases, according to Suva. Handball, basketball, and combat sports are also at risk.
We remind you that the specialists at the Sports Medicine Center at Hôpital de La Tour are available to assist you if you wish to receive treatment for this condition.
If you’d like to learn more about the ACL, we invite you to visit the following pages: