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Knee injuries can bring even the best female athletes to their, well, you know, says Dr. Michael Ciccotti, chief of the division of Sports Medicine at the Rothman Institute at Thomas Jefferson University Hospital, Philadelphia.

“That is a topic that seems to consume sports medicine orthopedists. We have found that the female athlete has a higher incidence of certain types of knee injuries, the most dramatic of which is anterior cruciate ligament (ACL) tears,’’ said Dr. Ciccotti, clinical assistant professor, Orthopaedic Surgery, Jefferson Medical College. “It’s a debilitating knee injury that abruptly prevents the athlete from participating in her sport.”

“This injury often requires surgical treatment to return that athlete to her sport,’’ said Dr. Ciccotti said, who is one of the orthopaedic consultants for the U.S. Women’s National Soccer team.

The sports medicine specialist said the ACL injury can occur most frequently in women ages 16 to 30 participating in pivoting sports such as soccer, basketball and baseball.

“It can also take place in activities such as rollerblading and field hockey, or any kind of sports that require twisting, turning, planting and pivoting,’’ he added.

Typically, an athlete with an ACL injury will feel or hear a pop in her knee, have significant pain and swelling, and be unable to pivot, Dr. Ciccotti said.

There are a variety of factors to explain why this injury affects women more often.

“We know anatomically that the female pelvis is in general broader than the male pelvis and that necessitates a more dramatic angle at the knee,” he explained. “Because the pelvis is broader, the knees come in at a sharper angle and that may pre-stress the anterior cruciate ligament, making it susceptible to tear with the dramatic, rapid pivot that may be required in the sport.”

“Furthermore, the ligament sits within a small boney corridor or notch and in females we believe that notch is narrower so that when they are involved in their sport and pivoting, the ligament can actually be bruised or damaged as it impacts on that narrow boney notch,” he said. “It also has been postulated that female athletes have a different ratio of anterior thigh muscle (quadriceps) strength to posterior thigh muscle (hamstring) strength than male athletes.”

Once the injury occurs, the most reliable course of action for repairing the damage and getting the young woman back to her sport is surgical reconstruction, Dr. Ciccotti said.

“Numerous female athletes who have had ACL injuries with pivoting sports have done very well and have returned to their activities,” he said.

However, such injuries can be prevented by following a stretching and strengthening routine before playing in a sport, the sports medicine specialist said.

“If it’s a running sport or a sport that involves a tremendous amount of lower leg motion like cycling, jogging, any of the field sports, then stretching will reduce the risk,” Dr. Ciccotti said.

Here are some of the stretching exercises recommended by Dr. Ciccotti. The stretches should be performed for a period of three to five minutes before playing:

• For quadriceps muscles, pull your heel towards your buttocks and extend your hip backwards.
• For hamstring muscles, stand and put your heel on a chair in front of you and lean forward.
• For calf muscles, stand approximately two or three feet from a wall and lean towards the wall with your heels on the ground.

For muscle strengthening, Dr. Ciccotti recommends the following exercises:

• For quadriceps and hamstrings, it’s recommended that athletes use some type of machinery such as the leg extension machine, where you sit on the side, over the end of the machine, and extend the knee with the weight around the ankle. Bring the leg up and hold it for a few seconds then relax, bringing the leg down to a full knee bend. Do this exercise 10 to 15 times.
  
  You can do the same exercise by lying on your stomach on a table or bed and having a weight around your ankle. Bring your heel up towards your buttocks and hold it there for five seconds and then relax, bringing it down straight.
  
  
• For strengthening calf muscles, stand up on your tip-toes, hold that position for five seconds and then relax. Repeat 10 to 15 times. A little more advanced routine is to step up onto a step stool, which when you come back down, allows you to sag down beyond the level of the step stool and so when you come back up you’re generating a little more force in your calf muscles.