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Women's Health

Differences Between Sexes Extend to Knees

Knee injuries are a common hazard for athletes -- especially those who play basketball, volleyball, soccer or other sports where knees are subjected to turning, twisting and jerking.

But a new University of Michigan Health System (UMHS) study shows that female athletes may be at an even greater risk for a certain type of knee injury than their male counterparts due to the differences in the muscle structure around the knee.

"Knee muscles are capable of protecting ligaments and preventing injury," said Dr. Edward M. Wojtys, professor of orthopedic surgery at University of Michigan Medical School and director of sports medicine at UMHS. "Female athletes are two to eight times more likely to tear their anterior cruciate ligament (ACL) because they may not be able to achieve the same muscle stiffness across the knee joint."

Wojtys called the study "one piece of the puzzle" in determining the differences between female and male athletes and, consequently, providing for the training and conditioning needs of female athletes in a safe, effective way.

Researchers studied male and female athletes who play "pivoting" sports, like volleyball, basketball and soccer, as well as "non-pivoting" sports such as cycling, crew and running.

"We found that female athletes in the pivoting sports often had less muscle protection at the knee than their male counterparts," Wojtys said. "That lack of muscle protection, which helps absorb the load on the knee joint, may contribute to the injury susceptibility."

In addition, researchers found, women who played jumping, turning, twisting sports actually had the poorest ability to protect themselves against rotational strains.

"Neuromuscular factors, like how an athlete lands from a jump, may also be factors in injury risk," said Dr. Freddie H. Fu, chairman of the department of orthopaedic surgery at the University of Pittsburgh. "It's important that female athletes learn proper jumping and landing techniques as part of their conditioning and training."

Wojtys said male and female athletes generally are trained the same way. But this research suggests that may be a big mistake.

"We may need to train female athletes differently. The long-term scenario is to try to find rehabilitation and training tools that will specifically help female athletes because they seem to be more susceptible to this type of injury," Wojtys said.

Women who are active in sports also are susceptible to developing a condition known as the "Female Athlete Triad," which involves disorded eating that can range from mildly disordered eating to severe eating disorders such as anorexia and bulemia, amenorrhea, absence of menstruation, increased risk for stress fractures and the development of osteoporosis.

"We have found that there are certain types of stress fractures that may be predictive of underlying osteoporosis and these fractures are seen in patients with disordered eating," said Dr. Jo A. Hannafin, associate professor of orthopaedic surgery at Cornell University Medical College and orthopaedic director of the Women's Sports Medicine Center, Hospital for Special Surgery in New York City.

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