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My teenage daughter has been told she should have surgery to correct her Q-angle so she won't injure her ACL during sports activities (she's in volleyball, soccer, and basketball). Wow -- this seems pretty drastic. Isn't there some other way she can prevent this injury? I see other girls wearing knee braces. How about that?
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Female athletes are at greater risk for knee injuries, especially the anterior cruciate ligament (ACL). The Q-angle (which stands for quadricapes angle) is a risk factor for ACL injuries but surgery is not the first step in addressing this issue and preventing knee trauma.
The Q-angle is measured from the hip to the knee and assesses the position of the patella (knee cap) in relation to the hip. A knee cap that is pulled off center laterally (away from the other knee) by the quadriceps muscle puts the ACL in a position where it is more likely to rupture.
There are two types of risk factors that contribute to the sex differences in rates of ACL injuries between men and women. The first is intrinsic, meaning things inside the body that affect the ACL. Intrinsic risk factors include anatomic and biomechanic variables. For ACL injuries, research has shown that the number of degrees of the Q-angle, the geometry of the intercondylar notch, the size of the ACL, and the slope of the tibia are contributing factors.
Hormone differences between men and women and genetic predisposition may be two additional risk factors. But data collected from studies so far has been insufficient to prove or disprove the role of either one in ACL injuries.
Extrinsic risk factors remain under investigation, too. One thing we know that does NOT seem to bear any influence on ACL injuries is the lack of playing experience among women. The rate of ACL injuries among women hasn't changed in the last 15 years. The number of females participating in sports HAS increased and along with that increase has come more injuries (not less as you might expect with increased experience).
Other extrinsic factors under consideration include shoe-to-playing surface interaction (increased friction) and shoe construction. Shoes with larger cleats and more cleats seem to increase torsional force on the knee (transferred up to the knee from the foot-to-surface effect). There is even evidence that turf surface and climate (dryer climate) can increase the shoe-playing torsional factor.
So you can see there are many modifiable factors that can be addressed to help prevent ACL injuries among female athletes. Physical therapists have identified landing position as a key area to focus on. When female athletes jump and land with both feet in control, both hips and knees deeply bent and facing straight ahead, and equal weight on both feet, there are fewer injuries.
But if even one leg is out of balance or the landing is compromised in any way, then the risk of ACL injury increases dramatically. The two different positions are referred to as the position of safety and the position of no return. Teaching women how to stay in the safety position (and having them practice this position daily) has proven to be successful in preventing ACL injuries.
This type of neuromuscular and proprioceptive training under the guidance of a physical therapist significantly can be done even with athletes who have excessive Q-angles; it decreases the incidence of ACL injuries in soccer and basketball players. Studies show up to an 88 per cent reduction of ACL injuries in the first year the prevention program was started.
The neuromuscular and proprioceptive program of exercises should be accompanied by other exercises as well (e.g., agility drills, core training, plyometrics). And a maintenance program is advised to avoid the effects of deconditioning.
Before beginning any treatment, it might be a good idea for your daughter to have an examination by a sports physician, orthopedic surgeon, or sports physical therapist. A posture assessment, examination of alignment (including the Q-angle), range of motion, and strength testing can be very helpful. This information can be used when planning a program to prepare for sports participation and prevent (or at least decrease the risk of) all injuries (not just ACL ruptures).
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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