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According to an article posted in Br J Sports Med, “ACL injuries is the largest single problem in orthopedic sports medicine, with the incidence of non- contact ACL tears being much higher in the female athletes in sports such as basketball and team handball than in male athletes.” ACL injuries remain significant problems, especially in young female athletes’ ages 14-19 years. Three National ACL surgical registries have been established (Norway 2004, Denmark 2005, Sweden 2006) gather information on the details of ACL surgery and to monitor the outcomes of this surgery.

According to the Norwegian data, a total of 2793 primary ACL ligament reconstruction operations were registered by 57 hospitals during 18 months. Annually this translates to 34 per 100,000 citizens (85 per 100,000 citizens in the main at risk age group of 16-39 years). The numbers of ACL operations differs between the sexes, with females having the most reconstructions in the age group of 15- 19 years. The Swedish registry found a higher proportion of both primary ACL reconstruction and revisions in women than men (59% vs. 41% and 55% vs. 45%).

The risk factors for ACL injury have been considered as either internal or external to an individual. External risk factors include type of competition, footwear and surface, and environmental conditions. Internal risk factors for ACL injuries include anatomical, hormonal and neuromuscular risk factors. The course of an ACL injury depends on many different factors, such as trauma mechanism, associated injuries, anatomical factors, and activity level after the injury.

Female athletes have a greater risk of incurring an ACL injury than male when they compete at the same sport at the same level of competition. There appears to be mounting evidence that women have significantly greater risk of ACL injuries during the preovulatory phase of the menstrual cycle than during the postovulatory phase. Athletes with a decrease intercondylar notch with have...