As female participation in Australian Rules Football continues to soar, the popular code faces a potential ACL injury crisis at all levels of the game warns SPORTSMED·SA Adelaide Orthopaedic Surgeon Dr Matthew Hutchinson.

According to worldwide orthopaedic literature and evidence, adolescent females have the highest rate of ACL injury.

“Adolescent females are at the greatest risk of sustaining an ACL injury in comparison to all other athlete ages and genders,” said Dr Hutchinson, a lower limb specialist who treats both adult and paediatric patients.

“Some studies have shown that their risk of an ACL injury can be 3-4 times higher than older, male athletes.

“We are still not 100% sure of the reason for the increased rate of ACL injury in adolescent females, however there are most likely several different factors contributing to it. Adolescent females have a smaller ACL than a male, different alignment of their knee joint, and in general they have less developed control of their hip and knee joint in comparison to more mature athletes.

“It’s not a case of adolescent female athletes lacking pure strength, these are very fit and strong young women. But it certainly does seem to take longer for a female athlete to develop improved control of their knee joint, especially when jumping, landing, dodging and weaving. This lack of control is what can cause the knee to give way, leading to an ACL injury.”

Classically, sports that featured a heavy female influence such as soccer and netball were known to produce a high number of ACL injuries and as a result those codes developed injury prevention programs in a bid to reduce the number of on-field occurrences.

The World Game introduced the FIFA 11+, a comprehensive warm-up program, while Netball Australia implemented the KNEE Program in 2015.

Netball Australia’s KNEE Program is designed to prevent serious knee injuries occurring, given that ACL ruptures account for 25% of injuries sustained on the court.

With almost 300,000 females now participating in Aussie Rules, Dr Hutchinson has called for the code to introduce similar injury prevention programs to avoid an ACL plague. The AFLW competition saw three players succumb to ACL injury in it’s inaugural season this year, including marquee stars Kiara Bowers (Fremantle) and Renee Forth (GWS), and Collingwood’s Canadian recruit, Kendra Heil.

“With the increasing number of females playing footy, we are also going to see a potential epidemic of young, female participants injuring their ACL if we don’t think about preventative measures to reduce the risks,” he said.

“I have seen a large increase in the number of adolescent females that I am treating with ACL injuries, and growing numbers of these athletes are being injured playing AFL.

“There is growing evidence to suggest that structured physiotherapy, strengthening and balance work can reduce an athlete’s risk of suffering an ACL injury considerably.

“I would certainly support the AFL in developing a nationwide injury prevention program inclusive of those recommendations that accommodates the demands of the unique game. It won’t reduce the number of ACL injuries to zero, but even if we can save a few young athletes from a severe knee injury then that is a huge win.

“As devastating as it is for a young athlete to rupture their ACL, the good news is that surgical techniques have evolved considerably in recent years, as has our understanding of how to treat ACL injuries in adolescent and adult athletes. This means more patients can expect to recover from their knee injury and get back to doing what they love.”