Frank A. Cordasco, M.D.

The New York Times recently ran an article about the pervasiveness of knee injuries in women’s basketball. As a specialist in sports medicine, what can you tell us about differences between men and women in sports-related injury?

With the participation of women in athletics growing rapidly over the last two decades, a disturbing gender-specific predisposition has emerged regarding anterior cruciate ligament (ACL) injuries of the knee. Female athletes are two to eight times more likely to sustain ACL injury than male athletes. It is estimated that 38,000 women sustain ACL tears each year. The majority of ACL injuries in female athletes are non-contact, meaning they occur during deceleration activities, such as landing from a jump, and not through physical contact. There are two types of risk factors for non-contact ACL injuries: intrinsic and extrinsic. Intrinsic risk factors include anatomy and hormones. Gender differences in anatomy such as the pelvis, joints, muscle development, ACL size, and the alignment of the lower extremities are thought to contribute to the higher female ACL injury rates. During the menstrual cycle, female hormones estrogen and relaxin fluctuate and are reported to increase laxity or slackness in the motion of ligaments and joints, and decrease performance between muscles and nerves. As such, hormones may decrease knee stability in female athletes. Extrinsic risk factors include environmental factors such as shoe type, playing surface, and other equipment (such as prophylactic knee braces) and do not vary much between genders. However, because females are at higher risk for non-contact ACL injury, factors such as a high-level of friction between shoes and the playing surface and cleat design should be investigated further to maximize safety and performance. Another extrinsic risk factor is biomechanic: females perform cutting and landing maneuvers with a more erect hip-trunk posture and less knee bending than males. Some authors have suggested that inexperience, lack of training, poor coaching, and poor field conditions contribute to ACL injury.

What are the most common orthopedic injuries you see in men and women, and how are they treated?

The most common orthopedic injuries in men and women are the same: ACL and meniscus injury to the knee, and dislocation, separation, and rotator cuff injury to the shoulder. The treatment of these injuries is generally not gender-specific as they are structural problems, which often require surgery. As noted in the answer to the first question, the prevention of some of these injuries is gender-specific, particularly regarding injury to the ligaments.

We hear a lot about "rotator cuff" injuries in such sports as baseball and tennis. Can you tell us about the rotator cuff and what an injury to it means?

The rotator cuff is a group of four muscles and tendons. The injury generally results in strains or tears. Strains can improve with rest, a modification in activity, the use of anti-inflammatory agents and physical therapy. Tears of the rotator cuff often require repair, which is currently performed using a local anesthetic and arthroscopic surgery on an outpatient basis.

What would your advice be to patients about exercising safely?

Athletes should warm-up and stretch before exercise and cool-down after an activity. Exercise should be increased moderately and good judgment and common sense should be utilized when increasing the frequency or duration of an activity.

What about patients with osteoporosis — is it safe for them to exercise regularly? What kind of exercise would you recommend?

The answer depends on the severity of the osteoporosis with respect to the bone densitometry results. Exercise is an excellent means of preventing osteoporosis and maintaining and increasing bone stock, however if bone stock is weakened by osteoporosis, improper exercise could result in fracture. Patients should consult with their physician or metabolic bone specialist regarding the proper exercise regimen.

Many teenagers who suffer from eating disorders end up with osteoporosis. Can you comment on the risks they might face, especially if they play sports?

This is a complex problem, which has short-term complications such as stress fractures, and long-term ramifications that include early onset bone loss and disability.

What protective gear do you recommend to patients who play various sports?

Collision athletic activities (football, hockey, baseball, soccer, lacrosse) have standard protective equipment requirements (batting helmets, shin guards etc.). Rollerblading should include the use of a helmet, knee and elbow guards and wrist guards.

You co-authored a paper about motorcycle injury and the strain it puts on public health funds. Can you tell us about your findings?

The most significant finding was the high incidence of death and permanent head injury in those individuals not wearing helmets.

What would your advice be to motorcyclists?

Regardless of state law, WEAR A HELMET!!!!!

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