'Safe Soccer' Important for Girls.

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Oct. 31, 2000 (Philadelphia) -- Women's progress in sports has changed the landscape of school athletics. Girl teammates play alongside the boys in several football and wrestling teams, and cheering on the daughter in soccer is a part of life for many parents. But this enthusiasm may need to be balanced with caution: A certain soccer-related knee injury is associated with early arthritis in girls.

The injury, an anterior cruciate ligament (ACL) tear, involves the tearing of a ligament inside the knee. This ligament, the ACL, provides stability to the knee and tends to tear with a popping sensation within the knee. Depending on the level of athletic involvement desired by the patient, among other factors, an orthopaedic surgeon may or may not surgically reconstruct this ligament.

This injury is commonly seen in sports that involve jumping and running. The twisting and turning movements on the soccer field can lead to ACL tears, and women seem to be predisposed to these tears more than men are, according to Harald Roos, MD, who spoke here at the annual meeting of the American College of Rheumatology. The reasons women are more vulnerable to these injuries is unclear, says Roos, an associate professor of orthopaedics at the University of Lund in Helsingborg, Sweden, but it may be because the ligament is narrower in women than in men.

While other experts have proposed different explanations for this, it is commonly accepted that women tear their ACL more easily than men. When young women get these ligament tears, they are at high risk of developing osteoarthritis of the knee while they are relatively young, still in their early thirties, he says. Osteoarthritis is the most common type of arthritis in which the cartilage at the joints has deteriorated and is often associated with "wear and tear" and with aging.

In a recent study, Roos and colleagues followed about 100 women who had these ligament tears when they were approximately 19 years old. Twelve years later, the researchers conducted follow-up evaluations on these women using questionnaires and X-rays. Among the 67 who were X-rayed, almost two-thirds had had reconstructive surgery of the knee, and one-third had osteoarthritis as confirmed by X-ray.

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Most of the women also complained of problems with the injured knee that affected their quality of life, and these symptoms were not related to whether the women had had surgery. The women were an average of 31 years old at the time of follow-up.

"The only way to prevent subsequent arthritis is to prevent the injury," Roos says. "Preventing arthritis after the injury can't happen." Because the number in the study was relatively small, investigators would have to conduct a larger study to verify the findings, he says

And in the United States, where so many female soccer players are in elementary and middle school, it may be particularly important to follow the girls and young women who have these injuries, Roos says.

The solution is not to go back to a time when a woman athlete was a rarity, he stresses. "The goal is not to exclude women from soccer," Roos tells WebMD. "However, some precautions are required. We don't want to put women athletes at risk for [osteoarthritis]." For example, balancing exercises are known to strengthen the knees and therefore are thought to help protect them from injuries such as ligament tears.

"Athletic activity has more benefits than risks for both boys and girls," David Felsen, MD, MPH, tells WebMD. "The way to prevent these injuries is not to discourage women's participation in sports." Preventive exercises and caution for women are in order, however, he says. Felsen is an associate professor of medicine at Boston University School of Medicine.

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