One in 100 female players suffers an ACL injury during her playing career; men, one in 300. Such injuries have increased by 208% in women during the last decade
“We are facing a national problem. Of State. And, of course, of all of us who are in the world of football. We talk about the deterioration of athletes. Also tomorrow’s osteoarthritis. Of the expenses for the society in prostheses, surgeries, medicines… This problem in the sport translates to us a problem in the society. The best thing is not to cure, but to prevent. We have to put our bodies in better condition for work.”
The doctor Ramón Cugat, from that Barcelona consultation where the congratulations of those who have passed through his hands are piled up -one of the Royal Family stands out, for example-, he does not hesitate to get up from his chair as many times as necessary. They are waiting for him in the operating room, but first he prefers to make everything clear. She squats, simulates gestures and knee rotations, and links arguments to explain a disturbing routine: the proliferation of anterior cruciate ligament tears in female athletes. A problem that appears when a relevant episode occurs [la lesión el pasado julio de la doble ganadora del Balón de Oro, Alexia Putellas, que le hizo perderse la última Eurocopa y quien no regresará a los terrenos de juego hasta la recta final de la presente temporada; o la doble rotura de la campeona olímpica de bádminton en Río, Carolina Marín]. So that, after the media impact, everything remains in the background. Despite the fact that the results of the studies in this regard are increasingly worrying.
The last of these reports, prepared by the Cugat Institute based on data from the Mutualidad de Futbolistas in its Catalan delegation between 2015 and 2021, determines that players are injured in the anterior cruciate ligament (ACL) between 1.5 and three times more than men, either with a sprain or a break produced during sports practice. And that one in 100 female soccer players suffers an ACL injury during her career. The ratio for men remains at one in 300. “And these data can be extrapolated to the entire Spanish territory,” warns Dr. Cugat, who also points out that, in the last decade, anterior cruciate ligament injuries have skyrocketed, increasing “208%” among women.
Anatomy and hormonal factors
The factors, beyond the increase in licenses caused by the boom of women’s football in Spain, are multiple. Anatomy and biomechanics are presumed essential. «The woman has a more open pelvis. Her knees close, and her feet open. She is one of the main handicaps », explains Cugat. And he abounds: «The knee bones of men and women are similar, but different. The kneecap is somewhat higher in women. Also, women’s muscles do not have the same volume as men’s. You can work them more, but the difference is there. In addition, the ligaments are more elastic in women, while the man’s structure is more resistant and fibrotic. The female anterior cruciate ligament is also smaller, and is in a narrower intercondylar space. Everything influences. Because the woman is different in the trunk. And also her gestures when she runs, when she jumps… In addition, as far as the hip is concerned, she doesn’t flex so easily in the drop jump and causes the knee to suffer more. Sometimes the buttocks are weaker and it is necessary to strengthen them more. The posterior hip muscles fail more than in men.”
There are even studies that point to hormonal factors, something with which Cugat also agrees: «It seems that, during the pre-ovulation and ovulation phase, hormones cause tissue elasticity to increase. An alteration of the collagen of the ligament is then produced. [el principal componente]. And the more elastic, the more easily it breaks.
In the 2021-22 season, up to three Barcelona players were treated in Dr. Cugat’s office. All of them had to be intervened due to ruptures of the anterior cruciate ligament: Bruna Vilamala, Jana Fernandez y Cata Coll. It did not pass through his hands Alexia Putellas, whose operation was carried out by the doctor Joan Carles Monllau. The time of leave was estimated in all cases between 10 and 12 months.
The risk
«The ideal time to recover is one year to avoid re-breaks. Latinos always want to run a lot. An ideology based little on science has been created, and much on the desire of the player, the doctor and the club, to return to activity as soon as possible. In the United States, it is not allowed to return a football player or soccer before 12 months after surgery. Although there are those who may be available after six months, or even four or five. We have seen that those who return to play and break less are those who wait 11 months. The longer we wait, the better. And it’s not that women take much longer to recover than men. There is some difference, but not too much. What we want today is to prevent them from relapsing. A re-tear is dramatic from a physical and psychological point of view”, maintains Dr. Cugat.
The traumatologist also warns of the risk of breaking the other knee: «If we have surgery on our left knee, you change the position and carry the opposite one. There is not enough muscle strength. When they return to sport after the cruciate operation, between 10-15% of footballers, after one or two years, break the other knee. Not only that, the hamstrings are also more easily torn because they are not sufficiently prepared for the wrong gesture.
Before finishing, Cugat’s gaze wanders between the paintings of all those fallen footballers who populate his home. Because, of course, he awaits an invisible demon, but no less harmful: «A physical injury entails a psychological alteration. I have always seen her. It’s fear.”
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