Knee Injuries in Women
Ross Hauser, M.D. Marion Hauser, M.S.,R.D.

Though males and females have the same musculoskeletal structures, there are some unique differences that actually make female athletes more prone to injury. In regard to skeletal differences, males usually have wide shoulders and narrow hips, whereas a female generally has a wide pelvis in relation to the width of her shoulders. This wider pelvis is necessary for childbirth. This wider pelvis is stabilized by the sacroiliac ligaments in the back and the Pubic Symphysis and pubic ligaments in the front. It is these ligament structures that are stressed and account for the significant back pain that occurs in 50 percent of women who are pregnant.1

This wider pelvis in females leads to an increased inward slant of the thigh and, therefore, an increased Q-angle of the knee.2 (See Figure 27-1.) The Q-angle, a measurement of the angle created by the line from the anterior superior iliac spine and the patella, and the line from the patella to the tibial tubercle, is normally less than 12 degrees. An increased Q-angle produces excessive lateral forces on the quadricep's mechanism and abnormal tracking of the patella. This is one of the reasons why chondromalacia patella or patellofemoral syndrome is more common in women.3

As stated above, a female's thighs tend to slant inward towards the knees more than a male's. This puts additional strain on a woman's hips and their ligamentous support. This is one of the reasons that the majority of the 120,000 hip replacements done each year are in women.4

Females also have a wider carrying angle of the elbows. This is similar to the Q-angle of the knee. This wider angle places additional stress on the medial elbow stabilizers, namely the ulnar collateral ligaments, which are usually the culprits when a female athlete has medial elbow pain.

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