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The number of female athletes participating in competitive youth sports has increased greatly over the past four decades. In 1972, only 1 in 27 girls played varsity sports. This translated to approximately 294,000 girls compared with 4 million boys. Twenty-five years later, 1 in 3 girls played varsity sports in high school as compared with 1 in 2 boys, translating to 3.86 million boys and 2.68 million girls.1 The dramatic and rapid increase in the number of female athletes began with the passage of Title IX (the Patsy T. Mink Equal Opportunity in Education Act), a federal antidiscrimination law that mandates non-discrimination in access, admissions, and treatment in all federally funded educational programs. This includes extracurricular activities, such as club sports, intramurals, and varsity sports. Currently, there are more than 55 million women athletes in the United States, many of whom are school-age participants. Today, girls are encouraged to be stronger, more competitive, and look more "fit." Research has demonstrated psychological, sociologic, and physiologic benefits in female athletes compared with non-athletes.2
Unfortunately, new issues that challenge healthcare professionals have arisen in the young female athletic population. Perhaps the most notable injury that occurs in young female athletes at a much greater frequency than their male counterparts is the anterior cruciate ligament (ACL) tear in the knee. Additionally, increased injury rates, sex discrimination, problems with drug and/ or supplement use, and disordered eating are of great concern for the female athlete. Whether the athlete is suffering from an overuse or an acute injury, the healthcare team must know what characteristics are unique to the young female population and must address these in a systematic and comprehensive approach to treatment.
The majority of this review focuses on the female athlete triad. The basic approach to diagnosis and treatment, as well as strategies for prevention using a case-based approach is discussed. A brief overview of acute ACL injuries in adolescent female athletes is included.
FEMALE ATHLETE TRIAD
Female athlete triad is defined as disordered eating, amenorrhea, and premature osteoporosis. The interrelatedness of the triad was recognized in 1991 at a meeting entitled "Medical and Orthopedic Issues of Active and Athletic Women." In 1992, the American College of Sports Medicine (ACSM) held a task force meeting and as a...