We can examine any area of medicine using the Gender Lens Tool. Use the Gender Lens Tool chart to guide your thinking about gender issues in anterior cruciate ligament (ACL) injuries.
Dr. Helen Perry* is a 50 year old physician who lives and practices in Toronto. She is an active clinician and teacher, has 2 children, and is very close with her family.
While on her annual ski holiday in British Columbia, Helen fell on a double-black diamond run and injured her knee. Initially she managed it with rest, ice and anti-inflammatories but when it continued to bother her and limited her active lifestyle she and her family physician, Dr. Chase, were concerned about an ACL tear and decided to seek a sports medicine consultation with Dr. Deschamps.
Her appointment with Dr. Deschamps was followed by an MRI. It was determined that she had torn her ACL and had some bone bruising.
Helen was told that it would be very difficult to find an orthopedic surgeon willing to repair her knee injury because "they don’t like to operate on women over the age of 40". Surprised by this, Helen began investigating gender issues in ACL repair.
Helen’s family physician recommended two surgeons she could see. The first surgeon, Dr. Weinmann, recommended that Helen not have repair surgery and suggested that she wear a brace to continue activities such as tennis and skiing. Dr. Weinmann agreed to re-evaluate Helen a month later. At that time, he recommended another MRI of the knee, as he thought there might also be a medial meniscus tear. MRI results confirmed that there was both an ACL tear and medical meniscus tear.
Dr. Weinmann still did not feel that the ACL required repair. He recommended Helen continue as best she could using a brace.
Frustrated, Helen decided to see the second orthopedic surgeon. Dr. Chase spoke to the surgeon before Helen’s appointment to make him aware of the case and Helen’s circumstances. He told Helen she had three options: to change her activities (i.e. not ski), use a brace, or have repair surgery. Helen chose to have her ACL repaired, as she was not fond of wearing a constrictive knee brace for the rest of her life and was not willing to give up her beloved sports activities at the age of 50. Helen has often wondered about the extent to which Dr. Chase’s intervention, in calling the surgeon about her case, was significant in her being offered the surgery option. What do you think ?
The surgery to repair Helen’s ACL repair was done without complication. She is now healing well and starting to resume her activities. She plans to ski again when weather permits and maintain her active lifestyle. She has since learned of many women who have not been offered surgery following an ACL injury. Of particular concern to Helen is a 38 year old women who is very athletic and had an ACL tear at about the same time as her husband tore his ACL. Her husband is also athletic and also 38 years of age. He had ACL repair surgery and she didn’t. Helen is now quite interested in the difference in, and seemingly biased treatment of, ACL tears according to gender.
*All names have been changed.