About the ACL
The anterior cruciate ligament, or ACL, is the most important of four ligaments in the knee. It goes from the back of the thigh bone, or femur, to the front of the shin bone, or tibia.
GLOSSARY OF TERMS
Anterior: Front; Cruciate: Crossed, from the way it crosses another ligament inside the knee; Ligaments: Very strong bands of fiber that connect bone-to-bone.
MIDDLETOWN — As more student-athletes compete in high school basketball, the incidence of knee injuries — especially among female athletes — is climbing as well.
When compared with their male counterparts, high school female basketball players have a higher incidence of knee injuries that require surgery, they require more time to heal and they’re more likely to tear their knee ligament completely.
But athletic trainers and physicians are learning that proper exercise, even something as simple as wearing the proper shoes, can help reduce the chances of a basketball player suffering a season-ending knee injury.
No level of preparation is going to prevent a knee injury that comes from a collision.
When an outside force acts upon the knee joint and forces it to bend differently from the usual manner it’s designed to bend, chances are there will be tendon or ligament damage of some kind involved.
But many knee injuries are the result of how the athlete lands on the leg, or how they twist the leg, without any outside contact at all.
“Most people believe that the injury is caused by contact. They think it comes from a situation where the athlete gets hit from the side or is clipped from behind,” said Dr. Timothy Kremchek of Beacon Orthopaedics & Sports Medicine in Cincinnati. Kremchek is in his 15th year as the Cincinnati Reds medical director and chief orthopaedic surgeon.
“And that can happen, certainly. But most of the time, anterior cruciate ligament injuries are noncontact injuries. They’re from running and twisting quickly, jumping, turning down and jumping onto an unbalanced foot and having your knee jut forward, and that tears your ACL.”
Kremchek said that quick twisting, unbalanced landing movement is what makes basketball one of the leading sports for ACL injuries.
“It can happen in any sport, but in particular, it can happen in basketball,” he said.
A loud pop
On Dec. 30, during a girls basketball holiday tournament on the Miami University Middletown campus, Madison High School senior point guard Abby Jerger was at midcourt when she caught a pass, turned to head upcourt and heard a loud “pop.”
“I went to plant my right leg and tried to push off and twist, like a pivot motion. And it just wasn’t right. It stayed planted and didn’t want to move. At first, I didn’t think that it could be my knee because of how loud it sounded,” Jerger said. “It was kind of unnatural, but then I realized it was the knee, because the pain then set in.”
Jerger tore the ACL in her right knee. Almost two weeks later, she had surgery. While she’s had knee-related injuries in the past, this was the first time surgery was required. Now she’s going through the painful process of rehabilitation.
“At first, it was hard to do anything that involved range of motion, because the muscles weren’t used to moving yet, because there was so much muscle loss and swelling around the knee,” Jerger said. “Progressively, it’s gotten better, but the doctors have added new and different exercises that I can do.”
‘Jake Ballard did it’
Jerger hurt her knee the same way New York Giants tight end Jake Ballard, a former Springboro High School and Ohio State standout, did in Super Bowl XLVI.
“A lot of times, kids have injured their knee (without a collision),” said Amy Anders, Atrium Sports Medicine’s referral coordinator and the athletic trainer at Fenwick High School. “Jake Ballard just did it. ... That’s a pretty good example of what happens. You plant, you turn, and things go wrong.”
Dr. Woody Goffinett, the manager of Sports Medicine Services of Grandview Medical Center in Dayton, says female athletes have a higher incidence of the plant-and-turn knee injury than males.
“There’s definitely a pattern here that has shown that there’s a big number of noncontact knee injuries to female basketball players. It’s much higher,” Goffinett said. “We still don’t know exactly why females have a higher risk of knee injuries, but research has proven that you can get these kids into preventative ACL programs, like the Fast-Twitch program that we offer here, and the ground-based drills help to improve an athlete’s core structure to the lower extremities. Then that helps to reduce the incidence of noncontact ACL injuries among females.”
The numbers don’t lie
According to the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, 24.6 percent of all high school female basketball injuries require surgery, compared to 12.4 for males. The same study shows that 40.4 percent of all high school females require more than three weeks to recover from a knee injury (24.6 percent for males); and finally 21.8 percent of all high school females tear their ligament completely (compared to 8.4 percent of males).
Three years ago, the British Association of Exercise and Sports Medicine analyzed a registry of people with ligament-related knee injuries. The study showed that females 15 to 19 years of age were more susceptible to knee injury than any other age group.
More than 500 cases were reported among the female 15-19 age group. The next highest age group was 20-24 year old males with slightly less than 350 over the same time span.
A Canadian study found that high school female athletes are three times more likely to sustain an ACL injury than males.
Building a better knee
But like Grandview’s core program in Dayton, there are ways to help prevent ACL injuries from happening. According to Blaire Burke, a member of the Atrium Medical Center Sports Medicine staff, a certified strength conditioning specialist and Mason High School’s athletic trainer, it starts with athletes learning the basics.
“It starts with the foundation,” Burke said. “A lot of these kids are out there doing exercises that they’re not ready for. It goes back to: ‘Can they do a body-weight squat correctly? How is their running form? How is their landing form? How is their deceleration?’ Those are the areas where I would start with any athlete. Make sure they can do those things before I would progress them to any type of exercise. When they have that foundation, it all stems from their form and balance.”
From there, Burke said she would then provide the athlete with a workout that is more specific to their particular sport for that season.
The Santa Monica Sports Medicine Research Foundation has created a Prevent injury and Enhance Performance ( or PEP) program designed to build the strength and coordination of the stabilizing muscles around the knee joint. Their entire program can be downloaded for free at: www.smsmf.org/pep-program.
Praise for the multisport athlete
Another common reason for knee injuries is overuse. Someone may wish to excel in basketball, so they’ll play during the winter high school season, then join a spring/summer league, then a fall league in preparation for the next winter high school season. This doesn’t give the athlete’s body time to rest up, and that leads to body wear and tear.
“We’re seeing athletes who never give their bodies time to rest,” Lakota East athletic trainer Cory Jacobs said. “You’ve got to think of your body as a car. The longer you push the engine, it’s eventually going to run down. You’re going to have to replace some parts.
“You’ve got to let your body rest and heal up a little.”
“When I come across athletes who are only doing one sport, they’re never really letting their muscles be trained in different ways,” Burke added. “They’re constantly doing a lot of repetitions the same way, and that wears those muscles down.”
It’s the shoes
Most athletic trainers tell student athletes to wear the proper shoes for their particular sport, but too often the athlete will choose a pair that matches their team’s uniform. Or they’ll be wearing the right athletic shoe, but it’s more than a year old. Jacobs said the typical athletic shoe loses its support after about 300 miles of use. A high school athlete can use up those miles in one season.
“There are some reputable stores where you can go. Find a place that will offer several brands of shoes, like Foot Source or Bob Roncker’s Running Spot, Fleet Feet or Mojo Running or Buckeye Running Club,” Burke said. “Those types of stores will actually sit down and help you find the right shoe for your foot. They might even offer a treadmill that you can use to make sure you’re contacting the ground properly.
“If your foot is out of alignment, everything else follows.”
Patience is a virtue
Jerger said her doctors at Mercy Fairfield have told her she’ll need six to nine months of rehabilitation to regain the full motion of her right knee. She’s willing to take her time, rather than risk further expense. Besides, that would mean spending more time on the sideline watching others play.
“I’m willing to be patient with this,” Jerger said. “You don’t want to rush back too soon and have that possibility of re-injuring the knee. It’s hard though. I think any athlete will tell you it’s hard just because you want to be back on the court. You’ve been playing for a long time, and it’s what you love to do. When you’re not able to play, it’s tough to just sit back and watch.”
Contact this reporter at (513) 705-2851 or jbombatch@coxohio.com.
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