ACL injury prevention: “If you had ten minutes…”

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Monday I did an interview with Paige Greenfield, a writer for ESPN for their women’s sports site. The question she asked was simple enough. If you had ten minutes to prevent injuries in female athletes, what would you do? I gave her several ideas, but after thinking about athletes I’ve seen in my clinics lately, there is one that I wanted to share with female athletes and their families, an ACL injury prevention program.

Readers of this sports section, and sports fans in general, are surely familiar with anterior cruciate ligament tears. The ACL is the main stabilizing ligament of the knee, and they are often injured in college and professional athletes. But I doubt that many realize that stars like Tom Brady are not the most common athletes to be sidelined by them.

Soccer is a common sport for ACL injuries in female athletes.

According to most studies, ACL tears occur between two and ten times more frequently in female athletes than males. If you were an orthopaedic surgeon who wanted to specialize in these surgeries, taking care of pro sports teams wouldn’t be very productive. Females who play jumping sports, like basketball and volleyball, or sports that require cutting and pivoting, like soccer and lacrosse, are the most likely victims. These athletes, and their coaches and parents, need to be familiar with the injury.

Female athletes are prone to ACL injuries because their knees are susceptible to the common mechanisms of injury. Getting tackled and having the knee twisted, like Tom Brady did, is actually not the normal injury pattern. An athlete who tears her ACL typically cites one of two events. She can land from a jump with her knees fully extended and the knee gives way. Or she can be running and plant her foot to change directions. The foot sticks but the knee rotates. Either way, she likely will feel a pop, have rapid swelling, and have difficulty bearing weight. Just like that, her season is over.

I have to deliver the news that an athlete has torn her ACL well over 100 times per year, and I have seen how devastated these athletes are. The thought of surgery and 5-6 months of rehab are often not as scary as missing the rest of the season and letting their coaches, parents, and teammates down.

Emily Gossen, the goalkeeper of Academic Magnet’s girls’ soccer team that won the state championship this year, tore her ACL as a freshman. She recollects, “Tearing my ACL was awful. I was not able to complete my high school season, and I got a late start into my club season. I was miserable because I felt so weak and couldn’t partake in typical activities that I enjoyed.”

So what would I recommend to prevent ACL injuries? First, I would recommend that parents of female athletes spend time finding a sports medicine program that teaches an ACL injury prevention program, specifically one that is tailored to that sport. Girls tend to land and turn with their knees fully extended (unlike boys), which put the ACL at risk. Fortunately exercise programs can teach girls to jump and turn with their knees bent.

Soccer player doing ACL injury prevention program exercises

And to answer the ESPN question, the ten minutes is spent daily performing the exercise program. These exercises, once learned, should be done every day before practices and games. They replace the traditional warm-up exercises players do. In fact, if someone watches athletes doing them and doesn’t know, it looks like they are doing a normal warm-up. But done every day, these programs have been shown to at least decrease the chance of ACL tears occurring.

And what is the risk? If a girls’ soccer player doesn’t tear her ACL, one could argue that she might not have torn it anyway. But if these programs prevented even one injury, it would be worth it. A torn ACL usually requires surgery and about six months of physical therapy. But more importantly, the team often loses a valuable member who is difficult to replace. ACL tears can devastate players and teams alike.

One of my partners once jokingly asked me why I promote prevention programs that could cut into surgeries that make money. Quite simply, it is the right thing to do. Sports medicine needs to evolve into a field that tries to prevent injuries instead of simply treating them.

Note: This post appears in a modified format in the June 8, 2011 edition of The Post and Courier.