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'One wrong step': Female athletes much more prone to tearing 'ACL' in the knee By
Lynnette Hoffman
In five years Utah State University graduate student Sarah Gray has had five surgeries on her right knee. Gray was almost 17 when she ruptured her knee for the first time. She was dismounting bars during practice at her gym in California. Everything seemed fine when she first landed her double twisting flyaway. But a moment later she fell and blacked out. "I either landed still twisting or I stepped on it weird when I landed," Gray said. She tried to get up, but couldn't. Her knee had dislocated and she had torn both her ACL and her MCL. "It didn't really hurt when I did it, but I knew something was wrong when I couldn't stand up," Gray recalled. Gray is one of a growing number of female athletes to suffer from a torn anterior cruciate ligament (ACL). In fact, according to an article put out by MCP Hahnemann University, a Pennsylvania medical college founded as a women's medical school, women are significantly more likely than men to tear an ACL. High school age woman athletes are 2.8 times more likely to tear the ligament than men, and in college the number increases dramatically. Female collegiate athletes are 6.3 times more likely to tear an ACL than their male counterparts. Women soccer players have double the risk of ACL injuries as male players, while women basketball players are four times more likely to suffer from ACL injuries than male basketball players. The ACL is one of four ligaments in the knee that connect the femur to the tibia. The ligament stabilizes the knee by limiting the forward motion and rotation of the tibia. Fawn Michel, athletic trainer at Utah State University for nine years, said that ACL injuries have become increasingly common in women's basketball, but Utah State does not have an intercollegiate team. The report by MCP Hahnemann University named basketball, gymnastics, soccer, volleyball, running and martial arts as the sports most commonly associated with ACL injuries. Michel said that most of the ACL injuries she has seen at USU are non-contact. "It's a cutting motion," she said. It occurs when the knee rotates after the person has planted their foot. There are several theories as to why women athletes have more ACL injuries than do their male counterparts. "Some of it seems to be the structure of the knee," Michel said. "There is a notch in your knee, and on women it tends to be narrower. The narrower it is the more of a chance of tearing your ACL." Michel said the posture of the body and positioning of the knee is different among women than men. Edward G. McFarland, M.D., the director of the Division of Sports Medicine for Johns Hopkins Medical Institutions, agrees. In an interview with InteliHealth, reported by the Milwaukee Journal Sentinel, McFarland said that women run in a more upright position than men do. "They don't have as much flexion in the knee when they do cutting maneuvers, and they put more stress on the inside of the knee when changing direction," McFarland said. Another factor may be the slower reaction time of women's muscles, said the MCP Hahnemann University report. Men's muscles seem to react faster to protect surrounding ligaments. But nothing insures prevention of an ACL injury. Stretching and strengthening surrounding muscles are important steps to take, but can't guarantee results. "One wrong step and the ACL is blown," Michel said. Gray knows how true that is. Two months ago she was working out at the Sports Academy with her roommate, Kata Vehar. She jumped off a piece of equipment and felt the eerily familiar shift in her knee. "I got all light headed and almost fainted," Gray said. The signs weren't obvious. It was hardly swollen and didn"t hurt much, but Gray knew in an instant that she had torn her ACL -- again. "She knew right away. She was like, 'I just blew out my knee.' But she walked the next day," Vehar said. Trisha Cracroft, an outside halfback on the USU soccer team, also knows the damage that "one wrong step" can do. She tore both of her ACLs within a year of each other. "I came down from a header weird and tweaked my knee," she said. But her father wouldn't take her to the doctor. He didn"t think anything was wrong so she played on it for three months before finally getting it checked. "I was lucky because it can cause other damage. I could have torn my meniscus," Cracroft said. "It dropped my skill for a while, but you can get that back. But I lost a lot of speed and I won't ever regain that," she said. Less than a year later she was running in an indoor soccer game when her left knee gave out. Like Gray, she knew right away what had happened. "I was more pissed than hurt -- I knew that I had blown it out, and I was more angry than anything else." In the first surgery the doctor used part of her hamstring to replace the ACL, while part of her patella tendon was used the second time. She said the patella tendon was more painful, but she recovered faster. Michel said the average recovery time is anywhere from six months to a year. There is no difference between men and women in terms of recovery time, she said. Gray took nine months to recover the first time, but feels like she pushed herself too fast. She was back from the second surgery after six months, possibly because she began riding her bike just two weeks later. But this time doctors expect her road to recovery to be a long one. Two months after the surgery, she still walks with a heavy limp, and she will likely have to wear a brace even when running and doing other non contact activities. Cracroft"s recoveries were considerably faster -- five months the first time, and four months the second time. Both women said they had heard genetics might be involved in the likelihood of tearing an ACL. Gray's dad and brother have both torn their ACL's. Cracrofts' sister, also a soccer player at Utah State, tore her ACL, and her brother tore his twice. Cracroft was able to heal and complete her four years of eligibility at Utah State. "Most athletes recover and return to their sports," Michel said. But Gray wasn't as lucky. In her first semester at Utah State, Gray was dismounting beam -- no twisting, nothing spectacular, "just a plain old back flip" -- when it happened all over again. "I landed and I just felt my bones shift. I had felt it before -- my knee moves like that occasionally so I didn"t think anything of it. It didn"t hurt any worse than all the other times." But it was torn. The second time she tore her ACL doctors told her to stop gymnastics altogether. Her knee was too fragile to handle the impact and potential damage. She quit and became the team's beam coach, but was never able to compete. Even after the first time she tore her ACL, Gray said there were some skills she had to change completely. "I was tumbling again and vaulting again but I couldn"t do any one legged landings on the hurt leg. I had to change it so I landed on the other leg or with both legs," she said. Doctors say that because Gray tore her medial cruciate ligament (MCL) and ACL simultaneously, she had even less support in her knee. The doctors had planned on letting her MCL heal on its own, but it never fully healed. Since the MCL wasn't as strong as it should have been, Gray was prone to repeated injuries, and she felt the effects more severely.
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