Torn ACLs all too prevalent

April 28, 2013
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Katie Roupe / Observer-Reporter
Physical therapist Darren Bradley checks out the angle of Canon-McMillan senior Veronica Rothka’s knee during a therapy session. Rothka is strengthening her knee through physical therapy after an ACL injury. Order a Print
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Katie Roupe / Observer-Reporter
Balance-training balls, such as the one being used here by Veronica Rothka, provide one way for athletes with ACL injuries to strengthen their knees. Order a Print

When Canon-McMillan senior Veronica Rothka was bumped into a wall while playing indoor soccer at the Vernon C. Neal Sportsplex two months ago, her first thought was to steady herself.

But a few seconds later, after her left knee buckled under the pressure of trying to support the rest of her body at such an awkward angle – a textbook torn anterior cruciate ligament – Rothka had another thought: She wanted to kick herself.

“I realized that I didn’t work out enough with my legs,” said Rothka, who had surgery roughly three weeks later and, as a result of the six-month recovery process, had to miss her senior softball season. “I knew if I would have done that, it might have prevented an ACL tear.”

Rothka isn’t alone when it comes to the injury or how she thought about what she could have done to prevent it.

Knee injuries to high school girls have become far too prevalent for anyone’s liking, popping up most frequently in basketball, soccer and gymnastics.

Why? Well, that’s up for debate. Female physiology, the way each gender lands, and even estrogen can play a part.

What’s less unsettled is that preventative care almost always reduces the chances of injury. Most, however, fail to learn that lesson until it’s too late.

“If you do special training, your chances of getting injured go down,” said Dr. Jan Grudziak, a pediatric orthopedic surgeon at Children’s Hospital of Pittsburgh and an expert in adolescent and pediatric sports problems. “It’s never zero, but we’re trying actively to prevent injured ACLs.”

Megan Parker knows how important preventative care can be – now. The Peters Township goalkeeper tore her ACL and lateral meniscus last year and missed the Indians’ march to a third consecutive PIAA Class AAA soccer championship.

“A lot of girls on my soccer teams have torn their ACLs, but I never really thought about it,” Parker said. “I wish I would have because there are a lot of exercises you can do and stretching and warming up before you play that can help that.

“Looking back, I do wish I would have done more.”

‘It worries me to death’

According to the American Orthopaedic Society for Sports Medicine, young female athletes are two to eight times more likely to tear their ACLs than boys, roughly 70 percent of them without so much as contact.

All of them, of course, are terrifying.

Just ask Bentworth’s Erin Ritzer, a three-sport athlete who tore her ACL playing soccer. Here’s what Ritzer remembers about tearing the ligament that connects the top of the tibia to the back bottom of the femur.

“I had just received a ball, and I was going to turn. As soon as I planted, I knew something was weird. It felt like forever going down.

“My knee buckled, popped and hurt really bad. If I never have to hear that sound again, I won’t be mad. It popped like four times on the way down.”

Grudziak estimated the ratio of ACL injuries – there are between 110,000 and 120,000 every year, he said – in girls to boys at 4:1. The youngest person he’s operated on was 7 years old.

“Not only are ACL injuries getting more prevalent, but the age seems to be going down,” Grudziak said. “Younger and younger kids are being diagnosed with ACL injuries.”

Ringgold girls basketball coach Nick Mandich has witnessed eight ACL tears on five different players over the past five years.

The trend concerns him, so much so that he has altered his practices to focus less on scrimmages and more on individual work.

“I pray over my team every day,” Mandich said. “Seeing what’s going on, it worries me to death.”

Reasons aplenty

Pinpointing the cause for all these knee injuries can be as complex as the knee itself.

One Grudziak suggested is body structure, how females are simply built differently than males, with wider hips and a smaller notch that the ligament goes through to connect to the femur.

Proprioception, the understanding of your body in space, is a word Grudziak throws around often, and it’s something that differs in men and women.

“The most important element of every program to diminish ACL injuries is the proprioception program,” Grudziak said. “Every single physical therapy place, every single sports center, has people who know how to develop the program and guide the patient.”

Dr. Greg Christiansen was a team physician at Peters Township (2001-07) and California University (2005) before joining Advanced Orthopaedics and Rehabilitation in North Franklin.

Christiansen, like Grudziak, points to the differences in how boys and girls land as major factors in susceptibility to ACL injuries.

“Boys are going to land with their toes forward, knees flexed and absorb the landing almost in a squat position. That’s ideal,” Christiansen said. “A lot of the girls, because they’re born with a wider pelvis, they have a higher angle bringing their knees together, and their kneecaps tend to lean to the outside more so than boys.

“That causes their feet to turn out when they land. Instead of their toes pointing forward, they’re in a toe-out position, which puts the ACL at higher risk. Then if they land more of a straight-leg land instead of a flex land, that gets you into a knock-knee position, foot turned out and a leg that’s extended. That’s the perfect storm for an ACL tear.”

Something even more simple has been driving this trend, too, Grudziak said.

“There’s also something that we don’t talk about, which is the fact that more and more girls are involved in high-level sports,” Grudziak said. “There’s a price to pay.”

A long road back

The recovery isn’t fun. Anna Cree can attest to that.

Cree, a senior at Carmichaels who had surgery for her torn ACL on Feb. 24, was on crutches for six weeks, then started physical therapy about a month after surgery. She pushes her body to the limit three days a week, about an hour at a time. She hates going to physical therapy but realizes there’s no other option.

“Every day, even without physical therapy, I can tell that it’s getting stronger from walking on it,” Cree said. “Right after surgery when I tried to tighten the muscles in my thigh, I couldn’t at all. The last time I went to the doctor, he was happy with how much I could tighten them.”

At the Bradley Physical Therapy Clinic in Southpointe, Rothka will do balancing exercises, straightening her quad and calves; she’ll ride an exercise bike; and other times bend the leg with a strap so she can work on regaining a full range of motion.

“It was rough in the beginning, but it’s better now,” Rothka said.

Prior to the injury, Parker, the Peters Township goalie, would casually run through some stretches, maybe go for a light jog. Now, she has an entire routine for loosening her legs, complete with exercises that focus specifically on sharp movements.

“I feel better mentally about having warmed up, but also physically I can feel that my leg is looser,” Parker said. “I can get a wider range of motion in the knee that I had surgery on. I can definitely feel a difference. My knee is warmer, and it’s more flexible.”

McGuffey girls basketball coach Amanda Burchett doesn’t pretend to have all the answers, acknowledging she’s been one of the lucky ones, a coach without a major knee injury. But she also believes wholeheartedly in prevention as a way to tamp down this recent trend.

“Injury prevention,” Burchett said. “I think that’s lost on people. They just go-go-go. I don’t think people do enough of that – preseason, strength and conditioning. I don’t think there’s enough of an emphasis.”



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