By Kim J. Harmon

ACL – those are the three letters a high school athlete never wants to hear because to hear them more often than not means surgery, at least six months of painful rehabilitation, and the loss of at least a full season of play.

Amanda Marsilio, a Newtown High School junior, heard those three letters a little more than a week ago after injuring herself in a scrimmage with Ridgefield and thus will miss the entire 1999-2000 basketball season.

As shocking as it was, the fact unfortunately remains that a rupture of the ACL is not all that uncommon.

ACL stands for anterior cruciate ligament and it controls how far forward the tibia (or lower part of the leg, below the knee) moves in relation to the femur (the upper part of the leg, above the knee) and if the tibia moves too far forward, the ACL can rupture. The ACL can also be torn if the knee is hyperextended.

And the National Collegiate Athletic Association (NCAA), in a study of anterior cruciate ligament injuries, determined that female basketball players were four times more likely to sustain an ACL injury than their male counterparts.

Four times.

According to James L. Moeller, MD, and Mary M. Lamb, MD – in their article Anterior Cruciate Ligament Injuries In Female Athletes: Why Are Women More Susceptible? – women’s sports “once dominated by a slow, defensive style, are now played with speed, precision and power. But with these changes have come increased injuries.”

The NCAA determined in its recent studies that overall knee injuries were more common among female soccer and basketball players than among their male counterparts. Also, non-contact injuries were the most common type of injuries in basketball.

Dr Moeller and Dr Lamb go on to write, “(The) women’s higher rate of ACL injury is probably due to a combination of intrinsic and extrinsic factors more than to the sheer increase in the number of athletes and intensity of play.”

Specifically, those factors relate to the anatomy. The doctors concluded that “complex, interrelated factors, possibly including hamstring-quadriceps strength imbalances, joint laxity, and the use of ankle braces could play a part in the susceptibility to an ACL injury.

Also, the female knee may be more cruciate-dependent, the doctors write, than the male knee.

Since the determination of what makes an ACL injury more likely in a female than a male is still difficult to understand, finding ways to prevent such an injury is also difficult. Dr Moeller and Dr Lamb indicate that leg muscle strength and the timing of hamstring firing are probably important and can be addressed with weight training and biofeedback. Avoiding straight-knee landing, one-step stop landing and sharp planting and cutting maneuvers, the doctors say, may also decrease the likelihood of injury.

It is clear, too, that the knee and the ankle are number one and two on the hit parade of joints most injured by athletes. And most research indicates that the ACL is the most commonly-injured ligament in the knee and the majority of ACL injuries are non-contact.

Basketball, soccer and volleyball suffer the highest rates of injury among the major sports – regardless of age group – but other sports such as gymnastics and running also suffer a high degree of injuries. Not so oddly, most injuries are suffered in game situations rather than practice.

Treatment begins with crutches and lots of rest until the swelling subsides (the knee joint may sometimes even be aspirated to remove blood). Once the swelling subsides, then physical therapy follows so the athlete can regain a normal range of motion.

Even though the Lady Nighthawks may be missing their All-League center, since most athletes return quite well and strong from an ACL injury, the ‘Hawks will simply wait and hold a spot for Marsilio on the 2000-2001 team.

Is Artificial Turf Bad?

While on the subject of knee injuries, it may be interesting to note, that with the many studies conducted on ACL injuries – in males or females – it has been determined that although playing surface may contribute to these types of injuries, especially when there is a high co-efficient of friction. And because of that, artificial turf has gotten a bad rap.

But artificial turf, according to Dr Moeller and Dr Lamb, “has long been blamed for causing many injuries, but injury data do not support this claim because severe injuries are just as likely to occur on natural turf or floors.”