Sports feature: Coping with ACL injuries
BACK ON NOV. 16, during the first girls varsity basketball game of the 2006-07 season, junior point guard Samantha Nguyen was carried off the court after injuring her left knee.
“It happened when I was cutting down,” recalled Nguyen. “Somehow another girl's foot stopped mine, but my knee kept going. It felt like something popped.”
She later found out that she had torn her anterior cruciate ligament, or ACL, and would be out for the rest of the season.
In fact, high school athletes are more likely to suffer ACL injuries than any other age group.
They are especially susceptible because during puberty bones grow in length but not in strength. This leads to decreased control of the knee, which increases the risk of injury.
Athletes involved in sports such as basketball and soccer, which involve abrupt stopping, cutting, and jumping, are especially prone to these injuries.
ACL injuries are caused when the knee is hyperextended beyond its normal fully straightened range.
They typically occur when athletes suddenly turn and twist their knee with their feet remaining on the ground.
The ACL is one out of the four ligaments in the knee that mediate joint mobility. It controls the joint connecting the femur (thigh bone) and tibia (shin bone). Without a functioning ACL, the tibia could slide in front of the femur and would be prone to dislocation.
Symptoms of an ACL injury include a popping sound at the time of injury, severe pain, and swelling in the knees within six hours after the injury.
These are symptoms that several Uni athletes have known all too well in recent years.
THE STORY OF ANDY RENNER
Just four games into the 2004 boys varsity soccer season, Andy Renner limped off the field against Judah Christian. The senior, who had looked forward to playing in the same lineup as younger brothers Al, then a junior, and Mike, a freshman, had just injured his right ACL.
When trying to gain possession of the ball, Renner hit it with his foot while an opponent hit it on the opposite side.
“The forward momentum of my foot was stopped, but my thigh was still going forward,” Renner said.
“Immediately after the injury … I was really pain free. This is why I didn't think there was really anything wrong, although I couldn't bear weight on my right leg. My dad came over and examined me and told me that [my ACL] was most likely torn.”
Renner underwent ACL reconstruction surgery and physical therapy to recover from his injury.
“My leg muscles … had greatly atrophied since I was not using them,” Renner said. “The physical therapy involved running, lifting, and range-of-motion exercises. I also wore a brace when I started to play baseball again and basketball during the summer.”
The torn ACL forced Renner to the sidelines for the remainder of soccer season and all of basketball season. He was, however, able to get back on the field to play baseball before graduating and heading to Notre Dame.
Renner accepted his injury with a positive outlook.
“The injury really didn't bother me too much,” he said. “I knew that things would obviously be different, but I guess I just immediately accepted the fact that I couldn't finish the soccer season or play any of the basketball season.
“I just considered myself lucky. I had played sports since I was a little kid all the way through my senior year of high school without a major injury. I never even had to sit out a game. And, even though I missed soccer and basketball, I was still able to play baseball. I guess I just knew that everything would work out and that there was really nothing that I could do to change my position.”
In fact, Renner's ACL injury allowed him to engage in activities other than sports.
“I helped Mr. Murphy [Rick Murphy] coach the subbie boys basketball team, and I was also able to perform in the musical that spring.”
ACL INJURIES AND FEMALE ATHLETES
Uni certainly has a history of female athletes with ACL injuries. Girls basketball coach Rebecca Murphy recalls that several of her players, including 2006 graduates Nuole Chen and Colette DeJong, 2004 graduate Natalie Prochaska, and current junior Eunice How have all been afflicted with damaged ACLs.
Female athletes are also particularly disposed to ACL injuries. According to WebMD, women are four to six times more likely to be affected with an ACL injury than men.
The exact reason behind that is unknown, although “it is believed to be a combination of less muscle mass, wider pelvic girdle, larger femoral notch size, and hormone changes,” speculated Dr. Jerrad Zimmerman of Carle Sports Medicine.
For Nguyen, tearing her left ACL meant more than losing a basketball season. A dedicated distance runner, she would have to forgo the 2007 track season. She hopes to resume running for the cross-country team in the fall, as the girls try to outdo their fourth-place finish in the 2006 Class A state finals.
“I was really upset, and I still am a little bit,” said Nguyen about how the injury affected her junior year. “At first, I was really sad and angry. But I just have to get over it because it's probably better that I don't do track this year anyway, because I want to be able to compete all of next year.”
Once the injury occurs, what treatment can someone expect to undergo?
There are two ways to treat ACL injuries: nonsurgical and surgical rehabilitation. Nonsurgical treatment may be recommended when:
— Knee cartilage has not been damaged.
— The knee is stable when engaging in everyday activity.
— The patient does not wish to participate in sports.
— The patient is a teen or adolescent with open growth plates (in which case surgery will be postponed).
During nonsurgical rehabilitation, patients typically wear an ACL brace or crutches to reduce movement in the knees. Physical therapy is also recommended to strengthen leg muscles to prevent future injuries.
Nonsurgical rehabilitation is less time-consuming and less painful than surgery. It usually takes a month for patients to resume their normal lives. However, nonsurgical treatment provides less effective results, and surgery may be required if another injury occurs.
When the ACL is completely torn and the knee gives way during everyday activities, patients have to undergo reconstructive surgery.
During the surgery, doctors will typically drill a hole through the tibia into the femur and thread a tissue from a chosen tendon through the holes.
“Surgery actually wasn't that scary,” said Nguyen. “After[ward], I stayed overnight in one of the recovery rooms, and that was it.”
After surgery, patients have to wear a knee brace and go through rehabilitation and physical therapy. The whole process generally takes six to nine months. During that time, patients have to devote 30 to 60 minutes a day to doing strengthening exercises.
According to Nguyen, exercises include quad sets (where you tighten the quad muscle and hold it for a few seconds), straight leg raises (when you tighten your quad and lift your leg up while keeping it straight), leg presses, and squats.
Athletes who wish to return to their previous level of competitiveness usually undergo surgery, which is the only way to effectively treat a broken ACL.
“Surgery has the best long-term outcomes, but return to sport after surgery is about six months [of rehab],” said Zimmerman, the Carle Sports Medicine doctor.
For her part, Nguyen so impressed her basketball teammates and coaches with her approach to training after surgery that she won the “most dedicated player” award at the annual basketball awards ceremony in early March.
The complications of ACL injuries can be prevented with strength training. The Santa Monica Orthopaedic and Sports Medicine Foundation created the ACL Prevention Project training program, targeted toward female soccer players. By learning proper jumping and cutting techniques, athletes can reduce their risk of injury by up to 50 percent, according to experts.
“Preseason conditioning, jump training, balance work, plyometrics, and some specific fitness programs have all shown to reduce the risk,” said Zimmerman.
Despite these precautions, ACL injuries are sometimes inevitable. Nevertheless, they do not signify the end of one's athletic career. Most athletes recover completely after surgery.
Renner, who is currently a sophomore at Notre Dame, can now participate in athletics with no complications from his injury. His case offers good news for athletes such as Nguyen who hope to compete again.
“I play some intramural sports and I also run and play pickup basketball games,” Renner says. “The injury still impacts me, but not in a negative way. I now have a story to tell and a scar on my knee. Other than that, I'm pain free and am able to play most sports without a brace.”
AT A GLANCE: TIPS FOR EARLY ACL TREATMENT
- Follow the “RICE” protocol as soon as possible.
- Rest: Resting prevents further injuries and speeds up the healing process.
- Ice: Icing can provide short-term pain relief and reduce swelling. Icing should be kept to no longer than 20 minutes to prevent skin damage.
- Compression: Wrapping the knee with an ACE bandage can limit swelling.
- Elevation: Propping the leg up so that the injured area is above the heart level can also reduce swelling.
- Source: Mayo Clinic