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The Dreaded ACL By Don Hunt Heather Fossen went up for a rebound last August, just like she had a thousand times before. There was contact with an opposing player, and as Fossen landed a bit awkwardly on the gym floor, the South Medford High basketball standout heard a popping sound in her left knee. "I knew it was bad," she says. Fossen had torn the anterior cruciate ligament during summer camp at Pepperdine University in Malibu, Calif. The dreaded ACL. The mere mention of that term to a coach will cause his or her jaw to drop and blood pressure to rise. It is the most common and among the most severe knee injuries an athlete can suffer. Rehabilitation from surgery � another ligament is grafted to replace the damaged one �requires a minimum of seven months. Usually, it�s more like nine until an athlete can return to his or her sport. And many of them don�t recover fully for the better part of two years. That means Fossen, who was the starting goalie on the South Medford girls soccer team and the heart and soul of its basketball squad � will miss both seasons. While ACL injuries doubtlessly have been occurring since man first challenged his neighbor to a race and jumped over a rock, the increase of ACL tears in recent years is alarming. And what�s most alarming are the ACL injuries to female athletes: They�re occurring at twice the rate as males in volleyball, four times the rate in basketball and soccer and 10 times the rate in the military, studies show. "It�s documented," says Steve Chamberlain, an orthopedic surgeon in Medford who performs about 300 knee operations a year. "Girls are definitely more vulnerable to this injury." In the past 14 months in Southern Oregon, Ashland High�s Chelsea Morgan (basketball), South Medford�s Emily Perttu (soccer), Klamath Union�s Sarah Davison (soccer) and Southern Oregon University�s Sarah Petersen (basketball) all succumbed to ACL injuries. And just last Tuesday, SOU volleyball player Katie Steinke suffered the same dire fate. The obvious question is, why is the rate higher in females? There is no shortage of theories: � Increased joint laxity. Knee ligaments are looser in females, and thus could be more susceptible to tearing. � Lower-extremity alignment. The hips of females extend further out, and it�s possible that more pressure is placed on the knees. � Smaller ligaments. The ACL itself is smaller in females and so is the notch that it feeds into. � Muscle ratio. The muscle to mass ratio is smaller in females and, perhaps more significantly, the quadricep muscle in females is much stronger than the hamstring muscle � more so than in men. The hypothesis here is that the quadricep muscle in females can pull the tibia (shinbone) forward and thus tear the ACL. The ACL connects from the femur (thighbone) to the tibia. � Hormones. Hormonal levels have a direct effect on ligament laxity, meaning that when higher levels are present, the ligaments become looser and thus possibly more prone to tearing. Estrogen levels rise when females go through menstrual cycles, and some studies have shown that ACL tears occur at a higher rate during this time. Of course, more females than ever are playing sports. They�re bigger, faster and stronger than their mothers and grandmothers were. And their footwear is better, giving them improved traction. All those factors can put more stress on knees, Chamberlain says. "The forces athletes generate are so much stronger than they used to be," he says, "and sometimes that force gets translated directly to the knee." And there need not be a hard jolt from an opposing player to snap a knee ligament. In fact, about 60 percent of all ACL injuries are of the noncontact variety. Southern Oregon University basketball coach Shirley Huyett saw one of her best female players fall victim to ACL tears three straight years when she coached at Philomath High in the 1980s. In each case, the only thing the player did was come to a jump stop. "I make sure my girls come in low and really gather themselves when they do that maneuver now," Huyett says. Hal Townsend, an orthopedic surgeon in Ashland who served as a doctor for the Los Angeles Dodgers, Lakers, Rams and Kings in the 1980s, says such preventative measures likely reduce ACL injuries in women. "Girls tend to land more straight-legged than guys," he says, "and that puts more stress on their ACLs. Efforts are now under way to train girls to land with their knees bent." Townsend and Chamberlain both say that strengthening the leg muscles � particularly the hamstring � is also sound advice. "The hamstring muscle pulls on the same line as the ACL," Townsend says. Stretching and warm-up exercises are also sound preventative measures. Once the ACL is torn and surgery is performed, a long road to recovery is inevitable. "You have to remember, a new ligament is grafted into the knee," says Medford physical therapist Steve Zerkel, who has been a physical therapist for the past 20 years, "and it takes nine months for that dead piece of material to become a healthy ligament that can withstand the forces of sports. "I work with a lot of athletes who follow our rehab program but keep asking, �What else can I do?� And I tell them, nothing. "Time is the great healer." But it can seem eternal for a high school senior missing out on her favorite sports. Mail Tribune Home | Ottaway Newspapers, Inc. | Dow Jones & Co., Inc. | Privacy | Contact Us Copyright � 2000 Mail Tribune, Inc.