For years, doctors and trainers have been on high alert to spot concussions among young athletes. This school year, parents may be hearing a lot more about ACL tears.
The anterior cruciate ligament connects two bones to give the knee stability. The American Orthopaedic Society for Sports Medicine has launched a campaign offering tips to prevent the often, season-ending knee injury.
The number of ACL tears reported among young athletes has increased over two decades, but orthopedic surgeon Dr. Alfred Atanda said it’s hard to know if doctors are simply noticing more injuries or if there has been a true increase.
The increase has coincided with a new trend in youth athletics.
“A lot of kids are super-specializing in an individual sport, and they are playing 12 months out of the year,” said Atanda, whose specialty is sports medicine at the Nemours A.I. duPont Hospital for Children in Wilmington, Delaware.
The same muscles, ligaments and tendons are used over and over and don’t have much chance to rest.
“I think the common fallacy is, that to become really good, or an eventual collegiate or professional athlete, that you need to play the same sport constantly year round to become a master in it, to become better than your peers,” Atanda said. “You are probably better off playing a couple of other sports. You can bring other skill sets from other sports that can help you in your primary sport.”
Girls especially prone to ACL injury
Girls and young women have four to eight times the risk for an ACL tear, Atanda said.
“Females tend to have wider pelvises for eventual childbirth, so what happens is they tend to stand in a more knock-kneed pattern,” he explained. “And when they jump and they land and they try to brace themselves, their knees go into this excessive knock-kneed position, and that puts a lot of excess force on the ACL.”
Studies show muscle training can lower the risk of injury, but many high school coaches and trainers are not trained in ACL-injury prevention. The focus is helping kids jump and land safely.
In women, the order in which thigh muscles are engaged is different than in men, Atanda said. One prevention strategy is to train the muscles of a female athlete to fire in a different way.
Beyond body alignment and muscle control, other factors also may increase the ACL-injury risk for women.
Normal fluctuations in estrogen levels as well as using birth control pills may affect the strength of the ACL, Atanda said.
“Some of the hormones in those pills can also adversely affect the integrity of the ACL,” he said.
ACL injuries are common in sports with lots of cutting, pivoting, accelerating and decelerating — in particular if the players wear cleats. That includes soccer, lacrosse, basketball football and field hockey
Injury — and the long road back
Hockey player Ryan Chinn had just taken a big hit when he suffered his ACL injury. But it wasn’t the hit knee that wast hurt; it was a tear in the ACL in the other knee.
“I tried to gain my balance with my left knee, I stepped down and I felt a pop, twist and snap,” said Chinn, an 18-year-old from Wilmington.
Doctors confirm an ACL injury with an MRI, but physicians also feel the problem by tugging on a patient’s limp calf.
“If you were to ever pull a rope, you would get leeway, leeway, leeway, and when the rope’s at length, it’s gonna catch and it won’t move any more,” Chinn said. “In my case, he was doing that and there was no catch. The rope just kept moving.”
You can live just fine without getting your ACL repaired. Many people skip surgery and choose strength training or wear a brace. But surgery is usually the choice of those who want to return to competitive sports.
“I never tell anyone that they have to have the surgery, but for very young, healthy and athletic people, it’s definitely something to consider,” Atanda said. “You are going to have a very tough time getting back without having your ACL fixed.”
After reconstruction surgery at duPont Hospital, Chinn said he was heartbroken when he realized how long he’d be sidelined.
“Dr. Atanda told me the recovery takes about 10 months,” Chinn said. “But I didn’t believe it.”
Chinn was on crutches riding the bench while his club team, the Delaware Ducks, lost a bid to play in the national championship.
His ACL was repaired using tissue harvested from his hamstring. During the autograft procedure, a surgeon drilled holes into nearby bone to secure the new ACL.
“It’s the most excruciating pain I’ve ever been in. Ugh. Before this surgery I thought I had a pretty good pain tolerance,” Chinn said. “I was screaming and crying in the [Post Anesthesia Care Unit] for like three hours.”
Bone healing takes time, and it was a long road back. Four or five months later, Chinn said, he felt ready to play, but his surgeon and physical therapist kept him off the ice.
“Yes, I was progressing great, but if I were to take a wrong step or to get hit or to trip and fall, I was at possibility of tearing my ACL again,” Chinn said. “I had to hold back.”
That wait was nearly as painful as his post-surgery pain, he said.
Chinn was back on the ice a year later. This summer, he’s headed to Bates College in Maine where he’ll play for the school’s club team.
Friday at 5:30 and 11pm on First on WHYY TV watch the story of Brennan Weber of Polytech High School in Woodside. He is recovering from an ACL injury that prevents him from being on the football field for his senior year.