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Female Basketball Players Hindered by ACL Injuries

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IMAGE Shea Ralph was a player for the University of Connecticut's nationally ranked women's basketball team. She was going full-speed when she hauled in a pass on the break in a National Collegiate Athletic Association (NCAA) tournament game.

"Kesha gave me a lead pass, but it was going out of bounds. I tried to stop on my right leg and reach out of bounds to get the ball, spin, and get a lay-up. When I planted my foot, my leg below my knee just stopped, but the rest of my body kept going. I felt my knee shift. [The pain] was continuous and sharp. Kind of like somebody stabbed me in the leg and was moving the knife around."

Female basketball players, like Shea, and other athletes are at risk of suffering from anterior cruciate ligament (ACL) tears. Why does this injury occur?

Learning About the Causes

Sue Bird, a teammate of Ralph's at the time, tore her ACL while performing a routine basketball move. "We were doing a 3-on-2 drill in practice. I just jump-stopped to take a shot and my knee kind of gave out. My calf went to the left and my quad went to the right. It felt like it split. I didn't hear the legendary pop that you're supposed to hear. I felt a little pain, but nothing excruciating. I got up and walked off the court. I thought I would be fine, but the MRI showed I had torn my ACL."

Ralph's and Bird's ACL tears represent the two common instances of the injury involving female athletes: violent planting of the foot during a high-speed, high-impact stop/change of direction, and a routine jump-stop that players do dozens of times in a game or practice. Most ACL injuries occur when landing from a jump, cutting, pivoting, or with sudden deceleration—essential movements in the game of basketball.

Anatomy and Function of the ACL

The ACL is the ligament in the middle of the knee that connects the thigh bone (femur) to the shin bone (tibia). Along with the posterior cruciate ligament (PCL), the ACL help provide stability for knee rotation and protecting the thigh bone from sliding forwards and backwards on the shin bone.

Ways to Rebuild the Ruptured ACL

Ralph and Bird had the same surgical procedure to reconstruct their ACLs. A graft was taken from the patellar tendon in the injured knee and used as the new ACL. Although, in Ralph's case, since she had had her ACL repaired once before, the tendon graft was taken from the other, healthy, knee.

Both players reported stiffness immediately after surgery and spent two weeks in an immobilizer that keeps the injured leg straight. Rehab began right away.

"You work on your range of motion a lot," says Bird. "I could straighten my leg easily, but bending was hard at first. I could get to ninety degrees, but past that, they would have to push and then it was pretty painful." Bird also worked on muscle building and balance because the muscles around the knee had wasted.

Ways to Protect the ACL

Ralph has made some adjustments to try to prevent another ACL injury, such as distributing her weight more evenly on both feet when jump-stopping. Because of her body type, she has taken even more precautions. "I worked on turning my feet outward and being conscious of it," she explains. "I also worked on keeping my knees faced out, how to jump and land, how to collapse if I fall, how to position my leg if people are about to fall on it."

What are some other ways to help prevent an ACL injury? Plyometrics, a type of jumping exercises, can be used to train and strengthen the leg muscles. You can also do warm-up exercises, strength training for your quadriceps and hamstrings, as well stretching exercises for your legs.

  • American Academy of Orthopaedic Surgeons

  • American Orthopaedic Society for Sports Medicine

  • Canadian Society of Exercise Physiology

  • Health Canada

  • Anterior cruciate ligament injuries. American Academy of Orthopaedic Surgeons website. Available at: Updated March 2009. Accessed January 30, 2014.

  • Anterior cruciate ligament (ACL) injury. EBSCO DynaMed website. Available at: Updated December 4, 2013. Accessed January 30, 2014.

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  • Moeller JL, Lamb MM. Anterior cruciate ligament injuries in female athletes: why are women more susceptible? Phys Sportsmed. 1997;25(4).

  • 7/6/2009 DynaMed's Systematic Literature Surveillance Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007;23:1320-1325.