What female athletes should know about ACL injuries

Editor's Note: Dr. Geier is Director of MUSC Sports Medicine and an orthopaedic surgeon. He writes a sports medicine column for The Post and Courier.

I recently did an interview with a writer for ESPN's women's sports site. The question she asked was simple enough. If you had 10 minutes to prevent injuries in female athletes, what would you do? I gave her several ideas, but after thinking about athletes I've seen in my clinics lately, there is one that I wanted to share.

Readers of this sports section, and sports fans in general, are surely familiar with anterior cruciate ligament tears. The ACL is the main stabilizing ligament of the knee, and they are often injured in college and professional athletes. But I doubt that many realize that stars like NFL quarterback Tom Brady are not the most common athletes to be sidelined by them.

According to most studies, ACL tears occur between two and 10 times more frequently in female athletes. Women and girls who play jumping sports, like basket- ball and volleyball, or sports that require cutting and pivoting, like soccer and lacrosse, are the most likely victims. These athletes, and their coaches and parents, need to be familiar with the injury.

Female athletes are prone to ACL injuries because their knees are susceptible to the common mechanisms of injury. Getting tackled and having the knee twisted, like Brady did, is actually not the normal injury pattern. An athlete who tears her ACL typically cites one of two events. She can land from a jump with her knees fully extended and the knee gives way.

Or she can be running and plant her foot to change directions. The foot sticks but the knee rotates. Either way, she likely will feel a pop, have rapid swelling, and have difficulty bearing weight. Just like that, her season is over.

I have seen how devastated these athletes are. The thought of surgery and 5-6 months of rehab are often not as scary as missing the rest of the season and letting their coaches, parents and teammates down.

Emily Gossen, the goalkeeper of Academic Magnet's girls soccer team that won the Class AA state championship this year, tore her ACL as a freshman. She recollects, "Tearing my ACL was awful. I was not able to complete my high school season, and I got a late start into my club season.

"I was miserable because I felt so weak and couldn't partake in typical activities that I enjoyed."

So what would I recommend to prevent ACL injuries? First, parents of female athletes should spend time finding a sports medicine program that teaches an ACL injury prevention program, specifically one that is tailored to that sport. Girls tend to land and turn with their knees fully extended (unlike boys), which put the ACL at risk. Exercise programs can teach girls to jump and turn with their knees bent.

And to answer the ESPN question, the 10 minutes should be spent performing the exercise program. These exercises should be done every day before practices and games. They replace the traditional warmup exercises players do. In fact, if someone watches athletes doing them and doesn't know, it looks like they are doing a normal warmup. But done every day, these programs have been shown to at least decrease the chance of ACL tears occurring.

One of my partners once jokingly asked me why I promote prevention programs that could cut into surgeries that make money. Quite simply, it is the right thing to do. Sports medicine needs to evolve into a field that tries to prevent injuries instead of simply treating them.

Read more about injuries in female athletes and other sports medicine topics on Dr. Geier's blog at drdavidgeier.com.