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Light at the End of the Tunnel: ACL Recovery Not As Treacherous As Before

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Light at the End of the Tunnel: ACL Recovery Not As Treacherous As Before

February 19, 2002
By Bianca Gwinn, Knee1.com Many athletes bear witness to injury-riddled seasons, and among their biggest fears is falling victim to an ACL injury. Ann Strother, one of the nation's top high school women’s basketball players, was on the top of her game and felt as if nothing could bring her down, until she went down with an ACL injury during her sophomore year. "When I went to the emergency room, they told me all of my knee ligaments were fine," Strother recalls of the injury two years ago. "They told me I pulled a calf muscle, but when I was walking down my hallway, I felt there was something wrong." After seeing her orthopedic doctor, Strother received the dreaded news: she had, in fact, torn her ACL and would have to miss her sophomore season. "I was in shock," Strother adds, "I didn’t want to sit out the entire season." This heart-wrenching experience is not uncommon in women’s sports. Medical experts say there has been an increase in ACL injuries among female athletes in the past decade. Since 1990, an estimated 1.4 million women have suffered ACL injuries, according to Women’s Active. Ligaments help stabilize the knee. The knee ligament most prone to injury is the ACL, which connects the shinbone to the femur at the center of the knee. The ACL functions to limit rotation and forward motion of the shinbone in relation to the knee. People who tear their ACL may hear or feel a pop and experience pain or swelling, causing the knee to buckle. Athletes suffering ACL injuries face a big decision regarding treatment: surgery or not. An ACL is not necessary required for normal, everyday movement. However, for athletes who want to return to a sport that requires pivoting and jumping, reconstructive surgery is the best option. Athletes including NFL superstar Jerry Rice, and the NBA's Danny Manning and Ron Harper have had ACL reconstruction. When deciding on a treatment, the doctor evaluates both the patient's physical and mental characteristics. If the patient has no desire to return to serious competition, there may not be a need to operate. A person's work ethic is also a good indicator of how seriously she will take the required physical therapy and rehabilitation. Ann’s situation made her a prime candidate for reconstructive surgery. ACL reconstruction involves fashioning a new ligament, typically using either a tendon in the patient's own knee or tissue transplanted from a cadaver. The favored method is to graft the patient’s own tissue using part of the patellar tendon from the front of the knee. You can sacrifice a tendon without creating further knee problems, and it's very strong. Another popular option is to use a hamstring graft because it causes less trauma to the knee in surgery. However, hamstring grafts do not fix to the bone as strongly as patellar grafts, thus making the knee inevitably weaker. Allografting, a procedure that uses a tendon from a cadaver, presents some drawbacks for the patient, including rejection and infection. New surgical techniques and technological advances in physical therapy have dramatically trimmed the rehabilitation time for many patients and have allowed athletes to return to the playing field sooner. Dr. Bert Mandelbaum is the team physician for both the U.S. Soccer Men’s National Team and Pepperdine University. "I think it depends on what population you’re looking at, but, on average, I would say somewhere around 90 percent or more go back. If you’re looking at a group of younger athletes, that number increases substantially." Five years ago, athletes typically had to go through physical therapy for at least a year before they could play again. "Now, routinely, we’re putting people back in the four- to six-month range," notes Mandelbaum. However, achieving the strength one has before an ACL injury requires a lot of dedication and commitment. There are risks, though, associated with aggressive therapy programs. Dr. Letha Griffin, an orthopedic surgeon in Atlanta, says rushing through rehab may pose a threat to the athlete and could jeopardize the reconstruction. "The chance for re-injury is obviously greater," says Griffin. "It’s difficult to say what is completely healed. No one is actually looking at the ligament. We’re judging on external parameters. Maybe the lining cartilage is not as healed as we would want it to be, but it’s impossible to tell." However, doctors should treat each patient on an individual basis. Rather than rely on a predetermined schedule, doctors and physical therapists work together to ensure that an athlete has regained a majority of the strength in the affected leg before allowing a return to competition. Ann’s determination would show as she worked to come back. Spending hours with physical therapists, lifting weights and shooting baskets, Ann came back better than ever. After her injury, she transferred schools and helped lead Highlands Ranch High School to a Colorado State championship in basketball. Strother has also amassed a lengthy list of high accolades, including being named Colorado Player of the Year by USA Today and "Ms. Basketball" by the Rocky Mountain News. In June 2001, she was named to the 2001 USA Basketball Women's Junior World Championship Team, only the second rising high school senior to be named to a USA Basketball Women’s Junior World Championship team. (WNBA star Lisa Leslie was the last female high school athlete to achieve such a prestigious position, in 1989.) This fall, Strother will step onto campus and the hardwood at the University of Connecticut, choosing the Huskies over Tennessee, Colorado, Notre Dame, Vanderbilt and Stanford. Read more about ACL reconstruction.

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