Knee injuries in women's sports

Less than a week before the start of the basketball season, Superior High School senior Britnee Blake was looking forward to her final year as a Spartan. Expected to be a leader on the team, Blake felt fine when she joined a pick-up game during open gym.

Midway through, Blake jumped up for a block and came down with all her weight on her left leg. As her foot hit the floor Blake felt something tear in her knee, and she fell to the ground.

"When it happened I was screaming," she said.

Blake was taken to the hospital, where she learned she had completely torn her anterior cruciate ligament (ACL). A few months before, she had visited a doctor with pain in her knee, but the news of an ACL tear was still a shock.

"I actually had no idea that it would ever be the ACL," Blake said. "I guess I never thought that's what it was because when I went to the doctor the first time, they said it was a bone contusion because my bones in the knee got smashed together and they were bruised. So I figured that's still what it was -- they never really healed completely."

Blake had first injured her knee in the summer, also playing basketball. While driving through the lane, she turned to make a cut and felt her "leg shift out and then just fell over." Unknown to her, she had suffered a small tear in her ACL.

Blake rested and iced her knee, and by fall, she felt well enough to run with the cross country team.

"I was off of it for a long time and then I finally was able to run on it," Blake said. "So I ran like four meets because I could run straight, I just couldn't make cuts."

Only when she returned to the fast stops and turns of the basketball court did Blake's knee give her any trouble, and she's not alone.

For years, ACL tears have plagued female basketball players. Reports have found ACL injuries occur anywhere from three to 10 times more often in women than in men. The injuries have become so common among female athletes they have been described in epidemic proportions.

David Kroll, athletic trainer and the University of Wisconsin-Superior, has worked with many athletes who suffered ACL tears. He said a number of factors play a role in the increased number of ACL injuries among women. Anatomical differences between men and women are one factor.

Women have a wider pelvis than men, so the angle at which the femur meets the tibia is also wider. The increased angle puts more stress on the ACL and the knee joint as a whole. In addition, the intercondylar notch in the femur through which the ACL passes is slightly smaller in women, as is the ligament itself.

Different body mechanics in women may play an even greater role in ACL injuries. Women have been shown to jump and run in a more upright position than men.

When female basketball players land from a jump or stop quickly -- typically the instances in which ACL injuries occur -- their knees tend to be further extended than in a male. Kroll said a players' knees should be bent in a half squat position when landing to activate the hamstring and redistribute the impact. If not done, all of the stress is placed on the ACL.

"That's a lot to ask of a ligament that's not much bigger than your little finger," Kroll said.

ACL injuries are still common among women, but Kroll has seen improvements. He feels coaches and the people in general are better informed, and advances in the medical field allow for a less invasive surgery, shorter recovery time and stronger tendon graft.

"There used to be scars all over the place," Kroll said. "Now there are just four little marks."

Blake had surgery on Dec. 11 to repair her left knee. She now goes to physical therapy about twice a week.

Her treatment began with workouts designed to help her extend her leg and regain full motion. Eventually Blake progressed to strength training focused on her hamstrings and quadriceps.

Recovery time from a torn ACL varies for every athlete, but the typical time period is six months. Blake hopes she can recuperate a little faster to return to her routine in four months -- when the softball season begins.

"It would take a lot of hard work to get it better by then, but I'm going to try," Blake said. "We'll see how it goes."

NOTE: Part II of the three-part series will run in Friday's Superior Telegram.

Emily Kram covers sports. Call her at (715) 395-5018 or e-mail ekram@superiortelegram.com .