Knee injury takes toll on girls playing soccer

Females are five times more likely than males to suffer a torn ACL.

By Nikki Usher

Inquirer Suburban Staff

Courtney Gaston will remember her last high school soccer game forever. But not because she got to savor a state championship or a big win against a rival school.

Instead, the senior from Clearview in Gloucester County will remember the Sept. 23 game as the one that crushed all her hopes of playing soccer in college.

And all it took was a quick change of direction on the field.

Gaston, like hundreds of high school girls in the New Jersey and Southeastern Pennsylvania region, tore the anterior cruciate ligament in her knee. "It was like everything I worked so hard for all my life was gone in a moment," she said.

The debilitating injury can mean major surgery and six to 11 months of intensive physical therapy. College coaches are often no longer interested in a young woman with a torn ACL - unless she was a top recruit before the injury.

About 30,000 high school and college athletes tear their ACLs every year. For high school males, the risk is 1 in 500, and for females, the risk is 1 in 100, according to the American Academy of Orthopaedic Surgeons. Doctors say that soccer players are affected the most, with basketball players a close second.

But it's more than just about the loss of a scholarship. Increasingly, research indicates that girls who suffer this injury are more than two times as likely to develop painful osteoarthritis at an early age.

"It's an epidemic, there's no question about it," said David Rubenstein of the Main Line Orthopaedic Institute, which has offices in Wynnewood and Newtown Square. "And there can be serious long-term consequences."

Mike Dicken, the girls' school coach at Delaware County Christian School, said the frequency of the injury alarms him, as does what it could cause later in life.

"If I had a daughter, I can tell you I wouldn't want her to play soccer," he said.

• 

The frequent cutting movements in soccer make it the high school sport where you're most likely to spot a girl sitting on the sidelines in an immobilizing brace.

Doctors blame a variety of factors, such as underdeveloped muscle strength and overuse. Anatomy plays a large part: women have wider hips, as well as disproportionate quadriceps-to-hamstring strength and joint flexibility. And adolescent girls are most vulnerable, said Arthur Bartolozzi, chief of sports medicine at Pennsylvania Hospital.

An ACL injury is severe because of the role it plays in movement. The ACL runs down the center of the knee and helps control front-to-back movement. Basketball players and skiers are also prone to hurting it.

As girls' soccer has also morphed into a year-round competitive sport, these injuries have multiplied.

"There's no question that I've seen more and more of these in the last eight to 10 years," said Merrick Wetzler of the South Jersey Orthopedic Association.

Players try to brush off the possibility that they will be sidelined for months, but they all know someone who has suffered the injury.

"My teammates and I think it's pretty much inevitable that if you play soccer, it's going to happen to you," said Natalie Capuano, a top player at Sun Valley in Delaware County who suffered the injury.

But doctors warn that coaches and parents need to stop thinking of ACLs as something that comes with the territory of being a top player.

"If we're not careful, we're going to have a whole generation of women with knee problems 30 years down the road," Bartolozzi said. "We talk about the problems of older women. This is the most serious problem for girls."

Often, an ACL tear isn't even the result of contact. A girl can just shift the wrong way, turn on a divot of grass, and tear her ACL the same way she might twist an ankle.

"The girls are just running and it looks like someone shot them. Boom, and they go down," said John Cobb, girls' soccer coach at West Deptford High School in Gloucester County. Cobb said he averages one to two such injuries each year on his team.

• 

Every girl who tears her ACL has a gripping story from the field - and the anguish of knowing that she may never regain her form as a soccer player.

"It happened to me junior year. I was so scared that I wasn't going to play as well," said Mandy Moraca, a top senior player at Gloucester Catholic. "But the college coaches told me they're used to seeing it."

Moraca made a stellar recovery, though she admits to being a little hesitant in her first game back. She has made an oral commitment to attend the University of North Carolina.

Other girls aren't so lucky. "If you aren't a top recruit, you're damaged goods," Dicken said.

So, when the injury happens, it can be a crushing emotional blow. And the months of physical therapy ahead can be even more difficult.

Erin Hardiman of Absegami High School in Atlantic County described the process as "mentally and physically draining." She said she "couldn't do the simplest things, like lift 1- or 2-pound weights."

Rick Romash, a physical therapist in Haddonfield, said he sees dozens and dozens of girls each year with the same injury. "It really depends on the girl. Some can come back. Some won't ever recover fully."

And to make matters worse, girls who tear one ACL are more likely to tear the one in the opposite leg as well.

"You'll see girls who tear one and because of the strength imbalance, you'll operate on them the next year," Rubenstein said.

Area coaches have taken notice of the problems with a vengeance and tried to implement plyometric drills that have been shown to reduce ACL injuries.

"It's always on the back of our minds," said John Kodluk of Kingsway in Gloucester County. "We're doing what we can."

The South Jersey Soccer Coaches Assocation even put out a pamphlet to help. But all of the exercises and education cannot combat a key contributing factor in ACL injuries - playing too much.

"Everyone thinks that their daughter is going to get a Division I scholarship," Romash said. "But they are playing themselves into an injury."

Bartolozzi agrees that muscle fatigue puts more pressure on the ligaments in the knee and increases the likelihood of a secondary injury such as an ACL tear.

High school coaches often find their players heading from 21/2 hours of high school practice to an hour of club practice. On the weekends, girls play three or four games in mini-tournaments.

"They are playing soccer six or seven days a week, 12 months a year. With the evolution of club soccer, it's crazy what they're doing," said Kate Ormsby, Gloucester Catholic's coach.

Kelly Keelan, a junior at Delco Christian, speaks of her soccer obsession and knee problems with the air of a veteran. Keelan plays on highly competitive club and high school teams. She has also torn the ACL in her right knee twice.

She will wear a brace to her high school games, but not to her club team. "I want to go to a good college to play soccer, and I don't want to scare a coach," she said.

And field conditions don't help matters much. Uneven surfaces can contribute to the likelihood of twisting and turning - and tearing an ACL. "Parents and coaches need to pay more attention to field conditions," said Gordon Boucher, a coach at Sacred Heart in Vineland.

While some girls recover, others are already starting to experience the serious consequences of their injuries - whether it be the loss of a college coach's interest or lasting pain.

Kristina Kuda had coaches from Monmouth University and the College of New Jersey watching her tend goal on a muddy day at West Deptford. She bent down for a ball but her cleat got stuck in the ground and she tore her ACL.

The senior should have no problem getting into college as No. 2 in her class academically, but she probably won't get a soccer scholarship. "It's just so frustrating to me. It happened while they were scouting me," she said.

And Olivia Campbell, a three-sport athlete at Delco Christian, is having difficulty getting her strength back.

"I see other girls with two legs, and they're strong and I have a weak knee and wear a brace. I'm jealous," she said.

Contact suburban staff writer Nikki Usher at 856-779-3234 or nusher@phillynews.com.

Protecting the ACL

Here are five steps that can help prevent injury to the knee's anterior cruciate ligament:

• Avoid playing sports when muscles are fatigued.
• Perform off-season and preseason conditioning of the quadriceps and hamstring muscles.
• Avoid footwear with too much traction. Wear turf shoes on grass, not cleats, or wear flat shoes on turf, not turf shoes.
• Do not play on surfaces (grassy fields) with potholes and divots.
• Participate in an ACL prevention program involving neuromuscular training. Ask a school athletic trainer for details.

Source: Arthur Bartolozzi, chief of sports medicine at Pennsylvania Hospital.