Seeking an end to career-ending ACL injury

July 26, 2006
By JENNY DIAL
Houston Chronicle

As 4 players on Katy Taylor's basketball team learned, ACL tears are devastating and debilitating. But proper training can reduce the risk.

Katy Taylor High School had four players, including two sisters, suffer a combined six severe ACL injuries that required surgery within a span of 27 months.

OCTOBER 2003 Julie Kroll tears her left ACL.

FEBRUARY 2004 Julie Kroll tears her right ACL in a preseason high school game.

DECEMBER 2004 Caitlyn Scelfo tears her right ACL.

FEBRUARY 2005 Kara Kroll tears her right ACL.

JULY 2005 Scelfo re-injures her ACL in an AAU game; has a second surgery

AUGUST 2005 Kara Kroll begins what will be a successful volleyball season.

NOVEMBER 2005 Knee problems prevent Kara from playing basketball.

DECEMBER 2005 Kara Kroll gives up basketball.

JANUARY 2006 Brittany Backhaus tears her ACL.

JULY 2006 Her playing career over, Scelfo becomes the Texas A&M women's basketball team manager.

PREVENTION TIPS

Texas physician Dr. Walter Lowe recommends females devote 4-6 weeks between seasons to strength training, or if that is not possible, 10-15 minutes every day. Some techniques females should use to decrease the risk of tearing an ACL:

• Increase hamstring strength
• Increase core strength training (especially lower abs, hips)
• Stress joint flexibility
• Bend knees more when jumping
• Turn knees less when jumping and running
• Land properly when jumping
• Perform maneuvers in a less erect posture

Julie Kroll's knee injury changed her outlook on basketball. Suffering the same injury twice in six months changed her outlook on life.

"I really miss playing basketball," Kroll, 18, said. "But after I tried to come back a second time, I realized that I would like to be able to walk in 20 years."

Athletes are susceptible to anterior cruciate ligament injuries because a tear can occur while changing directions, pivoting, jumping, slowing down from running and making horizontal movements.

An ACL tear is a devastating and painful injury for anyone. But research shows that women are far more likely to be stricken. The NCAA's latest research findings are alarming:

•About 2,200 female college athletes — one of 10 — tear an ACL every year.
•One in 100 female high school athletes will suffer a serious knee injury each year.
•Women have an incidence of knee injuries four to eight times higher than men.
For Kroll, these statistics became her reality. She was the first of four players on the same Katy Taylor basketball team to tear an ACL in a span of 27 months. All four are now 18, and at least three of them will never play the game again.

Kroll's second surgery was a failure, meaning the damaged ligament was irreparable.

Ten months after Kroll's injury, teammate Caitlyn Scelfo tore her ACL. Scelfo's tear — which she calls "the loudest sound I have ever heard" — required two surgeries and has knocked her out of basketball permanently.

Kroll's twin sister, Kara, tore her left ACL two months later. Her playing career also is done.

And 11 months later, Brittany Backhaus became the fourth teammate to suffer the same fate. She is attempting a comeback.

Most athletes who tear an ACL hear a loud "pop" and lose all stability in the bottom half of their legs. Rehabilitation takes from six to 12 months.

"It's like trying to walk on roller skates," Scelfo said of trying to move after the injury. "You have to learn how to use your leg again. You start slow. It was three months before I could even jog again."

Doctors: Training is crucial

With Amateur Athletic Union (AAU) basketball gaining popularity, year-round play is becoming more common.

Doctors say too much playing time and a lack of preventative measures during training increase the odds that girls will continue to endure these potentially career-ending injuries.

"In almost every sport, there are year-round leagues, and that doesn't always allow time for training," Texans physician Dr. Walter Lowe said. "If these young women don't have four to six weeks between seasons to devote to physical training, they should at least incorporate 10-15 minutes of that training in their everyday workouts."

Lowe and other leading orthopedic experts say an understanding of the problem by coaches, athletes and their parents and a commitment to proper training techniques can greatly reduce the chances of the injury.

For Scelfo, the impact has been extreme. Once an aggressive player who scored 19 points per game, her average fell to six per game before she gave up her dream to play. She recently accepted the position of team manager for Texas A&M's women's program.

"If I had only known what kind of training to be doing ahead of time, I would have," Scelfo said. "I learned so much during the rehab of my injury about how to build strength in my knee. I just wish I had done that before I hurt it."

Researchers have explored several probable causes for why women are more likely to tear an ACL. The female pelvis is wider, and girls tend be more "knock-kneed" than boys. Both of these anatomical factors contribute largely to why girls are more likely to tear their ACLs.

Also, in men, hamstring strength tends to be greater proportionally than in women. Working on hamstring strength is key for young girls planning on a basketball career.

Even a woman's hormone level can contribute to the problem because it can increase ligament laxity.

Lowe said that within the next 10 years, he hopes to see coaches everywhere utilizing preventative methods in daily athletic practices.

"We obviously can't eliminate torn ACLs — that injury will still happen — but strength training, speed training and building joint flexibility can help prevent the injury from happening," Lowe said. "Educating coaches and players and parents is the first step in preventing the injury."

Jerry Kroll, an area AAU coach and father of Julie and Kara, said education on the subject should start a lot sooner than it does now.

"In elementary school and junior high, physical education should include teaching kids, especially girls, about how to exercise properly and how to build core body strength," he said. "More physical activity at a young age would make a difference."

Several local training facilities focus on building speed, strength and agility.

"Any athlete could go into one of these places and say they are looking to work on preventative methods for ACL injuries, and there are programs that trainers can set up," Lowe said.

The situation isn't ideal, however, for those lacking time or money for a personal trainer.

"In that case, working on hamstring strength, landing properly when jumping and doing core strength training like building lower ab and hip muscles can help," Lowe said.

An ACL tear may seem temporary and fixable, but Lowe said that going through proper rehab is crucial.

"An ACL injury can affect you forever," he said. "Almost everyone who tears his or her ACL will have arthritis in that knee down the road. It's an injury you deal with for the rest of your life."

A fast-growing preventative exercise program cited by Lowe is Sportsmetrics, developed by Frank Noyes in Cincinnati. Details can be found at www.sportsmetrics.net.

"Frank's work with Sportsmetrics is great for young athletes," Lowe said. "It's a great foundation for any athlete, and I think eventually we will see it incorporated into more schools and athletic facilities."


Staying informed
In the meantime, the best thing young female athletes can do is stay informed, Lowe said.

"It's great that the level of competition in girls athletics is at a high level now," Lowe said. "Girls are dunking basketballs, running incredibly fast and all around closing the gap between what males and females can do athletically.

"But any sport can be dangerous. There is always risk for injury, and in girls there is a much higher risk for ACL damage. Staying educated and informed is important, and hopefully we'll keep the research growing and see the number of these injuries decrease."

That can't happen soon enough for Julie Kroll.

"It's such a tough injury, and it's really painful," she said. "It was really awful to have to watch two of my best friends and my sister have to go through that."