April 12, 2007

ACL Tears Cripple W. Lacrosse

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The anterior cruciate ligament, better known as the ACL, has added insult and injury to a less than satisfying season for the women’s lacrosse team. Although the ACL is not the only culprit, it is responsible for injuries to many of the squad’s best players this season.
Many may wonder why this injury seems to be preying on the women’s lacrosse team, claiming strong, skilled athletes at will. The answer is that it’s not just Cornell and it’s not just lacrosse. ACL ruptures are common in many sports, especially ones that involve quick changes of direction. While men are not excluded from this malady, women are almost three times more likely to become victims, according to the National Institute of Health.
Senior captain Margaux Viola and senior Anne Riordan tore their ACLs a week apart from each other at the end of last season. Viola’s ACL, perhaps with a flare for drama, gave out in the game against Harvard that clinched the squad an Ivy League championship.
“I was going to the goal, rolling around the crease when I got pushed from behind,” Viola said. “I took the next two steps but you could see my gait was off and then I just kind of fell, so it must happened somewhere in one of those steps.”
Viola described feeling intense pain immediately after she fell, but managed to hobble off the field. She then underwent a series of tests in order to diagnose the injury.
“I went to the hospital in Cambridge and got an X-ray that showed that a piece of my bone had chipped off, which is indicative of an ACL tear,” Viola said. “Then I got an MRI and I knew by the following Monday that I had torn it. I also tore my meniscus.”
About a week later, Riordan joined her fallen comrade on the injured list. In the final game of the season against Rutgers, she tore her left ACL trying to intercept a pass.
“The week before I tore the meniscus in my right knee and I didn’t want to stop playing because we were so close to the end of the season,” Riordan said. “I had a mark up in the Rutgers game and I wanted to make sure she didn’t score. She was running and I was trying to intercept the pass. She dropped the pass but picked it up and turned around. I tried to turn really fast to go with her but only half went with her and the other half kept going in the first direction.”
Riordan heard her left knee pop and had to be helped off the field. Later, Riordan learned that she had not only torn her ACL, but she had also dented her femur, tore her meniscus, LCL and MCL and reduced her cartilage by 75 percent. A player known for giving 100 percent, Riordan was not surprised when her injury followed suit.
The ACL is responsible for the rotational stability of the knee, yet it is notoriously unreliable, especially in female athletes like Riordan and Viola. According to the National Institute of Health, sports that involve pivoting, sudden starts and stops and landing from jumps are extremely demanding on the ACL. When the pressure becomes too great or the ligament is stretched too far, it tears or pulls away from the femur, causing the signature popping sound.
There are a variety of theories as to why female athletes are so much more likely to blow out their ACLs or endure the “unhappy triad:” tears in the ACL, MCL and meniscus. The difference in build and skeletal structure between men and women plays an important role but doctors contnue to debate the specific cause. One possibility is the difference in hormone cycles, since ligaments are affected by hormone levels. Another factor may be that, on average, women have slightly smaller ACLs and thus the notch through which the ligament passes is also smaller.
Although more research needs to be done, this anatomic difference may add to the vulnerability of the female knee. Some doctors also suggest that the increased susceptibility may be related to women’s tendency to play sports in a more upright position, while men tend to assume more of a crouched position. This is because most ACL tears occur when the athlete is relatively upright.
Despite all of these hypotheses, doctors cannot pinpoint the perpetrator. However, neuromuscular training programs that teach female athletes balance exercises and methods of reducing stress on the ACL have been shown to reduce the frequency of the injury. According to Orthopedics Today, women who are trained had a 72 percent lower incidence of ACL rupture.
According to Riordan and Viola, the turf that athletes play on and even the cleats that they wear could be to blame. Viola recalled a trainer mentioning that she was the fourth athlete to tear an ACL on Harvard’s field that year.
“The turf is definitely part of it; at least one person tears their ACL every year,” Riordan said.
Cleats provide better traction but they also stick in the ground, potentially locking the knee in place as a runner attempts to move in another direction.
“I re-tore my meniscus this year, so now I just wear sneakers,” Viola said. “I don’t want to risk it.”
Viola began playing lacrosse again this past January. Although she has been working hard to play at the level she had attained prior to the injury, this season has proven to be frustrating.
“I’ve had to work so hard to get even close to where I was. It was definitely a mental setback in that way,” Viola said.
Riordan has had an even rockier road to recovery. During the first few weeks of practice in the fall, she re-tore the same ACL, shattering her hopes of playing her final season for the Red.
“The doctors said that this time I only tore my ACL,” Riordan said. “My second surgery is still pending. This time, I want it totally healed, I don’t want it to happen a third time.”
The loss of Riordan in the lineup and the fact that Viola is still not fully healthy has definitely added to the many obstacles the squad has faced this season. However, it seems the best way to deal with the prevalence of ACL ruptures is to prevent them from happening in the first place. Perhaps implementation of a mandatory neuromuscular training program for all female athletes will prevent future players from succumbing to this pervasive injury.