ACLs more at risk for women

Women's soccer midfielder Erin Mikula took the field with confidence. Her knee finally felt secure mended from two medial collateral ligament sprains.

But with eight seconds to halftime during UNC's Sept. 12 game at Stanford" she took an awkward step and ended her season.

""I was just running at the (Stanford) girl and she was running at me with the ball" Mikula said. She cut it to the left" and I went to plant and my knee just gave out. I heard two pops. It's probably the worst pain I've ever felt.""

Mikula tore her anterior cruciate ligament" joining the slew of female athletes who have done so. Women are two to eight times as likely as men to tear ACLs.

Orthopedic surgeons reconstructed her knee grafting pieces of her hamstring to replace the ligament connecting the back of the femur to the front of the tibia and stabilizing the knee.

Now she walks with two crutches. She wears a black ankle-to-thigh brace" locked straight at 180 degrees and covered in abrasive Velcro. It will be months before she can jog alongside her teammates.

""It's all these new things where you have to accommodate for the injury"" she said.

Even though she has to learn to sleep on her back and navigate Chapel Hill on one leg, Mikula is lucky. Thanks to modern medicine, she'll be back on the pitch in six to nine months.

Our recovery rate right now is pretty consistently good" women's soccer coach Anson Dorrance said.

In the old days it was such a difficult surgery. The players couldn't really come back 100 percent" but now they can. So it's less of an issue than it was 15 to 20 years ago.""

Dorrance has coached young women at UNC at a championship caliber for 30 years. The family atmosphere he infused into his athletes to instill teamwork inspired his players to rally around Mikula in Palo Alto"" Calif.

""They brought the huddle to me" and they're like ‘We're playing for Erin now"'"" Mikula said. ""It kind of brought me to tears.""

Dorrance said the team receives instruction on how to prevent torn knees and tearful scenes from Greg Gatz"" North Carolina's director of strength and conditioning for Olympic sports.

""There are some ideas of prevention with fundamental movement"" which Greg Gatz deals with in warm-ups and preparations"" Dorrance said.

""That helps train the body to get a lower center of gravity" to do everything with knees bent as opposed to knees straight" which is actually something to try to mitigate the risks of ACL damage.""

Knee posture is one explanation for the estimated 38"000 ACL injuries a year for females with basketball and volleyball joining soccer as the riskiest sports for females.

Women typically run more upright than men so are more likely to throw body weight over the knee putting it in an unstable position where a ligament might snap.

Although decreased muscle mass and wider hips of women are also a factor in the higher number of female incidents" the problem goes beyond anatomy and delves into neurology and biomechanics.

""The research is showing that overall strength itself isn't really the most important factor. It looks like how do we use the strength is more important"" said Melanie McGrath, a fourth-year doctoral student and assistant in the sports medicine lab at North Carolina.

McGrath spends her time at UNC researching the biomechanics of the lower extremities and how they are affected by fatigue, but her connection to her research extends beyond the office.

She spent a year treating athletes as the head athletic trainer at Beaverton High School in Beaverton, Ore. During that year McGrath saw three incidents of ACL tears in the girls — two from basketball and one from soccer — and none in her male athletes.

She's also had two knee reconstructions to repair her own torn ACLs. The experiences paved the way for her work assisting Dr. Darin A. Padua with UNC's JUMP-ACL (Joint Undertaking to Monitor and Prevent ACL injuries) project.

In the majority of cases" ACL injuries occur when nobody else is around you McGrath said. You're cutting or you're landing from a jump and your knee just goes out on you. It's something that just happens" and therefore we think it's preventable.""

The study already came to one major conclusion.

""The biggest factor to injury to the ACL that we can find so far is already having suffered one"" McGrath said. If we can prevent that one from happening then we should be able to prevent a lot of ACL injuries from occurring.""



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