This article features a patient of Dr. Anthony A. McPherron who plays basketball for John Glenn High School. She had her ACL reconstruction performed by him at St. Joseph’s Regional Medical Center in Plymouth, Indiana.
The player she was guarding had cut down the sidelines, trying to get around her and head for the basket.
"I was trying to stop her when I felt a pop,'' she recalled. "I tried to run it off, but it was really unstable.''
Izdepski had suffered a serious knee injury some sports medicine doctors believe may be happening too often to female athletes: a tear in the anterior cruciate ligament.
The injury ended Izdepski's basketball season but not her sports career.
Surgery and hard work in rehab have enabled the 18-year-old to come back. She played tennis for the Walkerton high school last spring and volleyball this fall with no problems.
Now she's back on the basketball team, practicing for her senior season.
"People ask me about it, if I'm worried,'' she said. "I tell them I've been through two sports and it hasn't bothered me, so I don't think it should now.''
Gender differences studied
Lots of researchers have been thinking about ACL tears and why they happen so often. They are the "pop'' heard 'round the world of women's sports.
For reasons that are unclear, the injuries occur from two to eight times as often in females, according to Dr. Kimberly Harmon, a team physician at the University of Washington who served her residency at Memorial Hospital in South Bend. Female athletes in high school and college are affected with similar frequency, she said.
The ligament in question is a fibrous band that passes through the middle of the knee, connecting the thigh bone to the shin bone and keeping the lower leg from rotating too much.
Sports that involve a lot of "cutting'' -- quick changes in direction -- and jumping put stress on the ACL and tend to generate the most tears. Those sports include basketball, soccer and volleyball, Dr. Mark Lavallee, co-director of the Sports Medicine Institute in South Bend, said.
Title IX opened doors
That women are prone to ACL tears has become evident in the three decades since passage of Title IX, the federal law that expanded opportunities for girls and women to play organized sports in schools.
Before the 1972 enactment of the law, only 1 in 27 girls were participating in high school sports, according to an article co-authored by Harmon and Dr. Mary Lloyd Ireland, of the Kentucky Sports Medicine Clinic in Lexington.
In 1998, one in three high school girls was playing sports, and females now represent 40 percent of all college and high school athletes.
When the barriers to girls' sports first were raised, there was concern that women would have much higher injury rates than men. Those fears have proven to be unfounded, with overall injuries about the same for the two sexes.
The ACL, however, has proven to be a glaring exception, as was painfully evident during last year's NCAA women's basketball season. Many of the top teams lost players to the injury, among them Purdue's Erika Valek, Tennessee's Tamika Catchings and the University of Connecticut's Shea Ralph.
There are lots of theories about why women have up to eight times as many ACL injuries as men playing the same sports, Harmon said. Sports medicine researchers have looked at differences in anatomy, hormonal influences and movement patterns to explain the disparity.
Many of the contributing factors they've identified can't be modified, such as the fact that women have a relatively narrow "intercondylar notch,'' a niche inside the knee that holds the ACL in place.
But others can be modified, such as the jumping styles favored by women that seem to put their knees at greater risk, Harmon said.
Safe landings for jumpers
To land safely after a jump, children naturally learn to flex their leg muscles at the precise moment their feet hit the ground. If they didn't, they'd simply crumple to the ground. But researchers have found that men and women tend to do this differently.
Women stand straighter when they land, using their thigh and calf muscles to absorb the impact and
stabilize the knee. Men rely more on their hamstrings -- a muscle in back of the leg that protects the ACL -- by landing with knees slightly bent. Men's hamstrings are stronger, even accounting for weight differences.
Based on such "biomechanical'' research into gender differences, training programs have been designed to reduce ACL injuries in both men and women. Proper jumping and landing technique -- with knees flexed slightly -- is emphasized.
Other special exercises are designed to help increase an athlete's awareness of the position of their legs and feet during movement. This ability, which is closely related to balance, is called "proprioception,'' Lavallee said.
"The classic example (of proprioception training) I always think of is Ralph Macchio in 'Karate Kid,' where his teacher had him standing on a post on one leg,'' he said. "It's the ability of the mind to know where the body is.''
Training programs may help
A six-week preseason training program called Sportsmetrics, developed by the Cincinnati Sportsmedicine Research and Education Foundation, claims to have reduced ACL tears in a study of 1,200 high school athletes. It also increased vertical jump by 10 percent.
Dr. Stephen Simons, co-director of the Sports Medicine Institute, said a study of 600 male soccer players in Italy found that balancing exercises reduced ACL tears by sevenfold over three seasons, adding more evidence that the injury is preventable.
Many college coaches, including those at the University of Washington, are using the exercises in the hope of keeping their players safe, Harmon said.
"They are promising, but there is no specific program that's been proven,'' she said. "But I don't think that should prevent people from using them.''
The techniques have not filtered down to the high school level, although Dan Hutton, the varsity girls' basketball coach at John Glenn, said he would welcome training methods that prevent ACL tears. The injuries seem to have become more common in the 14 years he's been coaching girls.
"The girls' game is speeding up,'' he said. "They've gotten a lot better in the last few years and it's putting more stress on knees.''
Harmon said the risk of ACL tears for female athletes, while much greater than for males, is still low and shouldn't discourage girls from getting into sports.
A team consisting of 20 women, for example, should expect to have only one ACL tear every two years.
"And they can be fixed,'' she said. "All the benefits of participating sports outweigh the risks.''
Izdepski said she worked hard to rehab her injured knee, even using a pulley device her father rigged up in the family's garage. When she started playing tennis three months after her surgery, she didn't let the prospect of re-injury spook her.
"My parents were worried, but I thought, 'If it happens, it happens,' '' she said.
By DAVID RUMBACH, South Bend Tribune, November 7, 2001