Prairie guard Madison Dellamuth sits on the bench with a knee brace after tearing her ACL against Xavier in the regional finals Feb. 22. (Photo by Margaret O'Banion)Feb. 21 was the best of times and the worst of times for two local basketball players.
Cedar Rapids Washington High School point guard Tasha Roundtree was having “the game of her life,” according to Warriors Coach Frank Howell. She had scored 19 points and grabbed three rebounds and two steals in pacing her team to a 44-41 third-period lead over Iowa City High in a Class 4A regional final.
Running the court on defense, she leapt to intercept a pass at midcourt, landed awkwardly, and fell to the floor.
“My knee gave a little pop sound. When it popped, I knew what I had done,” says Roundtree, who had just torn the anterior cruciate ligament (ACL) in her left knee. It was the second ACL tear for Roundtree, who had injured the ACL in her right knee two years earlier during a sophomore game.
“I tore it all the way through this time, so I didn’t have as much pain,” says Roundtree, offering an excruciating bit of bad news-good news detail. But she cried into her jersey the rest of the game as her No. 13 Warriors fell 65-59 to the seventh-ranked Little Hawks.
“It’s just really devastating when it happens,” says Howell. “The thing is, we were in a pretty good spot late in the third quarter. She said, ‘Coach, I think I tore my ACL.’ I didn’t want her to think about the worst-case scenario. But the trainer knew.”
The same evening, in a regional final across town at Linn-Mar High School, the Prairie girls had hopes of extending their turnaround winning season by upsetting fifth-ranked Xavier. Thirty seconds into the contest, disaster struck, as the Hawks’ All-MVC and All-Metro first-team point guard Madison Dellamuth grimaced and fell to the floor.
“I took a girl baseline and planted wrong,” she recalls. “I felt something go over and something go under (my kneecap) at the same time, and I knew that wasn’t good. It was pretty painful at first.”
Prairie Coach Steve Doser was hoping for the best as staff attended to his sophomore star, he says. “The Linn-Mar A.D. gave me the look, and I knew.”
Roundtree and Dellamuth are in good company, if you can call it that.
Injuries plague high school, college athletes
Linn-Mar forward Shanice Cheatham also tore her ACL this season, and former Linn-Mar standout and current Iowa Hawkeye Jaime Printy tore the ACL in her left knee during overtime in a Feb. 2 victory over
Wisconsin. The Hawkeyes’ leading scorer, Printy had torn the same ACL as a sophomore at Linn-Mar.
“I went to box out, planted on my left leg, and got bumped,” says Printy of the latest episode. “I felt and heard the pop, so I knew I did it, but I was kind of in denial.”
The season-ending injuries to local athletes are emblematic of a scenario that has become all too familiar in high school and college sports venues: A young woman leaps in the air or makes a quick cut, lands abruptly, feels or hears a pop in her knee, possibly accompanied by sharp pain, and crumples to the floor.
Chances are, she has ruptured her ACL, a flexible, ropelike connector that holds the upper (femur) and lower (tibia) leg bones tightly together and allows for a smooth-functioning knee joint.
The American Orthopedic Society for Sports Medicine estimates that about 150,000 ACL injuries happen in the United States each year. The vast majority are non-contact injuries that result from rapid cutting, pivoting or landing movements that overstress the ligament.
“The ACL is the main stabilizer between the upper and lower leg bones,” explains Jennie Sertterh, longtime trainer for the Hawkeye women’s basketball team. “When it’s stretched beyond its normal range of motion, it will tear.”
Although boys still outnumber girls in sports participation and the overall number of injuries, the incidence of ACL injuries among women and girls has soared as their level of participation in organized sports has increased. In recent years, medical professionals have also determined that the rate of ACL injuries among girls is much higher – occurring two to eight times more frequently than among boys, depending on the sport.
Risk for ACL injuries higher among women
Basketball and soccer pose the greatest risk for ACL injuries, says Sertterh, with volleyball and gymnastics also high on the list. “Some studies suggest that the risk for women injuring their ACL in basketball is four to eight times greater than for men.”
A combination of anatomical, neuromuscular and hormonal factors appear to account for the greater rate of ACL injuries among girls and women. The most important one, says Sertterh, is that women’s hips are wider, creating a more inward facing angle from the pelvis to the knee, which puts more stress on the joint.
“Females also tend to use their quads more, while men use their hamstrings more. Hamstrings protect the ACL by pulling it back,” she says.
The notch in the knee through which the ACL is threaded is narrower in women, making the ligament more susceptible to tearing. There is also evidence that greater amounts of estrogen in a woman’s body make the ACL weaker at certain times during the menstrual cycle.
Surgery is first step for athletes
Fortunately, greater understanding of what causes ACL tears is leading doctors, therapists and trainers to develop new approaches to reducing and treating what was once considered a career-ending injury.
Although it’s possible for recreational athletes to retrain the knee to function without an intact ACL, says Sertterh, for high school and college athletes who hope to play at a high level again, surgery to repair the ligament is an essential first step. “You can’t do cutting, pivoting or landing without the ACL.”
Immediately after surgery, says Sertterh, the goal is to eliminate pain and swelling, begin working on range of motion, and rebuild strength. Most athletes are off crutches after a couple of weeks and able to begin a more intensive rehabilitation program.
“At 12 weeks out, the athlete will start jogging straight forward on the court, then we’ll begin functional drills for basketball, working on the muscles and reteaching them how to work.”
A typical ACL injury requires six to eight months to heal if nothing unforeseen happens, with girls and women tending toward the longer end of that time frame. “It will be about a year before an athlete will feel totally back to where they were,” Sertterh says, and even then the psychological impact may linger.
“It’s a long, grueling rehab, you’ve already missed a lot of time, and you don’t want to do it again.”
Hawkeye training focuses on prevention
Helping athletes learn to avoid ACL injuries in the first place is a growing, if inexact, area of sports training, especially among collegiate and elite athletes.
“Through our jump training program, we look at what their movements are and how they land,” Sertterh says of the Hawkeye training regimen. “We have them practice jumping in front of a mirror to get the knee straight and learn to land with knees and hips bent to absorb the shock.
"They’ll also work with our strength coach to strengthen muscles around the knee and keep everything stable when making a quick change of direction – keeping the muscles contracted so the knee isn’t wobbly.
“Jaime has very good patterns,” she adds, acknowledging the difficulty of ensuring positive results. “There’s nothing she does that would predict this happening to her.”
Physical therapist: Risks can be reduced
The idea of “ACL injury prevention” is indeed a bit of a phantom, says Mercy Medical Center Senior Physical Therapist Tom Cahalan, who has worked with hundreds of healthy and injured athletes. “I don’t think you can prevent athletic injuries, but you can reduce the risk.
“We have athletes run on a treadmill in front of a mirror and do a lot of jumping up and down over hurdles, landing with the toes pointed straight ahead or even outward a little,” he explains. “Girls tend to land more with a knock-kneed posture, and that’s a huge factor leading to ACL injuries. If a foot is planted and they’re twisting and the knee is bent inward, that’s going to put the ligament in great peril.”
Cahalan says it’s “absolutely” possible for an athlete to return to the highest level of competition after an ACL injury, although it doesn’t happen for everyone. “Results are getting better and better with surgical repair and rehab. But it’s a three-legged stool, with what the doctors can do and what I can do and – probably most important – the athlete’s grit and doggedness and follow-through.”
Learning proper form early is essential
Sertterh and Cahalan emphasize the need for athletes to learn proper form as early as possible in their careers.
“Find an ACL reduction program and work on motor skills in any sport where you’ll do some cutting,” Sertterh advises. “It takes a lot of work to change a motor pattern later. It’s also great to play a couple of different sports to have well-rounded muscles.”
Coaches Doser and Howell can both recall about five girls who have suffered ACL injuries in their programs during the last two decades.
“Of those, three did it more than once,” says Howell, who is skeptical about the possibility of training girls to avoid the injury.
Stretching and strengthening programs are valuable, he says, “but I don’t think there’s much good in talking about injuries. One of the worst things you can do to an athlete is talk about how you can get hurt. You could even make them more likely to get injured.”
For his part, Doser says he would welcome more guidance on how to help his athletes reduce the risk of ACL injuries. “I think we need to research it as a district to find out if there are things we should be doing.”
Surgery for injured high school players, UI player Printy
The Warriors’ Roundtree had surgery to repair her ACL on March 14. With her leg in a cast stretching from her thigh to her ankle, she goes to rehab every other day to do leg lifts and strengthen her muscles.
A senior, she expects to regain full use of her knee and pursue basketball at the collegiate level next year. “I did it before, so I know what it takes to recover and what to expect,” she says.
Dellamuth’s surgery is scheduled for April 10, but she has been able to walk on the knee in the meantime. She is already undergoing therapy to strengthen her muscles. She’ll miss a summer of AAU ball but plans to be back stronger and ready to go by next season, she says.
Both acknowledge the emotional pain of the experience. “I felt like I had let my team down,” says Roundtree, “but there was nothing I could do.”
“I was kind of upset because I knew what we had worked so hard for all season,” Dellamuth recalls, “but it wasn’t meant to be for us this year. It just gives us motivation for next year.”
Printy, who also suffered cartilage damage and a fractured femur due to the impact of her bones smashing together when the ACL snapped, had surgery the week after her injury and is deep into her rehab program. A veteran of the ACL injury crucible, she is quick to encourage her prep comrades.
“Keep your head up,” she says. “I truly believe it will make you stronger than before, and you can learn a lot from the bench cheering on your teammates. It’s really important to learn how to land the right way, butyou have to play and have fun, and if it happens, it happens.”
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