Understanding ACL injuries and their prevention could lead to the overall betterment of the sport.
Granada Hills basketball player Marianne Boco felt like she was screaming for five minutes straight when she tore her anterior cruciate ligament (ACL) during a July tournament with her club team, Troop West.
“In the moment, it was such a sharp pain,” Boco said, “and then after that, I just felt like it was burning. I could feel it swelling up. I’ve gotten a lot of injuries before but it was the worst pain I’ve felt so far.”
Boco was last year’s City Section Open Division Player of the Year. Due to her injury’s recovery process, she will miss her senior season.
Her situation isn’t uncommon. Multiple girls basketball teams in the area are missing key players this season due to ACL injuries — leaving coaches, players and athletic staffs to figure out how to best handle the effects of this injury while trying to reduce the occurrence.
The ACL can tear in both contact and non-contact scenarios, but a valgus force, as medical professionals call it, is common in both. A player might get hit in the knee, pushing the leg into an unnatural motion. Or, in a non-contact situation, a quick change in direction during movement could do damage.
“The movements that are required in basketball or girls soccer or girls lacrosse,” said Stephanie Hong, a physical therapist who works for Oaks Christian’s athletic department. “Not to say it doesn’t happen in boys sports, but yeah, there’s a lot of plant, cut, change direction, speed up, slow down. It lends itself to the possibility of ACL tears.”
Leia Edwards, a junior on the Sierra Canyon girls basketball team, is out for the season due to an ACL tear as well as Harvard-Westlake junior Bella Spencer. Two players on Alemany’s roster are dealing with the injury this season in sophomore Maddie Borquiren and senior Maleyni Tolliver. And that’s just in the Mission League.
Having ACL reconstruction surgery while young rather than waiting until adulthood puts the athlete at a decreased risk for arthritis, according to Dr. Katherine Coyner, an associate professor of orthopedic surgery at the University of Connecticut.
“Any time you have an ACL injury, you’re also placing your cartilage and meniscus at risk,” Coyner said. “So with those types of injuries, you’re increasing your risk for arthritis. We’re very good surgeons these days and we try to do it as anatomic as possible, but we still don’t make it like it was made when you were born.”
Sierra Canyon coach Alicia Komaki tore both of her ACLs as a player. She now dedicates time to figuring out how to best protect her players.
“It’s always been a big passion of mine to try to prevent that as much as possible,” Komaki said at Mission League media day in late October.
“We do a ton of stuff that’s been researched just in terms of a pre-practice routine, landing certain ways,” she continued. “Our strength and conditioning coach is looking at different people’s mechanics and making sure that their knees don’t move this way or that way.”
She preaches post-practice maintenance, like taking an ice bath. Alemany coach Jeff Dosado emphasizes work in the weight room to build stronger bodies as well as getting enough sleep.
“It’s underrated work, how many hours of sleep,” he said. “It used to be a punishment as a kid, but I’m sure all us coaches would love to nap once a day. Sleeping is really, really important to taking care of your body.”
Harvard-Westlake coach Melissa Hearlihy, who has been coaching girls basketball since 1985, said she has observed a decreasing amount of ACL injuries due to the preventative practices that have been developed over time.
A 1996 study published in the Journal of Athletic Training surveyed 22 colleges and universities across the state of Wisconsin across five years found that 26 out of 545 female athletes dealt with an ACL injury.
The study also concluded that the rate of ACL injuries in women was 2.3 times higher than their male counterparts at the time. More presently, Coyner said that an ACL injury is four to eight times more likely to occur in women than men.
Females are more susceptible to ACL injuries due to their anatomy. Wider-set hips create a greater quadriceps angle — or Q-angle — a measurement that is formed between the quadriceps muscle and the patella tendon in the knee.
Male Q angles can range from eight degrees to 14 degrees, while women’s can be anywhere from 11 to 20 degrees, according to Pedriatric Manual Medicine.
“Which means we’re more predisposed to go into a position and that will tear an ACL,” Hong said.
Coyner said that women are anywhere from four to six times more likely to suffer an ACL injury. Hormones and fluctuating hormone levels due to menstrual cycles might also factor into the injury for girls, although more research is needed to solidify that idea.
Most elite high school girls basketball players compete in the sport year-round, but overuse doesn’t necessarily increase the risk of injury — ACL tears aren’t classified as overuse injuries like a stress fracture, for example, might be. However, athlete specialization might be a contributing cause.
“As an orthopedic surgeon, we love to see kids continuing to play multiple sports,” Coyner said. “It gives athletes time to develop in different manners because different sports require different things of our body. So if you’re only repetitively playing one sport, you’re not developing the muscle strength and conditioning and proprioception that one would if they potentially are playing multiple sports.”
The risk of injury is impossible to completely eliminate, and there is also a chance for re-injury. Coyner mentioned research that shows athletes under the age of 20 are particularly at a higher risk of re-injuring an ACL. There is roughly a 30% risk of suffering an injury to a surgically-treated ACL or the ACL in the opposite knee within two years after surgery.
While scientific ACL research continues, there is also an emotional aspect to the injury. Players have a passion abruptly taken from them, forcing teams to develop new game plans while still including the injured player in some way.
At Sierra Canyon, Komaki has leaned on humor to help Edwards, suggesting that she record a video of herself when she comes out of surgery and send it in the team’s group chat.
“It was one of the most funny videos of all time,” Komaki said. “But it’s a horribly tough process for an athlete at any stage of your career. And I think for all of us coaches, I think we all know any time somebody’s out for a year or for a significant amount of time, it’s making sure they still feel like they’re part of the team.”
Boco is doing everything she can to shorten her recovery time and get back to playing with her Granada Hills teammates. Until then, she’s still finding ways to lead the team and is helping bridge the gap between Granada Hills’ previous coach, Jared Honig, and its new coach, Rai Colston.
“Just trying to have continuity and also helping the new players understand,” Boco said. “And also keeping each structure for the team in general. Giving pointers from what I can do from the sideline and giving energy as always.”
The sudden pain of an ACL injury has devastating immediate as well as ripple effects. What’s done in response, however, controls the capacity for healing and growth for the future of girls basketball.
