Could an ACL tear halt your athletic career?

(Sentinel photo by Roy Tucker) Former Le Mars basketball player Katie Sponder looks to pass. Sponder tore her ACL in her final high school game and now plays for Morningside College. [Click to enlarge]

Never a sprain, strain, pull or broken bone.

Sponder, a frenetic, scrappy 5-foot-9 guard for the Le Mars girls basketball team, simply had no room in her game to be sidelined.

(Sentinel photo by Roy Tucker) Former Unity Christian basketball/volleyball player Jaci Moret recovered from and ACL tear and now plays volleyball for Northwestern College. [Click to enlarge]

Then came February 20, 2006.

The Le Mars girls basketball team was locked in a tight Class 3A District 1 semifinal contest with No. 10 Cherokee when Sponder lurched for a ball that was headed out-of-bounds.

She planted her leg and fell to the ground, but there was no pain or even a distinctive 'pop' sound.

"I really didn't think that I (injured my knee)," said Sponder, who was being courted by Morningside College, Hastings College and Southwest Minnesota State, among others at the time. "It felt funny to go backwards, but I could run forwards like normal."

The Lady Bulldogs saw their season come to an end by a 59-45 margin that night, but Sponder got more devastating news later that week when she learned she had torn her anterior cruciate ligament, or ACL.

"It didn't hurt (when I went down) and that's why I didn't think I did it," Sponder said. "I watched my friend (and former teammate) Molly Reuter who did it and you would have thought she broke every bone in her body."

Like Sponder, former Unity Christian athlete Jaci Moret tore her ACL trying to execute a jump-stop during a pickup basketball game prior to her senior year.

"It was kind of a freak thing," said Moret, who counted Iowa State and Northwestern College among her volleyball suitors at the time. "It was sort of Jello-y feeling. You feel something is not right.

"Some people's pop really loudly. Mine I didn't hear, but it was a little bit painful. It was a sharp pain and I was like 'Whoa, what just happened?' I didn't lay there in agony or anything."

A common concern

The plight of Moret and Sponder is not unique.

Torn ACLs are an issue for athletes, particularly high school girls. Research indicates that depending on the sport, females are anywhere from two to four times as likely to tear their ACL during their high school years than their male counterparts.

In fact, roughly two-thirds of tears occur in female high school athletes.

"I didn't know how common it was until after I did it," Moret said. "Actually since I've torn it, I've known three people, close friends on the team, who have had the injury...it became much more evident after I tore mine."

During the college years, female ACL tears still occur two to three times at the rate of males. The incidence appears equal in the professional ranks.

Seventy percent of ACL tears are non-contact - meaning they occur from activities like landing and cutting during competition.

Tyann Meyer, a physical therapist at Le Mars Physical Therapy, said that most tears occur when the femur (thigh bone) rotates underneath a stable tibia (knee), known as hip pronation, and snaps the ligament as seen in cutting and jumping injuries.

"If someone's hips are weak, they can't control their femur," Meyer said. "They don't have the strength to control the rotation that can occur when landing and the knee collapses inward."

Hip strength and femur control comes from strengthening the hip abductors and gluteal muscles, not from the quadriceps.

Females generally show more hip weakness and greater dependence on their quadriceps muscles than males, which predisposes them for ACL injuries as well as knee injuries in general.

"Guys tend to have more of the hip-dominant strategy where they will land with their butt back and knees flexed," Meyer said. "They don't have as much of that hip weakness that causes hip pronation. Guys historically have done a lot more strengthening of their hips than girls and the hip weakness becomes more evident in growing females. Then they come up with that quad strategy- that stiff, knocked-kneed landing with hip pronation - to compensate for glute weakness and ACLs are stressed and can tear."

Tear prevention

The notion that too much activity plays a role in tears may also have some indirect merit.

"I think overuse can play a role in it where you're asking the body to perform repeatedly and they don't have the strength to do it," Meyer said. "The muscles don't have the endurance and once those muscles get fatigued and you're still having them jump and squat and whatnot, you're going to see all those bad mechanics occur more frequently, setting them up for injury."

With kids beginning sports at younger ages, Meyer said the key to preventing ACL tears is teaching young athletes proper jumping and landing techniques while strengthening the muscles that control the femur.

"As (kids) are growing, the bones grow faster than the muscles," Meyer said. "The muscles get stretched and weak and kids can lose a lot of strength during their growth period. To make up for that and still keep going with all their activities, they develop bad habits."

Meyer runs a program as part of the Xcelerate programs at Le Mars Physical Therapy that addresses many of the common risk factors associated with ACL tears. This program focuses on teaching proper landing/jumping techniques as well as developing adequate hip strength and motor control to prevent hip pronation and consequently decrease stress to the ACL. The basic outline of the program follows the current sports medicine and physical therapy recommendations.

There are a number of programs available to coaches and research has shown that performing the actions 2 to 3 times per week for 6 to 8 weeks can reduce ACL tears by up to 88 percent.

Adding the strength-training component is also a crucial step.

"Since I've been in college I've taken lifting a lot more seriously," Sponder said. "I know lifting can help prevent - obviously there's nothing that can (completely) prevent it. But there's things that can help."

When an injury occurs

There are several ways orthopedic surgeons can repair a torn ACL.

One method is to take out the central third of the patellar tendon, put in two bone plugs and reattach it through the tibia and femur. Doctors can also take a tendon from the patient's hamstring or use an ACL from a cadaver.

Moret and Sponder each had surgery within two weeks of their initial injuries under the hand of CNOS orthopedic surgeon Dr. Thomas Jacobson in Dakota Dunes and began rehabilitation almost immediately.

Both girls agreed rehab is tougher than the actual injury.

"You get frustrated and no one else seems to understand quite how you're feeling," Moret said. "Like when the doctor clears you to run and everyone else is like, 'Oh, that's good.' You feel like 'Wow, finally.' You feel really excited with the small things."

For Sponder, it was the monotony that made rehab so difficult.

"I hated rehab, (but) it makes you 10 times better," Sponder said. "You have to try to keep your hopes up. Once you do the rehab and you're doing these exercises that seem so pointless and you don't see progress immediately. Being an athlete, you think you'd see progress right away. It's a process."

Moret missed most of her senior volleyball season, but did get to play in two games at the Knights' state tournament appearance.

The injury didn't scare off Iowa State, but she eventually chose to attend Northwestern where her family could watch her play. She recorded 26 kills and five ace serves in the 18 varsity matches in which she appeared for the Red Raiders, who advanced to the quarterfinals of the NAIA Tournament. She led the junior varsity with 99 kills to go along with 17 aces and 109 digs.

"I learned a lot of lessons along the way," she said of the rehab process. "Patience is a big one because it is not a fast recovery with that injury. (I learned) how to be a good teammate, (and how to be) encouraging. That's really all you can do on the sidelines. That was a big one. Probably that God is in control. It wasn't my plan because I wouldn't have wanted that to happen but God had other plans."

Sponder rescinded a verbal commitment to NCAA Division II Southwest Minnesota State and signed with NAIA Morningside College.

She battled mononucleosis as a freshman and only appeared in one game during the 2006-07 season.

She appeared in 25 games for the Mustangs' national runner-up 2007-08 team and was a key contributor off the bench during Morningside's 38-0 championship season in 2008-09.

As of December 21, she has appeared in all 15 games off the bench for Morningside this season and is averaging 5.7 points per game.

"When I've seen people go down since I've (been injured) it makes you sick," Sponder said. "You're so thankful....there's times when you're so mad in practice and you hate your coach, but then you realize you could be out all season with a torn ACL."