After nine months off the soccer pitch, Corey Capozziello returned to playing soccer as though she hadn't missed a day. Last season, she earned the "golden boot" award for scoring the most goals on her first-division San Francisco soccer team, The Mad Dog Lassies.
Though in May of 2005, Capozziello, a 33-year-old physical education teacher at Visitation Valley Middle School, suffered one of the most common injuries among female athletes -- a tear to the anterior cruciate ligament (ACL). The ACL is one of the two ligaments in the knee joint critical to providing stability to the knee and preventing it from "giving way" during activity and dislocating.
"There was no one around me and I went to make a cut and had a searing pain, which felt like my knee was falling off," remembers Capozziello. "I fell on the ground and all I could think was, 'Oh my god, I'm going to need surgery.'"
The ACL is injured when it sustains a force that exceeds the strength of the ligament. As in Capozziello's case, this may result from a non-contact injury, such as landing awkwardly or cutting or changing direction. It may also occur from a contact injury, like getting tackled during a football game.
After a trip to the emergency room, Capozziello was referred to Dr. Christina Allen at UCSF Medical Center's Sports Medicine Center, who has treated many of Capozziello's teammates for other knee injuries. Compared to men, women -- both athletes and non-athletes -- are at a higher risk of knee injuries, especially ACL tears. Research suggests that one of the causes is the way women are built. Women tend to have wider hips and have slight knock-knee alignment, which can create added stress on the joints. They also tend to use their leg muscles differently than men.
"Unfortunately, ACL injuries happen all too frequently in sports such as soccer, basketball, and football," says Dr. Allen. "Women are especially prone to ACL tears, and have much higher ACL injury rates then men in many sports. Most of the reasons for the increased injury rate in women can be attributed to anatomic and biomechanical differences between men and women."
Dr. Allen is an avid soccer player herself and a renowned expert in treating shoulder and knee injuries. She is the orthopedic doctor for the women's soccer team at the University of California at Berkeley, the U.S. National Women's Soccer Team and the U.S. Taekwondo Teams. Dr. Allen also has served as a volunteer doctor at the U.S. Olympic Training Center in Colorado Springs.
Though Capozziello thought she had only sprained her knee and possibly torn her meniscus -- a protective cartilage that reduces stress between the knee bones a magnetic resonance imagining (MRI) test detected a much more severe injury. Capozziello had suffered a double injury -- she had torn her meniscus and her ACL, which is often a common combination in ACL injuries to the knee.
Dr. Allen recommended ACL reconstruction surgery, which replaces a patient's torn ligament with healthy tendon -- either from a patient's own body in a procedure called an autograft, or healthy tendon from a cadaver donor, called an allograft.
After discussing the two surgical approaches with Dr. Allen and conducting her own research, Capozziello decided to have a patellar tendon allograft in June 2005. While both an autograft and allograft have their own advantages and disadvantages, Capozziello chose the latter because a donor's tendon, rather than her own tendon, would be used. Therefore, there was no need for a tendon harvest, resulting in less operative time and less pain following surgery compared to using an autograft.
"I had never had surgery before and was very scared," says Capozziello. "But I felt better about it knowing that Dr. Allen does ACL reconstructions all of the time. She was the best thing about the surgery because she's very personable and knowledgeable."
Following surgery, Capozziello went to physical therapy once a week for nine months and exercised on her own to build back the strength in her knee. After almost six months, she was able to practice with her soccer team and by nine months, she was back in the game, though she says it took a little over a year for her knee to feel completely "normal" again.
"I was so excited to be back on the field with my knee working again. Even after a couple of falls, it felt alright, so I knew it could withstand anything," says Capozziello.
Story written in December 2006
Abby Sinnott is a freelance writer in San Francisco.