After scoring a goal during her soccer game, Kristi Martinez, a 30-year-old high school art teacher was hit by an opposing player and heard her left knee pop -- often the telltale sign of an anterior cruciate ligament (ACL) tear.
The ACL is one of the two ligaments located within the center of the knee joint that cross over each other as they run diagonally between the thigh and leg bones. The ligament provides stability to the knee and prevents it from "giving way" during sports by limiting the movement between the bones.
"A defender from the opposing team ran into the side of me like a Mack truck," says Martinez, who tore the ACL in her other knee in 1998. "My left leg was just planting when she struck. I heard my leg crack and went down."
It is not uncommon for other injuries to occur with an ACL tear. Martinez also tore one of her meniscus cartilage pads (designed to be a shock-absorber in the knee) and sprained her (MCL) -- a broad, thick band that runs down the inner part of the knee which stabilizes the joint and prevents the knee from buckling inwards. These three injuries are known as the "unhappy triad" which often affects athletes when they are hit on the outside of the knee.
Martinez's soccer coach referred her to Dr. Christina Allen at UCSF Medical Center's Sports Medicine Center. Dr. Allen is an avid soccer player herself and an expert in treating knee and shoulder injuries, including ACL injuries. She is the Orthopedic doctor for the Cal women's soccer team at the University of California at Berkeley, the U.S. National Women's Soccer Team and the U.S. National Taekwondo Team. In addition, Dr. Allen has served as a volunteer doctor at the U.S. Olympic Training Center in Colorado Springs.
A month before her injury, Martinez actually played with Dr. Allen on her soccer team. "I was really glad that Dr. Allen played soccer and knew what I was going through and recognized the support I needed," says Martinez. "She was great about communicating everything I needed to know and I felt like she gave me special attention because of the soccer bond and people we know in common."
Allen notes that unfortunately, ACL injuries happen all too frequently in sports such as soccer, basketball and football. "Women are especially prone to ACL tears, and have much higher ACL injury rates then men in many sports," says Allen. "Most of the reasons for the increased injury rate in women can be attributed to anatomic and biomechanical differences between men and women."
Because the ACL is so important in keeping the knee stable, it is extremely difficult for an athlete with an ACL tear to return to cutting and pivoting sports, which are those that require rapid cuts and changes in direction, such as soccer, football, and basketball without causing further damage to the knee. After consulting with Allen, Martinez decided to undergo arthroscopic surgical reconstruction of her ACL, which is performed using small instruments through small incisions. In most cases, like Martinez's, the surgery is performed on an outpatient basis.
Following surgery, Martinez went to physical therapy each week for four months to build back the strength in her knee. By the end of therapy, she was able to jog and kick the soccer ball around. Now she's back on the playing field, and a member of three different San Francisco soccer teams.
"I'm playing soccer again and my left knee seems to be working and feeling fine," says Martinez.
"Kristi is doing great and was a terrific, motivated patient," says Allen. "She recovered from her injury in record time because she worked hard at her rehabilitation in physical therapy and in the gym. It's easy to have a great outcome after a surgery when you have a model patient."
Story written in July 2005
Abby Sinnott is a San Francisco-based freelance writer.
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