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ACL surgery may not shorten WNBA career

By Kathryn Doyle

NEW YORK (Reuters Health) - A common knee surgery that can sideline athletes for months does not ultimately affect the career length of women invited to the Women's National Basketball Association (WNBA), according to a new study.

"With appropriate rehabilitation, ACL injuries do not mean an early end to an otherwise promising athletic career," said lead author Dr. Moira McCarthy, an orthopedic surgeon at the Hospital for Special Surgery in New York City.

McCarthy told Reuters Health she was surprised and impressed by just how many women enter the WNBA with a history of knee injury or surgery.

In particular, the anterior cruciate ligament (ACL), which runs through the knee joint and connects the thigh and shin bones, can be damaged during running or pivoting. Women are at higher risk for ACL injuries than men, and that gender divide widens in intense sports like basketball and soccer.

To see whether female athletes with repaired knees suffer long-term career consequences, McCarthy and her colleagues looked at a healthcare database for 500 players entering the WNBA combine, an invitation-only precursor to the draft, from 2000 to 2008.

Fifteen percent of the athletes reported having torn an ACL, compared to less than a tenth of one percent in the general population. Almost all the injured athletes had reconstructive surgery.

No position on the team appeared more likely to suffer damage to the ACL or to the meniscus, another part of the knee joint subject to tearing injuries.

"The meniscus is a shock absorber, a shock transmitter, all the pounding that goes on in a performance athlete can wear that down," Dr. Richard Parker, an Orthopedic surgeon at the Cleveland Clinic in Ohio who wasn't involved in the study, told Reuters Health.

And each ACL injury is different, Parker said. Most people take six or eight months to return to sport, but "We all hear the story about the person who gets back at four months, and the person who doesn't get back at all."

With or without a history of surgery at these locations, the average WNBA career lasts between three and four years.

McCarthy's team also found that neither career length nor the round in which an athlete was drafted were affected by having had knee repairs.

Parker points out that some women with more severe injuries probably could not return to their previous level of play and were not invited to the combine, skewing the results.

But the young athletes who are able to return to form after surgery and are still invited to the combine do just as well in the WNBA as women who never suffered the injury, according to the results published in the American Journal of Sports Medicine.

These are still serious injuries, said Dr. Amanda Weiss Kelly, director of pediatric sports medicine at UH Case Medical Center in Cleveland, but "what this shows you is that at least at the professional level, if you work hard, you can get recruited."

ACL injury is more common in women than in men in every sport, noted Kelly, who was not involved in the new study. This could be due to differences in core strength, joint flexibility, hamstring and quadriceps strength, and the size of the notch in the thigh bone where the ACL connects, she said.

"That is what we saw back then and see now," said Parker, who has been the team doctor for the Cleveland Cavaliers men's basketball team for 13 years, and also tended to the Cleveland Rockers WNBA team until it folded in 2003.

On the women's professional team, seven of the 12 players had one or both ACLs reconstructed, he recalls, compared to just one of the men on the Cavaliers now.

While ACL injury is still a serious problem, things are looking up, according to Parker. "Our rehab techniques are better, prevention exercises are better, surgery is better," he said.

Coaches of girls sports teams invest more in learning about prevention now that they know the risks are higher for women, Kelly said.

Prevention exercises teach girls to jump and land in a way that puts less stress on the ACL, and training to strengthen the hamstrings and quadriceps. The exercises have been effective at reducing the number of injuries on a team, but they aren't a guarantee, according to Parker.

"At the end of the day you can't go out and play a sport at the highest level and be afraid," Parker said. "The only way to 100 percent prevent these injuries is to outlaw basketball."

SOURCE: http://bit.ly/12M5Zve American Journal of Sports Medicine, online February 1, 2013.

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