Why are torn ACLs happening so frequently to Dallas-area girls basketball players? A look at an epidemic with no easy answers

Colleyville Heritage girls basketball coach Dianna Sager thought the epidemic couldn’t get any worse after two of her players tore their anterior cruciate ligaments last season.

That was only the beginning.

Sager lost two more players to the same injury over the summer, then another last week.

“That is five in about a year and a half, and they were all varsity players,” Sager said. “I have been coaching for 31 years and I have never had this many knee injuries.”

Sager’s team, which fell two wins short of the state tournament in 2017 and 2018, is 10-17 this season.

“What is crazy frustrating is that there is absolutely nothing you can do,” Sager said. “I’ve had a physical therapist come to our school and walk my players through several preventative exercises for warmup and cool-down. We lift weights year-round and do specific lifts to strengthen our players’ quads and hamstrings. For the last two years, we have spent the first 15 minutes of practice stretching and warming up. I honestly do not have an answer for these injuries.”

Season-ending torn ACLs are occurring at an alarming rate as players rupture one of the key ligaments that helps stabilize the knee joint. Females are at least two to three times more prone to injure their ACL than males, and not enough teams are utilizing injury prevention programs, Dallas Wings team doctor Jit Mookerjee said.

A SportsDay survey found that 28 Dallas-area girls basketball players tore their ACL this summer or school year. The list includes three of the top 20 recruits in the area in the Class of 2020 — Florida signee Jordyn Merritt of Plano, Harvard signee Harmoni Turner of Mansfield Legacy and SMU signee Jayla Brooks of Sachse.

“Unfortunately, it’s common,” said Dr. Theodore Shybut, associate professor of orthopedic surgery and sports medicine at Baylor College of Medicine in Houston. “That is a very, very high-risk demographic in general — young-adult female agility athletes.”

Irving MacArthur five-star point guard Sarah Andrews, the state’s No. 1 recruit in the Class of 2020, strained her ACL in late November, but she avoided a tear. The Baylor signee played Friday for the first time since her injury, and she scored 11 points as MacArthur moved into a tie for first place in District 6-6A with a 57-54 overtime win over Flower Mound.

It was the first time that Andrews and five-star Baylor signee Hannah Gusters, the state’s No. 2-ranked recruit, had been able to play together in a game for MacArthur after Gusters transferred from Duncanville.

“I think there is overuse involved with some of these injuries,” Mookerjee said. “A lot of these athletes are playing year-round, and they don’t take any time off.”

Girls who play high school and AAU basketball might play 80 games a year, including 20 to 25 in a single month (July), South Grand Prairie coach Brion Raven said. More athletes are playing year-round at an earlier age, starting at 9 or 10.

“The only age group that logs the hours and wear and tear on their bodies is this age group and younger. College athletes and professional athletes have an off-season to recover and develop, but not this age group,” said Midlothian coach Amy Tennison, who lost leading scorer Kierra Middleton (was averaging 26.3 points per game) to a torn ACL in the fourth game of the season.

A 2018 position statement from the National Athletic Trainers’ Association reported that an estimated 200,000 ACL injuries occur annually in the United States, and the rate is rising rapidly. Shybut said that about 70% of ACL tears are noncontact injuries.

DeSoto 6-4 sophomore Sa’Myah Smith, the state’s No. 1 recruit in the Class of 2022, has played AAU all summer since she was in sixth grade. The four-star forward tore the ACL in her left knee in the championship game of the Sandra Meadows Classic on Dec. 28, but the first major injury of her career occurred when she simply slipped and landed awkwardly.

While some athletes may hear a popping sound when a tear occurs, Smith didn’t think her injury was that severe and said, “I wanted to go back in, but they wouldn’t let me.” It was good that she listened to her coaches, because two days later an MRI revealed that her season was over.

There is growing concern that athletes who specialize in one sport at too early of an age are more susceptible to knee injuries because they are repeating the same motions over and over and aren’t developing core muscles, balance and agility in the same way as athletes who play multiple sports. Mookerjee said doctors would recommend waiting to focus on one sport until later in high school, such as junior or senior year.

Studies have found that females are more at risk of a torn ACL because of how their bodies are built.

Women have wider hips than men, which can affect the alignment of the knee and leave women more prone to knees that move inward (knock-kneed), according to Sports-health.com. Shybut said a bigger factor is that females tend to be more quadriceps dominant, which means they land with their knees a little more extended and the hamstring muscles don’t get a chance to engage as much.

The standard recovery time used to be six months, but doctors are extending that to nine to 12 months to ensure a full recovery. Rehab programs are becoming more patient-specific, and athletes aren’t cleared to return to their sport until they achieve certain goals.

Once an athlete tears an ACL, they are at greater risk of tearing the ACL in the other knee. Clemson pledge Sydney Standifer suffered the injury in back-to-back years and will miss the rest of the season as Argyle tries to become the second girls basketball team in UIL history to win six consecutive state championships.

Shybut recommends FIFA 11+ (an online video and article) and the American Orthopaedic Society for Sports Medicine as good resources for injury prevention information. Coppell isn’t among the 22 area schools that lost a girl to a torn ACL, and athletic trainer Brian Terrell credits that to year-round work in the weight room.

“We’re big on Performance Course, getting our young ladies in the weight room and working on their muscle strength, overall lower-body strength — the glutes, the hamstrings, the quads,” Terrell said.

Coaches and athletes can do everything right and not be rewarded.

For the first time, Raven brought in an outside group to conduct an injury prevention program, providing strength training and teaching athletes how to jump, land, plant and cut properly. SGP still had three JV players tear their ACLs.

Nationally ranked DeSoto gives its players two recovery days a week in an effort to ward off overuse injuries. Coach Andrea Robinson warns that it may soon become necessary to follow the lead of the NBA and implement load management — resting healthy players in games in order to preserve their long-term health.

“I think high school coaches are going to have to start doing that if they don’t cap some of the AAU and some of the training,” Robinson said.

At this point, coaches are willing to try anything.

Twitter: @DMNGregRiddle

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Recovering for college

A look at college basketball signees who are out for their senior season because of a torn ACL.

*Has not played this year, but could possibly return before the end of the season.