By JERÉ LONGMAN
PHILADELPHIA — This is not the homecoming that Caroline Doty wanted, surgical scars having formed a vague T on her left knee, her contribution to Connecticut this season limited to charting plays from the bench instead of leading the team at point guard.
Three times Doty has torn the anterior cruciate ligament in her left knee, an injury that has afflicted sports like basketball and soccer, where women are up to five times more likely than men to have their careers interrupted for reasons that are believed to be anatomical, biomechanical and hormonal.
“I’m hanging in there, but it’s tough watching,” said Doty, 21, a junior at UConn and former basketball and soccer star at Germantown Academy in Fort Washington, Pa.
On Sunday, UConn (34-1) will face its Big East rival Georgetown (24-10) for the third time this season in the semifinals of the Philadelphia Region. A year ago, Doty was a starter as the Huskies won a second consecutive N.C.A.A. title. Now, she can only watch.
“I told her the other day, ‘If we had you, we’d be undefeated,’ ” Coach Geno Auriemma said, referring to the end of UConn’s record 90-game winning streak last December at Stanford.
Doty was expected to run the team, providing an outside shooting threat, feeding Maya Moore, tutoring the freshman point guard Bria Hartley. Instead, Doty has rehabilitated the knee she injured last summer and has faced daily reminders why the acronym A.C.L. has become a four-letter word in women’s college basketball.
Shea Ralph, a UConn assistant and former star, has five times torn the ligament that stabilizes the knee and controls its pivoting. Michala Johnson, a freshman forward, tore an A.C.L. twice in high school, the peak years of vulnerability, experts said.
“A.C.L. injury rates sadly are staying the same across the country,” Dr. Thomas Trojian, a UConn team physician, wrote in an e-mail.
A number of possible risk factors have been identified in women: wider hips; ligament laxity at certain stages of the menstrual cycle; the smaller size of the notch through which the ligament connects to the femur in the upper leg; a tendency to land straight-legged and knock-kneed; core instability; a greater imbalance than men in the comparative strength of the hamstring to the quadriceps, or thigh muscle.
An improved surgical technique, called double bundling, uses two tendon grafts instead of one to resemble the normal A.C.L. There is a better (though not definitive) understanding today of what causes the ligament to tear, increased attention being paid to preventive techniques and a more consistent return by athletes to previous levels of activity.
Yet players who tear the ligament seem to be significantly more vulnerable to tearing it again in the same knee or the other one. And researchers have found troubling rates of osteoarthritis 10 to 15 years after an A.C.L. is torn. “This is more than a sports medicine problem,” said Dr. Edward Wojtys, the director of sports medicine at the University of Michigan. “It’s becoming a public health problem.”
A number of coaches and trainers have criticized youth development in sports, where far more attention is paid to winning and athletic skills than to injury prevention. Auriemma and other coaches also wonder whether girls are reinforcing poor biomechanical behavior by specializing in a sport too soon.
Jenny Moshak, the trainer for women’s basketball at Tennessee, said: “If we want to turn this situation from an epidemic to something else, we really need to hit the youth sports when they are in their motor-development phases. The habits they come in with are very difficult to change.”
Doty first tore her A.C.L. while playing soccer as a high school senior in the fall of 2007; when a teammate passed her the ball, she turned, and an opponent slid into her knee. On Jan. 27, 2009, during her freshman season at UConn, Doty drove for a layup against Syracuse and landed awkwardly, a typical way that women tear the ligament, often without making contact with another player.
Last August, while practicing one-on-one moves, Doty drove for a left-handed layup and felt her left knee shift when she landed. The A.C.L. was 80 percent torn, she said, and a third operation was required.
A cadaver tendon had been used for the second operation, Doty said, “and my body never really took it in; it never really healed, wasn’t really strong.” A graft from the patellar tendon in her right knee was used for the third operation, she said.
Some studies indicate that cadaver tendons used to reconstruct the knees of young, active athletes are up to four times more likely to fail than tendons grafted from their own bodies, said Trojian. The reason, in part, is that athletes often feel better more quickly after a cadaver graft and are more likely to return to full activity before their bodies and the graft have reached full strength, Trojian said.
After that third operation in late summer, Doty spent three months regaining range of motion in the knee, strength and neuromuscular control. At four months, she began running.
In the preseason, her teammates were given movement screenings and videotaped while performing a jump-landing test to determine whether any players were at increased risk of A.C.L. tears. Individual programs were designed to correct biomechanical faults. Essentially, when jumping and cutting, female players are taught to depend less on their quadriceps, which pulls the shinbone forward, tightens the A.C.L. and can create a shearing force. Men rely more on the hamstring, which provides an opposing force.
When landing, UConn players are taught by the trainer Rosemary Ragle to bend at the hips and knees to softly absorb the load, keeping their knees behind the toes, striking the ground toe to heel. The knee should be in a neutral position; ideally, Tennessee’s Moshak said, the center of the kneecap should be aligned with the second toe.
Amanda Kimball, UConn’s strength and conditioning coach, has designed warm-up drills before practices and games meant to prevent A.C.L. tears. Chris Dailey, UConn’s associate head coach, says players are taught that if they cannot pass the ball before a teammate reaches the opponent’s free-throw line on the fast break, not to attempt the play. This is to keep players from having to stop suddenly to avoid going out of bounds or to make a move that puts their bodies in an awkward position.
At this point, Doty is allowed to participate in noncontact basketball drills. She continues to increase strength, balance and neuromuscular control by performing one-legged bounding exercises and by standing on inflatable bladders and tilt boards while performing shooting, passing and ball-handling drills.
To break the monotony, UConn also uses Wii video games to enhance hand-eye coordination, strength, flexibility and balance. (While traveling, Tennessee’s players sometimes balance on one leg as elevators in the team hotel move up and down.)
In the summer, Doty expects to begin her full return to basketball. She will have two seasons of eligibility remaining. She has kept a buoyant public face, serving as a coach on the bench and making trick-shot videos that became popular on the Internet. But Auriemma can sense her disappointment, too, which is sometimes as visible as the scars on her knee.
“We still have a chance to win the national championship, but it won’t be the same because the look on her face if we win will make me feel bad,” Auriemma said.
Sometimes when she is alone, Doty asks herself about her rehabilitation: “Why am I still going through this? Why am I working so hard?”
The answer, she said, is: “I love basketball. I can’t see myself doing anything else.”
Date: March 26, 2011