MONROE - Darlington senior Cassidy Chambers hated having to sit on the bench while watching her team play in last year's WIAA regional basketball tournament. But after tearing her anterior cruciate ligament late last year, Chambers had little choice.

Fast forward a year: Chambers is one of the leaders of Darlington's team that is 18-6 and looking to help upset No. 1 ranked Cuba City in a WIAA Division 4 sectional semifinal in Monroe today, March 5.

"Now that I'm playing again, it (ACL injury) showed me that you can lose what you have quick," Chambers said. "It showed that I can't take basketball for granted."

For many years, a torn ACL served as a death sentence for a basketball player's season. But through advanced physical therapy regimens, the timetable to come back from an ACL injury is dwindling.

"It used to be a career-ending injury," said Eric Katzenberger, practice manager of sports medicine at Monroe Clinic. "Now days it's so common to have a torn ACL - they can be back on the court in four to six months."



Girls more susceptible

The ACL is one of four major ligaments in the knee. The American Academy of Orthopedic Surgeons and the National Athletic Trainers Association report there are 200,000 ACL injuries each year across the country.

Players in sports with a lot of sudden stops are especially at risk for an ACL injury. Katzenberger said the injury occurs most frequently when a player is jumping, cutting, pivoting and twisting and overextends the knee joint. The sports with the greatest number of ACL injuries include basketball, soccer and volleyball.

The injury has plagued local sports teams. Over the past two years, Monroe Clinic has treated more than 45 ACL injuries in athletes 18 and younger, Katzenberger said.

And young female athletes are especially at risk: The American Academy of Orthopedic Surgeons and the National Athletic Trainers Association estimate that girls are five to eight times more likely to tear their ACL than boys.

There are several factors that lead girls to be more susceptible to ACL injuries. Katzenberger said the No. 1 reason is that girls are anatomically structured different. The other factors Katzenberger pointed to are differences in girls' hormones and muscles.

And, there are more girls playing high school sports now than 10 or 20 years ago.

"Girls sports have become more popular," Katzenberger said. "As you add more girls into the mix, you are going to see more ACL tears."

Local incidents bear this out: There are at least eight female players who have had ACL injuries this year, or have had to battle back from injuries last spring.



Brodhead plagued by injuries

No team has been hit as hard as Brodhead girls basketball team, which has five players who have had to rehab from ACL injuries since spring 2012. That includes three starters - senior Taylor Douglas, senior Amanda Pickel and junior Carly Mohns. Mohns and Douglas missed the volleyball season this fall, but were able to make it back for basketball. However, their minutes were limited early on.

Brodhead coach Brad Pickett said the team has dealt with the rash of injuries.

"It's a stretch of bad luck," Pickett said. "We have dealt with it and hopefully we don't have to deal with it again any time soon. It's just one of those things that happens. You never want to see a kid get hurt, but I think it has made us stronger as a team because other kids have had to step up into different roles. We have had to deal with some adversity."

Brodhead senior Jenessa Arnsmeier tore her ACL Jan. 8 in a game against Big Foot. She had surgery conducted by Dr. Lance Sathoff at Monroe Clinic in February. Teammate Megan Olson suffered an ACL injury in summer basketball.

"It's hard, but I love my team," Arnsmeier said of having to sit on the bench to cheer on her team during the postseason. "They still make me feel like I'm part of the team. I want them to go far in the tournament."

When Pickel grabbed a rebound in a game earlier this season, she came down and said she heard a pop and tearing right away. She later learned her ACL was 30 percent torn, but she also had a torn meniscus. She didn't have ACL surgery, but she had her meniscus repaired and missed most of the season before returning to play against Palmyra-Eagle Feb. 8.

"I feel like I'm well enough to play and help my team," Pickel said. But, "I may not be as fast as I was before."

Other local players who have had ACL injuries this season include New Glarus senior Anya Schween and Albany senior Cassidy Bump. Darlington senior Storm Wiegel missed the football playoffs last year after tearing his ACL. Monroe senior Joe Latimer suffered an ACL injury and missed 16 days before coming back and scoring nine points in a sectional semifinal loss to DeForest.



Surgical options

The good news for athletes is that a torn ACL doesn't always require surgery.

Katzenberger said some players who have partial ACL tears can continue playing basketball as long as the knee is stable. ACL tears can be suffered in combination with medial collateral ligament tears or meniscus tears.

"If you have a partial tear, your knee could still be unstable and you could need surgery," Katzenberger said. "If your knee is stable you won't need surgery."

There are three types of surgical grafts doctors can use for ACL reconstruction including hamstring tendon, patellar tendon and cadaver grafts, Sathoff said. All three types of ACL out-patient surgeries are offered at Monroe Clinic. However, Katzenberger said 95 percent of the time, surgeons use the patellar tendon.

"It's considered the gold standard choice for the high school and college athlete because of it's durability," he said.

Not every patient is a candidate for a certain type of graft, Sathoff said.

He usually uses the patellar tendon in ACL reconstruction. The patellar tendon is the connecting tissue for the end of the quadriceps muscles. Most patellar tendons are about 30 mm wide, he said. The graft is harvested from an anterior incision on the knee, Sathoff said. The graft from the patellar tendon is taken from the middle third of the tissue, usually about 10 mm.

Sathoff said small pieces of bone are taken from both the patella and the tibia, resulting in a graft that has small bone plugs on each end.

"I think the fixation of those bones in that tunnel allows for the quickest recovery times," Sathoff said. "You get a strong graft when you are done."



Recovery the big hurdle

The recovery from an ACL injury is rigorous - Sathoff said the rehab time after an ACL injury is about four to six months.

"However, each case is unique," he said. "Some athletes take up to one year or more to return to pre-injury health. The surgery only lasts 1 to 1 1/2 hours. I always tell patients the hardest part is the rehab.

"The reason why people are getting back into sports quicker now than in the past is those physical therapy protocols," Sathoff said. "We know how far we can push a person in the advancement of therapy."

The physical therapy after an ACL surgery includes range-of-motion exercises by patients, leg stretches, leg presses and a continuous passive motion machine (CPM) that hospitals use to bend and straighten the knee to aid patients in getting the range of motion to return.

"There is a lot of healing time," Katzenberger said. "Swimming is an excellent rehab option. Not everyone does that. In water exercises you are more buoyant. There is less weight and strain on the joint during exercise."

For Arnsmeier, the biggest hurdle was overcoming the mental challenge of dealing with the injury.

"The first thing that was really hard was thinking that I was done," she said of playing basketball this season. "My mom and dad always tell me to keep my head up and I will be fine."

Chambers was anxious to play basketball after a long road back after surgery last year. She missed playing summer basketball with her teammates, but it gave her more time to strengthen her knee.

Chambers said physical therapy at times got frustrating, but it was worth it.

There is no sure-fire way to prevent the freak ACL injury from occurring.

Monroe Clinic offers an ACL prevention clinic called "Sports Metrics" each summer. Katzenberger said the clinic focuses on jumping training and improves an athletes' landing mechanics after a jump. Katzenberger said the clinic also improves speed, power and agility of athletes.

Athletes can build strength to make sure their hamstring and quad muscles are equally as strong, Sathoff said.

"The hamstring is usually weaker," he said. "You can do all the strengthening and get your knee in optimal shape ,and you can still tear your anterior cruciate ligament by coming down wrong."