By Neil Schmidt
The Cincinnati Enquirer

Erica Hallman, Kentucky's reigning Miss Basketball, has heard the statistics about knee injuries in females. So the Holmes High grad, a freshman guard at Kansas, wasn't stunned when she tore her ACL three weeks ago.

"It comes with the territory," she said. "You never know what's going to happen when you step out there."

One can look at the studies, including one of NCAA basketball players in which women suffered 3‡ times the number of ACL tears as did men, and know why women would worry. (In soccer, it was a 2‡-to-1 ratio.)

Or one can find a correlation just through anecdotal evidence. Four of the past five Miss Basketball winners in Kentucky have had knee surgeries - Beth Vice, the 1998 winner, blew out both ACLs - and the one who hasn't, Jody Sizemore (1999), has missed two seasons in college because of shin splints. The last three such winners from Northern Kentucky - Hallman, Katie Schwegmann and Jaime Walz - all tore ACLs.

ACL tears in women have become what Dr. Angelo Colosimo, director of sports medicine at the University of Cincinnati Medical Center, terms "epidemic."

"Depending on the study, you'll see even 7-to-1 or 10-to-1 (ratios) for ACL tears compared to men," he said.

Said Dr. S. Michael Lawhon, another leading Cincinnati orthopedic surgeon: "We started looking, and most of your major colleges were losing one player a year to an ACL injury in (women's) basketball."

Orthopedists have hunted for reasons over the past decade. The key conclusion is that there are physiological differences that make females more susceptible to such injuries.

Girls tend to have more ligament laxity and flexibility than boys, which may contribute to greater incidents of sprains and other types of injuries to the joints in female athletes.

Also, females almost always have wider hips than men, thus creating a different lower-extremity alignment. That puts an added strain on knee compartments, ligaments and muscles.

But doctors say preventive measures can be taken to offset some of the biological differences.

One of those changes recommended is getting female athletes involved in weight training to strengthen other leg muscles. In particular, hamstrings often are underdeveloped in relation to quadriceps muscles.

"What's needed is early training in balance, landing and sports-specific skills," said Dr. Mary Lloyd Ireland of Lexington, a leading expert in injuries to female athletes.

Said Colosimo: "Are we getting to the girls too late? When kids are growing up, the boys are given balls and the girls are given dolls. Because of that, they're lagging behind in that coordination as they get into sports."

Hallman, who tore 90 percent of the ACL in her right knee, will need surgery after the season. But her knee is stable with a brace on and she expects to play this season, perhaps without missing a game.

"I just have to be careful," she said. "After you do this once, it's never the same."

E-mail nschmidt@enquirer.com