By Peggy O'Farrell
The Cincinnati Enquirer

INFOGRAPHIC

Volleyball, soccer and basketball make women and girls especially vulnerable to knee injuries, especially tears of the anterior cruciate ligament (ACL). • PDF infographic of ACL

RELATED STORIES

• Risk factors for women • How does the knee work? • Warm-up exercises protect the knee

It's amazing what Jody Jenike can tell about an athletic woman's knees just from watching her jump off a box.

Does the athlete land on both feet? Are her knees turned inward or out as she jumps? Is her body centered over her knees or thrust forward? Does she wobble as she lands, or is she in control?

All of those factors tell Jenike, Xavier University's head athletic trainer, whether a woman's at greater risk for an ACL (anterior cruciate ligament) injury.

Nationally, researchers and athletic trainers such as Jenike are working to identify which women are most at-risk for knee injuries and to design training programs to help prevent those injuries.

"You're not going to change everything about a kid," Jenike says. "You're not going to change the way God put their hips in the socket and all of those little things, but we can increase their flexibility and their quad strength and make a difference that way."

Depending on her sport and her age, a woman is two to nine times more likely than a man to suffer a knee injury, says Dr. Robert Burger, team physician for Xavier and an orthopedic surgeon with Beacon Orthopaedics and Sports Medicine.

An intense program focusing on building muscle strength, balance and flexibility while improving body control can cut a woman's chances of blowing out her knee, experts say.

Dr. Tim Hewett, a physiologist and director of the Sports Medicine Biodynamics Center at Cincinnati Children's Hospital Medical Center, recently developed a model that predicts which women are likely to suffer knee injuries. The model predicts injuries with 90 percent accuracy. Hewett will present the study this week to the Academy of Orthopaedic Surgeons at its annual meeting in San Francisco.

For the study, Hewett and colleagues followed hundreds of female athletes from around Greater Cincinnati to see which muscles and ligaments they used as they performed various drills and movements.

"First you have to figure out who is at high risk in order to prevent injuries and try to intervene with training," Hewett says. "We think if you get to these kids early enough, you can do a lot to prevent knee injuries.

"Before puberty, there's no difference in girls and boys on how often they tear their ACL. After puberty, there's this big difference, this five- or 10-fold differential, in how often the ACL is torn," Hewett says.

Boys get proportionately stronger as they get taller during their teenage growth spurts, he says. Girls don't. But weight training can help build and balance muscle strength.

Dr. Frank Noyes, an orthopedic surgeon at Cincinnati Sportsmedicine, has been studying and doing research on women's knee injuries for years. He has developed Sportsmetrics, an intensive training program aimed at reducing knee injuries.

With the training, girls and women learn the right way to jump, to land, to pivot and to stop in their different sports to reduce the stress on their vulnerable ACLs.

The trainers at Xavier use a similar program, enlisting the aid of physical therapist and strength coaches, Jenike says.

Screening girls in middle school and high school could give athletes an early enough start to prevent many knee injuries, Hewett and Noyes say.

Carmen Quatman, now 23, was a senior at Anderson High School when she tore her ACL while playing volleyball in 1999.

She says she knew as soon as her feet hit the floor and she felt a series of "pops" in her knee what had happened. Her twin sister, Catherine, had suffered the same injury a few years earlier.

"Once my sister hurt her knee, I knew it was a matter of when, not if, I'd be injured," Quatman says.

After three surgeries, her knee is healthy again. She won a volleyball scholarship to attend Edinboro University of Pennsylvania, and now plays and coaches recreational leagues.

Quatman's experience inspired her to go to medical school. She'll start classes in the fall, and she plans to specialize in sports medicine.

She works as an intern at Cincinnati Children's with Hewett. "We didn't work on prevention when I was in school," she says. "It's exciting to see there's ways to prevent it."

E-mail pofarrell@enquirer.com