Last March Rianna Jarrett made her senior international debut, earning her first cap coming on against Italy in the Cyprus Cup. Nine minutes later she was down holding her knee. This was the third time that she has felt this pain, this time, it is her left knee.

The incident occurred due to a direct blow to the side of her knee causing her Anterior Cruciate Ligament (ACL) to tear. The injury usually occurs when the knee is hit from the side while the foot is planted, when the knee bends back too far (hyper extends) or from quickly stopping and changing direction while running.

Jarrett, who plies her trade as a striker for Wexford Youths, suffered her first ACL tear to her right knee in April of 2013 during Youths’ Women’s National League campaign. After reconstructive surgery in June, Jarrett was back playing for her club in March. Then January of 2015 came around. Jarrett was called up to play in La Manga for a winter training camp with the International squad against Norway in a challenge game where she tore her ACL for the second time. She was back playing by October before the latest of her trilogy of ACL injuries.

Enda King, the head of performance at the Sports Surgery Clinic in Santry, Dublin, told the Irish Times that this is down to the movements required for field sports which put the knee at more risk. “The high risk positions are single leg landing and single leg change of direction… Cyclists, swimmers and track and field athletes are moving straight ahead; I can’t remember the last person I saw doing their ACL like that.”

Rianna doesn’t know why she has been so prone to ACL tears. “I think it’s been put down to being unlucky.” With strength tests deeming her strong enough to return to the game on both occasions, she doesn’t feel she went back into high performance competition too early.  An injury where 70 percent of tears involve no contact, it’s scary to think it could happen to anyone at any time during a game. “I definitely know more people that have torn their ACL in the last two or three years at least once… definitely more female than male. All the people I know that have suffered an ACL tear have all been non contact.” Jarrett added.

Rianna raises a good point. “…definitely more female than male.” A study in the American Journal of Sports Medicine compared 1140 athletes between the ages of 9-17. The results state that young female athletes are four to six times more likely to suffer a serious non-contact ACL injury while NIH Medline Plus state that women are between two and eight times more likely to rupture their ACL than men.

Jarrett in action for Wexford Youths.

Annie Stafford was competing at an elite level in athletics before her injury. She was ranked as the third best senior at 17 years of age. With county, provincial and national titles in long jump along with representing Ireland in the Celtic Games and the European Youth Championships finishing 7th out of over 30 countries, she was set up for a very successful future in the sport. Studying Physical Education and Biology in Dublin City University (DCU) Stafford was required to engage in PE practicals. “I was participating in a triple jump PE practical involving hard gymnastic mats in the DCU sports hall when I got injured. The technique for a triple jump involves a hop, skip and a jump. I performed the hop, but as I landed for the jump phase my knee twisted as my leg hyper extended resulting in a torn ACL.”

Explanations online say a wider pelvis, slower reflex time (a millisecond longer) and a smaller ACL can possibly cause women to be more prone to tears, but, for athletes like Jarrett and Stafford, none of that matters. Reaching that peak level of performance is the only thing on the mind of both women. Rianna has a sense of optimism about her recovery. “I’ve had it done twice before so I don’t see any reason why I can’t come back from it again.”, She said. Stafford has been less lucky with her recovery. It was only after constant, tedious rehab and adapting new exercises into her rehab did she begin to see progress. “Honestly, it is only now, two years post surgery that I can say I’m finally back to the same training level as what I was doing pre injury. This is the first athletic season in which my knee hasn’t caused any interruptions so I’m hoping by outdoor season, 2017, I will be close if not back to the same level I was at before I tore my ACL.”

So, is there actually a rise in ACL treatment in recent years? An American Journal of Sports Medicine report from 2014 found that there was a steady increase of ACL reconstructions performed in New York State (Chosen database surveyed) over the past 20 years from 17.6/100,000 in 1990 to 50.9/100,000 in 2009. Clear proof that the injury is on the rise. Well, it’s not as simple as that.

Ray Moran, an orthopaedic surgeon in the SSC in Santry has performed hundreds of ACL surgeries including Dublin footballer Ciaran Kilkenny’s reconstruction in 2014 after his injury against Kildare during a league game in Croke Park. Mr Moran told the Irish Times that there is no definitive answer whether ACL injuries are becoming more common as there is no concrete data from the past to compare with. “If you go back 20 or 30 years you have a situation where the MRI scan was only coming into its own. If you go back about 40 years and you got a rotational injury to a knee… it was assumed to be cartilage.” He said. “I still see patients today in their 50s and 60s who have ruptured their ACL and don’t know it.”

Dr Ray Moran, has performed hundreds of ACL surgeries

Enda King, mentioned earlier, is completing his PhD on 3D Biomechanics in Return to Play decision making after ACL treatment. King believes prevention is possible for the somewhat random yet catastrophic injury. He believes ACL injuries that occur through contact are unavoidable; however, non-contact injuries can be prevented by “improving movement and lower body strength.”

Sports Health: A multidisciplinary Approach, found that there are four ways to reduce the risk of ACL damage; leg and core strength training, balance and speed training, better coaching on jump and landing, and better footwear. If steps aren’t taken by leading sports organisations to help solve this problem, more and more athletes are going to find themselves on the end of a quick turn and a snap and months of rehabilitation.

Andrew Byrne