Every year, thousands of athletes tear their ACL. But, in recent years, that number is becoming more made up of female athletes.
For Westminster soccer player Kaelynn Puhalla, the journey from torn ACL to recovery took nine months.
"I never felt it either time. I never felt it pop or heard it pop or anything. It just moved, and it didn't feel right," Puhalla said.
Puhalla, who suffered two separate injuries to her knee, said she feared her career would be over. Having played since she was five-years-old, the injury was crushing.
But Dr. Patrick Riley, Jr., Puhalla's surgeon says she'll play again.
But come next season, Puhalla will likely be replaced by yet another female athlete with a torn ACL.
"Unfortunately, we have recognized that females, especially, high school and college-aged female athletes, are at a significantly increased risk of ACL tears than their male counterparts," Dr. RIley explained. "Depending on what we're reading between two and eight times the risk of ACL tear than their male counterparts."
Part of the problem comes down to female anatomy.
"The pelvis. A woman's pelvis is a little bit wider than a males, and so that can put the legs at a little bit of knock-kneed angle, the knees at a bit of a more knock-kneed angle, and it puts more stress on the ACL," Dr. Riley said. "We've also identified that inside, the anatomy of the inside of the knees, can be a bit different and put more stress on the ACL."
"Also, neuromuscular control, which is just a fancy way of saying women, and girls jump different than males and boys. Jump different. Cut and pivot differently. And so we've identified some problems there."
While the issue of anatomy can be combatted through training, there are other issues.
"Research done at Akron Children's, we've looked at ACL tissue from girls and boys, and actually the ACL is made up with a little bit different genetic components to it," Dr. Riley said.
Also, the popularity of female sports is likely a cause for the increase in ACL tears in girls.
"Probably it's just the vast majority. There are so many girls in sports now. Twenty to 25 years ago there weren't as many girls playing these high-risk cutting and pivoting sports," Dr. Riley said.
Where students are playing can also cause issues with the majority of high school and collegiate athletic programs turning to turf fields.
"We do see an increased risk of ACL tears on certain types of turf," he explained. "The turf can tend to be super grippy, to the point where it doesn't give the way grass does. And so if the turf is too grippy and doesn't give away, a lot of the force that normally would give through the grass, may travel up through the knee and give out through the knee." Dr. Riley said.
And while the risk for ACL tears has always been there, Dr. Riley said student-athletes are no more likely than ever to suffer a second or third ACL tear.
"Before, 20-25 years ago, if you had an ACL tear it was like you had a blow, you blew out your knee, you're probably done. I had a good career; I was a high school football player. I blew out my knee; I'm done. Now we're getting people back on the field. And now we're going back to the scene of the crime, so maybe they are getting reinjured because 20-25 years ago they weren't getting back to the sport at all," he said.
And while female ACL tears are most likely in soccer and basketball, Dr. Riley said he has seen them in just about every sport imaginable.
However, there are prevention programs that coaches and trainers can use to make sure female athletes are taught how to run, jump, and pivot properly for the way the female body is shaped.
"They're relatively new, but already we've seen a decline in girls with ACL tears," he said.
And while Kaelyn is headed back to the field, she's hoping other girls who tear their ACL will find the same strength that's kept her going.
"Just stick to it, even when it gets hard. Life gets hard sometimes, and you just have to show them you can overcome it," she said.