You can't blame Geneva High School varsity girls basketball coach Sarah Meadows for being a little apprehensive these days when she hears these three letters spoken -- A, C, and L.
Located in the front portion of the knee, the anterior cruciate ligament controls the movement of the knee joint. Connecting the femur (thigh bone) to the tibia (leg bone), it acts to limit side-to-side motion and prevents the knee from straightening beyond its normal range of motion.
According to the American Orthopaedic Society for Sports Medicine, approximately 150,000 ACL injuries occur in the U.S. every year, accounting for $500-plus million in U.S. health care costs each year.
For Geneva girls basketball players, ACL injuries have been occurring at an alarming rate the past few years.
"We've had five in a little more than a year," said Meadows. "One parent came up to me the other night and said, 'it's like the Geneva plague.'"
In Geneva, perhaps a better acronym for ACL is Almost Cruel Luck.
Less than 20 minutes into her first varsity basketball practice 2 years ago, then-freshman Sidney Santos heard a loud pop while participating in a simple layup drill.
"I was on the floor crying," Santos recalled. "I couldn't walk because there was so much pain."
The diagnosis -- a torn ACL in her right knee -- which required surgery and forced her to watch the rest of the season from the bench.
Amazingly, the unthinkable took place for Santos a little more than a year ago.
"I was playing in a fall league game, made a jump-stop and heard the pop again," said Santos. "This time though, I walked off the court on my own. I was actually surprised when the MRI revealed another ACL tear (right knee)."
Last January, Sidney's older sister, Ashley, suffered a torn ACL (right knee) during the Vikings' victory over previously unbeaten Lincoln-Way East at the McDonald's Shootout in Villa Park.
"It has been so frustrating for our family," admitted Sidney, who is off to a -- knock on wood, please -- promising start this season for the 6-2 Vikings.
For the third consecutive year, the Vikings lost a player to injury before the season even began when senior Erin Kozlow suffered a torn ACL during a summer league game.
Two weeks ago, it happened again.
Junior starting point guard Michaela Loebel suffered what is believed to be yet another ACL tear by a Geneva player in the second quarter of the team's 57-52 loss to Crete-Monee at the Rachel Bach Memorial Tournament at Glenbard East.
"Initially, I heard a pop and felt sharp pain in the center of my (right) knee," said Loebel, who has received doctors' opinions of a torn ACL but awaited the official MRI readings earlier this week.
"At first, I thought I had dislocated my kneecap," added Loebel, who admittedly felt discomfort in her lower left hip earlier in the game. "I started putting a ton of weight on my right leg. I was getting back on defense and the girl crossed over (the dribble) on me when it (knee) just gave out."
The majority of Geneva's ACL injuries have been non-contact events, something substantiated by statistics from the American Academy of Orthopedic Surgeons that show 70 percent of ACL injuries happen through pivoting, cutting, sidestepping or awkward landings.
"Five of the six ACL injuries we've had were in non-contact situations," said Meadows. "There was a collision associated with Erin's but we're not sure if she got hurt right before the collision or not."
The fact that the ACL injuries have struck Geneva female athletes more than their male counterparts isn't a surprise.
According to the American Journal of Sports Medicine, ACL injury rates are 4 to 8 times higher in women than men, with the high school years being the peak of vulnerability.
The question then is why?
While there is no definitive answer, there appears to be several external and internal factors.
Some external factors include an athlete's coordination being disrupted just prior to landing or slowing down, the shoe-surface interface, wearing a knee brace, and/or the playing surface itself.
Internal factors include anatomical and hormonal differences between females and males.
For example, females may be predisposed to ACL injuries because they have a wider pelvis, an increased hamstring flexibility and/or foot pronation (flat-footed). In addition, estrogen levels may relax or allow stretching of the ACL which can then be compromised upon landing or sharp deceleration.
"Females have become so much more athletic," said Meadows. "They're working a lot harder and training more and more.
"Plus, the pace of the game (basketball) is so much faster today than it was when I played."
Whatever the case, the typical rehabilitation process for young athletes following ACL surgery takes between 6 months to a full year.
"My rehabilitation period has been the same each time -- around seven or eight months," said Sidney Santos. "But I handled it much better the second time. I was a complete wreck the first time because I didn't know what to expect."
While there's physical pain involved with the rehabilitation process, Santos feels it pales in comparison to the mental anguish.
"The mental part is the toughest part," she said. "It can be exhausting. There will be down days no matter how positive a person you are.
"Three months after the surgery, you're walking again and feeling fine. You want to start running and jumping but you keep being told by doctors and trainers that you can't do it yet. It starts getting frustrating but you have to remain patient."
Watching your teammates play can also test one's patience.
"Sitting and watching is very difficult," admits Santos. "You're watching games thinking, 'I could've gotten that rebound or made that shot.'"
Nevertheless, Santos feels that maintaining a positive attitude still plays an important role in the healing process, something she has passed on to both her older sister and teammates.
"Michaela is one of my best friends," said Santos. "She has one of the most positive attitudes I've ever seen. I've already told her that she'll be better because of this and that she'll come back stronger. I told her that 'I'll always be there for you.'"
Santos has gained a new perspective the past few years.
"I think you appreciate the sport you play a lot more," she said. "I know I won't take anything for granted."
Loebel, who also plays soccer, can lean on several friends for advice, including the Santos sisters and club soccer teammate Savanah Uveges of South Elgin.
"She tore her ACL back in June," Loebel said of Uveges.
Some preventative measures involve stretching before and after practices/games, and strengthening other parts of the body, including the hips and upper body.
"We've introduced weightlifting sessions during the season for the first time," said Meadows.
Even some former Geneva athletes haven't been immune to the ACL injury bug.
Ohio University sophomore guard Kat Yelle, one of the Vikings' all-time leading scorers, suffered a torn ACL during a game against Oklahoma last December.
Ashley Santos, now at Marquette, is now a medical redshirt after reinjuring her right knee recently.
"She partially tore her ACL again," said Sidney. "But now at least her knee will be at its strongest when she comes back next season."
You can reach Craig Brueske at firstname.lastname@example.org