| By Dr. Charles Ruotolo

As is the case for any athlete, taking care of the body is one of the most important things for a competitive tennis player. This means having all muscles, tendons and ligaments loose and strong before taking the court to play. The knee is considered the most important body part for the mobile athlete and injured knees have far and away derailed more collegiate and professional careers than any other injury.

While tennis players may struggle with tendonitis in the knee (jumper’s knee) or meniscal tears, the injury that has become an epidemic to all athletes is the tearing of the anterior cruciate ligament (ACL). There has been a huge increase in the number of ACL reconstruction procedures in recent years, with more than 200,000 being performed in 2014 alone.

The ACL is one of the two cruciate, or “crossing,” ligaments in the center of the knee, and while small in length, roughly the size of the pinky finger, it plays an instrumental role in the process of stabilizing the knee. The ACL runs through the center of the knee connecting the thigh bone (femur) to the shin (tibia). When the ligament becomes torn it will cause the shin bone to slide forward in relation to the thigh bone. This abnormal motion can cause further injury to the meniscus and cartilage of the knee. Acute ACL tears typically are accompanied by a loud or audible pop followed by severe pain and swelling, which will immediately sideline any athlete.

All tennis players are aware that their success is tied to their ability to change direction quickly and move their body weight on a dime. Unfortunately, this is the exact action that results in so many ACL injuries. Fifty to seventy percent of ACL tears are caused by non-contact injuries of twisting or suddenly stopping. Some athletes are at a higher risk than others for these tears. In fact, female athletes have a higher risk for an ACL injury, and studies have shown females to be four to eight times more likely to sustain this injury as compared to male athletes playing the same sport.

Females have been known to be ligament dominant, meaning the knee ligament in their dominant leg are stressed more as the limb plants on the ground prior to muscle activation. At the same time, females are also quadriceps dominant, meaning that their quadriceps muscle is stronger than their hamstring muscles in their dominant leg, which can put unnecessary stress on the ACL. 

Utilizing the most current neuromuscular training program significantly reduces the risk of an ACL injury for females, down to that of their male counterparts. The cornerstone of this program would be the use of plyometric exercises and balance training.

One popular drill of the many featured in this extensive program, is a basic plyometric exercise called “hops.” To perform this exercise, lay an agility ladder out in a wide open space and stand at one end with your feet together. Slowly descend into a squatting position and hop down the length of the ladder. At first attempt, use both feet, being sure to touch each space along the way without skipping any. Once you get to the other end, jog back to the other side and repeat. As you become comfortable with the drill and become warmed-up, try skipping a space or jumping off one foot. The goal for this exercise is to spend very little time touching the floor with each movement, as is the case with all plyometric drills in the program.

These exercise programs do not only need to be applied to females and can be applied to all athletes playing cutting and pivoting sports such as soccer, basketball, and football. Professional athletes and teams across the country have developed similar training programs to be performed daily as part of a warm-up routine before practice or a training session.

Physicians focus on injury prevention for athletes of all ages and all sports. If surgery is necessary, a multidisciplinary approach can be used to create a treatment plan that focuses on the patient’s lifestyle and activities and helps them get back to those activities quickly and effectively.

Dr. Charles Ruotolo

<p>Dr. Charles Ruotolo is a Board-Certified Orthopedic Surgeon and the founder of Total Orthopedics and Sports Medicine with locations in Massapequa, East Meadow and the Bronx, N.Y. Dr. Ruotolo completed his orthopedic residency program at SUNY Stony Brook in 2000. After his residency, he underwent fellowship training in sports medicine and shoulder surgery at the prestigious Sports Clinic of Laguna Hills, Calif. He is also a fellow of the American Academy of Orthopedic Surgeons. As an Associate Master Instructor of Arthroscopy for the Arthroscopy Association of North America, Dr. Ruotolo actively teaches other orthopedic surgeons advanced arthroscopic skills in shoulder surgery. As an avid researcher he has also published multiple articles on shoulder injuries and shoulder surgery in the peer review journals of Arthroscopic Surgery and of Shoulder and Elbow Surgery. For more information, visit <a href="http://www.totalorthosportsmed.com" onclick="window.open(this.href, 'wwwtotalorthosportsmedcom', 'resizable=no,status=no,location=no,toolbar=no,menubar=no,fullscreen=no,scrollbars=no,dependent=no'); return false;">www.totalorthosportsmed.com</a>.</p>