Izzy Orlando drove down the sideline to attack the basket, like she’s done hundreds of times before. It was business as usual – until she went to jump.

“It was just instant pain. It hurt so badly, I actually thought that I broke my leg at first, and I couldn’t look down,” she said. “I didn’t even make it into the air, I just collapsed.”

It was a torn anterior cruciate ligament, a knee injury that has sidelined the Freeport High junior for the entire season.

Orlando is one of at least six girls’ basketball players in southern and central Maine who are out for the year after suffering torn ACLs either on the court or in other sports. At least eight other girls’ basketball players began this season after tearing an ACL last year.

Dangers involving the anterior cruciate ligament, which creates stability within the knee, are found in sports such as football, soccer and basketball that feature constant jumping, landing, cutting and twisting. The road to recovery after an ACL tear is long, tedious and draining.

And female athletes are at higher risk. Dr. Ian Patten, a sports medicine surgeon for Maine General Health, said they are “three times more likely” to tear their ACLs than male athletes. Doctors say some of the reasons for this disparity include the anatomical structure of the female knee, as well as female athletes being “more quadriceps dominant” than males.

In high school athletics, ACL tears accounted for an average of 28.6% of knee injuries for girls over the last 10 years compared to 20.3% for boys, according to the Datalys Center’s National High School Sports-Related Injury Surveillance Study. In basketball, knee injuries made up 18.7% of total girls’ basketball injuries over the past decade compared to 11.7% for boys, according to that same study.

One of those athletes is Cheverus junior guard Rachel Feeley, who jumped for a rebound, came down on another player’s foot and felt her knee give out during a game against Scarborough in January 2023.

“I had no clue what it was in the beginning,” she said. “I had only heard of ACL tears in football. I didn’t know it could happen to a women’s basketball player, but I found out it’s more likely to happen to women than men.”

Orlando suffered her injury during a club basketball game in October. She immediately knew something was wrong.

“I started panicking and I started freaking out, saying ‘My whole high school season’s over,’ ” said Orlando, who also tore her meniscus in three spots and partially tore her medial collateral ligament, or MCL. “When I first heard (the diagnosis), I was just completely overwhelmed with pain. … After I was sitting in the hospital for a little bit, that (fact) set in and I was more grieving the loss of the season.”

COACHES NOTICE AN INCREASE

Jeannine Paradis started coaching girls’ basketball in 1997. Now the head coach at Biddeford High, she said ACL tears have become more common than early in her career.

“In the past, there might be just one (girl) in your league that’s out with an ACL injury; now, you’re seeing four or five,” Paradis said. “You’re seeing more ACLs versus ankles. Back in my day, it was always ankles. You always had a sprained ankle. … You saw a lot more ankle braces versus knee braces.”

Julie Petrie, the Mt. Ararat High girls’ basketball coach, said she’s seen a similar trend.

“Unfortunately, this is an injury that we keep seeing more of in the basketball world,” she said.

Patten, the surgeon with Maine General Health, said he has seen an increase in the number of ACL tears among female athletes – in large part because there are more girls and women participating in sports. He cited statistics from the National Federation of State High School Associations that show the number of girls taking part in high school sports across the nation rose from 2 million in 1992-93 to 3.3 million in 2022-23.

“The general rate of tear is the same,” said Patten, who is also the physician for sports teams at Lawrence High in Fairfield. “The overall number is more because there are more participants.”

Dr. Robert Parisien, an orthopedic sports medicine surgeon at Mount Sinai in New York, also said that the number of ACL tears has been on the rise.

“We are (seeing more), and we think that’s likely related partly due to the increased participation in ACL-risky sports,” said Parisien, a Biddeford native who won the Fitzpatrick Trophy in 1998 as Maine’s best senior in high school football. “Female participation in athletics has increased and continues to increase. That’s stemming from Title IX way back in 1972 but has still been increasing in the last few years.”

Parisien said rising athleticism in girls’ and women’s sports – leading to athletes who run faster, jump higher and cut more sharply – doesn’t necessarily lead to a higher frequency of ACL injuries.

“That’s hard to say,” he said. “That’s also increasing your muscle strength and lumbar musculature … (which is) also what we use to decrease our risk (of injury).”

MEDICAL REASONS VARY

One of the reasons doctors point to is the anatomical structure of the female knee, which can leave the ligament in a more vulnerable state.

“The part of the knee where the ACL resides, we call it the notch of the knee, is a little bit more narrow in females,” Parisien said. “Having a narrow notch does increase your risk for an ACL rupture.”

Parisien said the structure of lower body in girls and women lends itself to more frequent ACL tears as well.

“Females have a larger quadriceps angle by about 5 to 7 degrees compared to males,” he said. “That means their hip is a bit wider than their knee, so that points to a valgus angle, kind of a knock-kneed angle. … That can increase, as well, the risk of an ACL (tear).”

Parisien added that girls and women who play sports are “more quadriceps dominant” than males, which can tax the anterior cruciate ligament. Male athletes rely more on their hamstrings when landing and cutting.

“The main function of the ACL prevents the tibia from moving forward in relation to the knee … and it also stops the twisting and pivoting of the knee,” he said. “When you’re quad dominant, the quads actually are pulling on the tibia moving forward. The hamstrings help to hold the shin bone back.”

Patten said female bodies have more “laxity,” which can cause them to bend and flex more, thereby putting the ACL under more strain.

“As they’re potentially going through that pivoting motion that causes the injury, men … can resist that last, final (motion),” he said. “Having that dynamic stabilization confers them maybe not having an ACL tear, whereas the female athlete, it might give way because there’s a little more play and give to their knee to begin with.”

As the science has revealed risk factors, emphasis has turned towards keeping the injuries from occurring. Injury prevention programs, according to Parisien, can be up to 90% effective in reducing ACL injuries.

“These are mostly focused on neuromuscular and proprioceptive treatment, (meaning) training muscles, and it’s also landing biomechanics,” he said. “When females land … they land in more of a valgus moment, and that’s more knock-kneed. When males land, they land straight. That’s part of the injury prevention program, working on landing mechanics.”

UP TO A YEAR OF RECOVERY

Recovering from an ACL tear often is a lonely and arduous process that can take six to 12 months.

“No one else gets it. They’re not living it,” said Gorham High junior guard Vanessa Walker, who’s back this year and starting for the Rams after tearing her left ACL and meniscus in December 2022. “(They say), ‘It’s only nine months,’ but (it’s) a full nine months of your life to not be moving around like you normally could. I was a 16-year-old girl. I wanted to be able to move.”

Walker had her surgery Jan. 20, 2023, and was on crutches for six to eight weeks. Her physical therapy started two weeks after the surgery and consisted of everything from practicing walking to retrain the atrophied muscles, to leg presses and deadlifts to build up strength.

“You have to learn how to walk. They tell you to put your heel down, then put your toe down. They take you through that,” said Walker, who did 60- to 90-minute sessions twice a week for nine months. “You have to be motivated enough to go through your exercises every single day. I don’t think people understand that part. It’s every single day. You have to do it on your own, not just at PT.”

Feeley, now a starter for undefeated Cheverus, recalled sessions filled with squats, lunges, stationary bike riding and leg curls with a yoga ball.

“I was definitely like, ‘This sucks,’ in the beginning. I was like, ‘I don’t want to do this.’ But then I realized that if I didn’t do it, I wouldn’t be coming back,” she said. “It was very hard because I had to learn to do these things again. My leg just wasn’t strong after the surgery, so I had to gain the muscle back and know how to do it again.”

At Freeport High, Orlando is five weeks post-op after undergoing surgery on Dec. 26. She underwent a different surgery called a BEAR procedure, which uses an implant to repair the ACL as opposed to a grafted tendon. Because of the procedure, Orlando said she was told not to bend her leg for two weeks, then not bend it past 45 degrees for two more.

“I have to remember when to flex my quad and when to straighten my leg and when to bend it when I walk, or else I’ll walk in a limp,” she said. “It’s going to be really hard to start new, but I know that I have to. And to get back to where I was before, I’m willing to do anything.”

‘IT WAS GRUELING’

One recovery is taking place as the high school basketball season is heading toward its postseason tournament. Oxford Hills senior Tristen Derenburger suspects she tore her left ACL during a field hockey game her sophomore year, but she was unaware of the damage until it was revealed after she also tore her meniscus while twisting her knee at home last spring.

Her surgery to repair her knee was in July, and she missed the field hockey season while she was going through the laborious rehab of ACL recovery.

“At some points, it’s really frustrating. But as soon as something locks in in your mind and you’re able to accomplish it, it’s like a breath of fresh air,” she said. “Like losing my crutches (or) being able to do a single-leg, 6-inch jump. The smallest things would mean so much.”

Derenburger had a goal in mind. A sharp-shooting guard and key contributor to Oxford Hills’ championship run last winter, Derenburger attacked her rehab in order to try to make it back before the end of the season.

She was successful; she returned to practice Jan. 19 and made her return to game action Friday. That timeline, she said, helped keep her focused and prevented her from slipping into a recovery funk.

“It was grueling. Just the fear of, ‘Will I make it back? What’s going to happen when I try to run? Am I going to do it in a quick time, or am I going to keep failing and failing and failing?’ ” she said. “It’s definitely more of a mental challenge. … Just to hear there is light at the end of the tunnel played a huge role.”

That fear doesn’t always fade away by the time an athlete is cleared. Walker, at Gorham, said she’s “still struggling” with concern towards re-injury, and that she panicked when she hyperextended her knee in a game this December.

“When I go up for a rebound, I’m like, ‘That could have been bad, be careful next time,’ ” she said. “That’s the battle I’m fighting.”

Derenburger said she’s had those same thoughts but makes sure to fight them off.

“There’s always a sense of doubt,” she said. “But when you’re playing, you can’t play scared. Your risk of re-tear if you play scared is a lot higher, so you have to go in there fully trusting your body to do what’s right.”

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