Steph Sutherby took a couple of hard dribbles, darted toward the basket along the right baseline and launched a shot midst heavy traffic.
Landing from her sideways leap in the middle of the key, the Ipswich High girls basketball captain let out one big scream, fell to the floor and began writhing in pain.
The C. Elliot Roundy Gymnasium crowd, which just seconds before was as loud and spirited as you'll find at a local girls basketball game, fell library silent.
Everyone was thinking the same thing: torn ACL.
The anterior cruciate ligament (often referred to as ACL) is one of four major ligaments in the human knee, and it is the most common serious injury in sports — especially in female student-athletes.
In this particular case, the crowd's fears were put to rest when Sutherby rose to her feet and walked off the floor under her own power.
It's easy to understand the unrest created by Sutherby's fall, considering the Tiger point guard missed all of last season with a torn ACL in her right knee.
While Ipswich dodged the worst with Sutherby, they weren't so lucky last week when senior forward Lia Webb, who was enjoying the best season of her career (10 points and 8 rebounds per game), went down with a torn ACL in a Cape Ann League clash against Manchester Essex. Webb is out for the rest of the season and won't be able to play a spring sport, either.
"It's a devastating blow to our team," Ipswich coach Mandy Zegarowski said of losing Webb.
Fortunately for the Tigers, Sutherby is still around.
"I knew everyone probably had that fear," said Sutherby, who simply bumped knees with a Pentucket player after her shot. "After a while they must have known it wasn't (my ACL) because I wasn't screaming as loudly. It ended up being a bad bruise, but it scared some people."
Not the least of whom was Zegarowski, who knows more than most the pain and sorrow of dealing with ACL injuries from a coaching standpoint.
Since taking over the Ipswich girls program, Zegarowski has had to deal with torn ACLs every season.
Zegarowski and the Tigers lost Sutherby last year in the first game of the season. So when the senior guard hit the floor against Pentucket, the Ipswich coach and team doctor Hugh O'Flynn quickly stepped out onto the court to assess the situation.
"She did the Paul Pierce there: went down hard, then bounced up and ran around," said O'Flynn, an orthopedic surgeon who has seen countless ACL injuries. "I responded (last year) at North Reading when she went down, and (this instance) was the same way.
"I can walk out on the court or the field and know (if it's an ACL injury) in five seconds."
More often than not
Diagnosing ACL injuries takes little time. A quick test at the moment of injury can often show a torn ACL, but they are not usually confirmed until magnetic resonance imaging (often called an MRI) is conducted.
The hard part is preventing such injuries, especially in female athletes, who are thought to be eight times more likely than men to tear their ACL.
There are many theories why females suffer far more ACL tears than males, but they all seem to come back to simple anatomy.
"Girls are more knock-kneed because they have wider hips, and their ACLs are smaller and the notch where it runs is smaller," O'Flynn said. "Girls have less thigh muscle development also. Girls and boys are pretty much the same until they're 12 or 13 years old. Then boys get more muscles in their quadriceps and girls don't."
That leads to more stress on females' ACLs, and more injuries.
"I've had players come back to me after they've (torn an ACL) in another sport, but I've never had it in-season," Masconomet girls basketball coach Bob Romeo said. "I've never had to deal with it, but in the back of your mind you think it's inevitable at some point. You hold your breath when you see girls land awkwardly."
Romeo is clearly in the minority when it comes to ACL injuries. Most girls basketball coaches on the North Shore have dealt with an ACL injury at some point.
Beverly coach Matt Smith has seen at least one such injury in each of the last four years, and Peabody's Jane Heil dealt with three girls from her program blowing out knees in the fall last year.
It's widespread, but prevention is extremely difficult and maybe impossible.
Preventive measures not foolproof
The large knee brace commonly worn by players who are coming off ACL injuries isn't as protective as it may seem. Sometimes it is wrongly assumed that all players could wear those cumbersome braces to protect their knees at all times.
"I played football at Harvard and we were part of a study to see if the 80-hinged knee braces prevented ACL and ligament tears. It did not," O'Flynn said. "It lowered the extent and it was less severe. That's the idea of prophylactic braces — to still protect kids with ACL reconstruction — but realistically it doesn't help like you'd think it would. The force (involved in knee injuries) is so quick and the braces don't work at the same speed."
Other prevention methods are constantly being explored. One such method is specific training that is designed to strengthen the muscles that stabilize the knee.
Even that type of training is not foolproof.
The Ipswich girls soccer team adopted the PEP (Prevent injury and Enhance Performance) Program developed by the Santa Monica Orthopaedic and Sports Medicine Group this season. The series of stretching, strengthening and plyometric exercises may have helped some players, but clearly it did not help everyone.
"It's frustrating. A lot of it is trying to get women stronger and cross-trained more to limit exposures (to knee injuries)," O'Flynn said.
"Single-sport athletes and the intensity of AAU and club competition has made it difficult. Kids play four, six, eight games in a weekend and have that many more exposures, especially since their fatigue rates will be higher. (ACL injuries) lead to a litany of other troubles too."
