Opinion

Another Critical Loss – star out with ACL injury

Today, the Queensland Firebirds reported the devastating news that star defender and Vice-Captain Tara Hinchliffe had ruptured her anterior cruciate ligament (ACL) during a training session last week.

This is the third ACL injury for the 2021 season so far for Suncorp Super Netball.

During a pre-season match, Sunshine Coast Lightning’s Ash Unie suffered the same injury after finally being elevated into the full-time squad.

Then, newly-blooded Diamond and GIANTS Netball starting goal attack Kiera Austin succumbed to the same fate during the opening round of the 2021 season in Adelaide.

GIANTS and Diamonds GA Kiera Austin moments after her ACL injury in Round 1 2021. Image GIANTS Netball

An ACL rupture has to be one of the most dreaded injuries in netball due to the often innocuous nature of the incident and long rehabilitation timeframe. For elite athletes, it almost always involves surgical repair.

Only one current player is known to have opted for conservative management following her ACL rupture, Northern Mystics and Silver Ferns defender Sulu Fitzpatrick in the ANZ Premiership.

Not only does the injury have an impact on the player’s season and career, but knee injuries and resultant surgical interventions also increase the risk of developing osteoarthritis later in life.

Mwai Kumwenda, Maddy Proud, Ingrid Colyer and Mahalia Cassidy clutching at their knees post-ACL rupture

Why is it so common?

Women are more likely to damage their ACL compared to men for a number of reasons.

Unfortunately due to the lack of elite men’s netball, a direct comparison for our sport can’t be made. However in basketball women are 3.5 times more likely to suffer an ACL injury, and 2.8 times more likely in soccer.

One of the key reasons is women have an increased risk due to their lower limb alignment.

Since women have wider hips than men, women are more likely to have a larger “Q-angle” (shown below), which during landing puts additional forces through the knee, placing more strain on the ACL and increasing it’s chances of “failing”.

The increased width of a women’s pelvis, and resultant impact on the angle of the thigh attributes to their increased ACL rupture risk. Image courtesy Washington Orthpaedics & Sports Medicine.

But why is this injury so common in netball?

There are many contributing factors to this but a study conducted by University of the Sunshine Coast reports that netball often appears in the top five sports associated with ACL injuries due to the repeated high impact loading put through the legs.

This study looked at video footage players from ANZ Championships (the now defunct trans-Tasman league) to analyse ACL injuries, what contributed to them, and how they could potentially be prevented.

Interestingly of the 16 injuries observed, 14 were suffered by players in the mid-court, with wing attack recording the most at 10.

The only non mid-courters to suffer the injury were both goal shooters.

The break down for the area of the court these injuries occurred in can be seen in the diagram below.

None of the 16 incidents were deemed to be contact induced, with half being non-contact and half being indirect contact (a perturbation in the air, not on landing).

Break Down of ACL Injuries by Court Area

Suncorp Super Netball and ACL injuries

Since the Suncorp Super Netball competition started in 2017, 17 players have injured their ACL across training, pre-season and game days.

Interestingly, 10 of these players are mid-courters, five shooters and two defenders.

Three mid-courters, Mahalia Cassidy, Madi Browne and Beth Cobden have been unfortunate enough to have repeat injuries, alongside shooter Cody Lange.

Cassidy is the only one to suffer both during her time in SSN, the others all had injuries from their ANZ Premiership or Vitality Netball Super League days.

Side Note: Ash Brazill also ruptured her ACL, but since it was during an AFLW match it won’t be counted in this instance.

This means in total there have been 18 ACL injuries since the inception of SSN (not including training partners), and 11 (65 per cent) to those in mid-court positions.

This is slightly under what the USC study reported, but such a small sample size is likely to see discrepancies.

The 18 players to suffer ACL injuries while contracted in the SSN

What does an ACL injury mean for players, other than close to 12 months out of the game?

After surgery athletes progress through a variety of rehabilitation phases focussing on the following

  • range of motion
  • strength
  • balance/proprioception
  • agility
  • sport specific activities

The rate at which an individual progresses through these stages varies, and should be determined by working closely with a qualified health professional such as a physiotherapist.

In netball, we tend to see a return to competitive match play between 9-12 months.

This is always preceded by significant amounts of sports specific training drills behind closed doors.

A lots goes into not only rehabbing from an ACL injury but also the injury in the first place.

Due to the high prevalence of ACL injuries in our sport, Netball Australia developed the KNEE Program, an on-court warm up designed to ‘enhance movement efficiency and prevent injury’.

Unfortunately we are going to continue seeing these injuries in our sport, but we can rest easy knowing they have access to incredible medical teams that will get them back on court, often stronger and more powerful than they were before.

By Georgia Doyle – Physiotherapist

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