2016-12-15 12:36:13 by Holly Pupino, Media Relations Specialist, as posted on the inside.akronchildrens.org blog.
Bethany Jewell, right, has already had surgery to repair the ACL in both knees.
As a freshman, Bethany Jewell has already distinguished herself as an up-and-coming leader on her United Local High School soccer team in Salem, Ohio.
She has been honing her skills since age 6 and also competes on a highly competitive club team, Keystone Premier.
But, at age 15, she has already had surgery to repair the anterior cruciate ligament (ACL) in both knees.
Painful, season-ending ACL injuries are up to 8 times more common in female athletes than their male counterparts. An ACL surgical repair requires at least 6 months of rest, intensive physical therapy, wearing a knee brace for a year, and a gradual return to play.
"Bethany's second ACL tear was like a bad joke," said her mother, Lori. "She had been released to play in January 2012 from her first ACL surgery and had fought so hard to come back. Even while injured, she never missed a practice or game. Then, in September, the right knee went. Bethany's dad and I took it very hard. I think, in fact, we were more devastated than Bethany because we know what this sport means to her."
In trying to explain the higher rates of ACL injuries for female athletes, theories have pointed to differences in bone structure and mechanics.
Girls tend to be more knock-kneed than boys and land jumps with their knees straighter and closer together. An additional consideration may be hormonal differences since ligaments are more lax during menstruation.
Dr. Kerwyn Jones
But, in a groundbreaking study, Dr. Kerwyn Jones, chairman of orthopedic surgery at Akron Children's (and Bethany's surgeon), found genes may explain the differences.
The study, presented at the annual meeting of the American Academy of Orthopedic Surgeons in March, identified differences in genetic material of ACL tissue of young men and women.
The research team, led by Dr. Jones and William Landis, PhD, the G. Stafford Whitby professor of polymer science at the University of Akron, obtained a biopsy of normally discarded, ruptured ACL tissue during surgery from 7 male and 7 female athletes. Biopsies underwent microscopic and gene microarray analysis.
The focus narrowed to 3 genes not found on the X- or Y-chromosomes. The differences in expression of each of these genes result in differences in their counterpart proteins. These proteins could significantly weaken the structure of the ligament in the female compared to male athletes.
"We were a bit surprised by the findings," said Dr. Jones. "We didn't anticipate the genes specific to the structure of ACL tissues could affect the strength and integrity of the ACL."
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