Izzy’s Story: Returning from a Torn ACL

Contributor: Elizabeth Matzkin, MD

Nov 1, 2023

10 minute read

One high school girls soccer player, with a ponytail and headband dressed in a red team jersey and socks with grey and orange soccer cleats, plays against an opposing high school girls soccer player who is dressed in a white team jersey shirt, navy blue shorts with white trim, white socks, and orange cleats during a match; the soccer ball is on the ground between both players on the pitch

When 17-year-old Izzy Graziano collapsed on the soccer pitch in April 2023, her mother Kathleen assumed the worst. Izzy had sprinted down field and prepared to pass the ball across her body. It was a routine play; one Kathleen had seen her daughter complete countless times in worse conditions.

But Izzy never met the ball. With no other player in sight, Izzy’s knee buckled, and the rest of her body tumbled.

“Oh my gosh, she just tore her ACL,” Kathleen, of Norfolk, Massachusetts, remembers thinking to herself on the sideline.

Days later, an MRI confirmed the worst. The injury devastated Izzy, who was competing at college showcases and preparing to play her senior year of high school soccer. Her focus immediately shifted to surgery and grasping the reality of her lost season.

Izzy is one of thousands of high school athletes each year who tear their ACLs, or anterior cruciate ligaments. Elizabeth Matzkin, MD, co-leader of Mass General Brigham Women’s Sports Medicine, feels the heartbreak of each ACL patient she sees. She is a mother of three girls, each of whom played competitive high school sports.

Girls like Izzy, Dr. Matzkin insists, want to regain more than the ability to walk and run; they want to play at an elite level again. It took one conversation at Mass General Brigham Healthcare Center in Foxborough for Kathleen to trust Dr. Matzkin with writing her daughter’s comeback story.

“I asked her how many times a month she reconstructs an ACL,” says Kathleen. “When she said, ‘sometimes upwards of 4 to 5 times a week,’ I knew we had come to the right place.”

Tearing an ACL

ACL injuries are common. The ACL connects the thigh and shin bones so neither slides past the other. Without the ligament, the knee feels unstable when it twists, turns, or pivots.

ACL tears occur most often from non-contact injuries as opposed to collisions. An athlete might plant their foot and twist their leg inward too quickly, or they might hyperextend their leg. The knee often swells immediately, or shortly after, a tear, and the pain varies from person-to-person.

Females tear their ACLs at a much higher rate than males. Anatomy and muscle strength help explain why. According to Dr. Matzkin, females have wider pelvises and less quadriceps, hamstring, and gluteal muscle development compared to males.

“If you can imagine an athlete jumping off a 2-foot box, they’re supposed to land with their knees bent, shoulder-width apart and facing forward,” Dr. Matzkin explains. “Female athletes tend to land with their knees knocked inward. This places more stress on the ACL, making it more likely to tear.”

“I won’t let my final memory on a soccer field be of my coach helping me off it. Thanks to Dr. Matzkin, I know I will be back competing soon.”

Izzy Graziano
Mass General Brigham Sports Medicine Patient

ACL reconstruction

Torn ACLs do not heal on their own. A surgeon must reconstruct the ligament.

In rare instances, an athlete might forgo surgery and wear a functional ACL brace. Unfortunately, younger athletes often damage the cartilage padding between the thigh and shin bones during an ACL tear. This padding, called the meniscus, prevents both bones from rubbing against each other. Meniscal tears and cartilage damage can lead to osteoarthritis later in life.

“Life goes on fine without an ACL if you’re doing things in a straight line, like riding a bike or going for a walk,” says Dr. Matzkin. “But if you’re playing a sport with a lot of stop-and-go, you’re going to need surgery to provide stability and protect your knee from long-term damage.”

Surgeons can reconstruct ACLs using different tendons from the patient. They take these tendons, often called an ACL graft, from the quadriceps tendon, hamstring tendon, or patellar tendon.

Regardless of which tendons the surgeons use, the graft must be strong enough to support an athlete’s frame.

Minimally invasive ACL surgery

Decades ago, athletes considered a torn ACL a career-ending injury. Today, thanks to minimally invasive procedures and savvy grafting techniques, athletes can expect to return to the field 8 or more months after their surgery.

Before scheduling surgery, Dr. Matzkin meets with patients and parents to discuss their preference for a graft. Younger female athletes may have smaller tendons compared to older high school or collegiate athletes. Each type of graft has its pros and cons, which can vary by patient and by the sport they play. Dr. Matzkin allows each patient to choose the right path forward.

Izzy, who had a history of hamstring injuries, chose her quadriceps tendon for the ACL graft. During surgery, Dr. Matzkin used three tiny incisions and an arthroscope (miniature camera) to tunnel the graft from the bottom of the thigh bone (femur) to the top of the shin (tibia).

Dr. Matzkin ended the operation with an extra precaution. She added an additional graft called a lateral extra articular tenodesis (LET) next to the new ACL. The innovative technique provides extra stability to the knee and helps reduce the likelihood of the ACL retearing.

“Dr. Matzkin explained to us that [the LET] is essentially a seatbelt they place on the knee to reduce the likelihood of a future retear,” says Kathleen. “For us, it was a no-brainer.”

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Recovering from ACL surgery

Weeks after surgery, Izzy watched her club soccer team play for a national championship in Ohio from a live stream at home. She kept her leg still and straight on her couch, even as she cheered on her teammates hundreds of miles away. When the final whistle blew and her team stormed the field to celebrate their victory, Izzy could feel the full weight of the injury crash over her.

The excitement of a championship faded to a deep sob in moments. Izzy couldn’t help but think of the road ahead. She wondered whether she would ever return to the national stage she had helped lead her team to before her injury.

After undergoing surgery in June, Izzy couldn’t run for 4 months. She could exercise on a stationary bike, however, and began seeing a physical therapist at Dr. Matzkin’s office shortly after the injury.

Twice a week, Izzy traveled to Foxborough, where the Mass General Brigham Sports Medicine team helped reestablish range of motion in her knee. Her physical therapist Alex Neal, DPT, OCS, tailored her workouts to the amount of pain and swelling in her knee. Together, Alex and Izzy wrote goals for each day, week, and month. Whenever Izzy hit a setback, Alex shared his notes with Dr. Matzkin to strategize a new path forward.

Slowly but surely, Izzy’s knee regained enough movement and strength for her to jog on the treadmill by October 2023.

“I bawled my eyes out once I started running,” says Izzy. “I was so excited to get back to that moment, and I just remember saying to myself, ‘Yes, I can do this!’”

Protecting a repaired ACL and mental health

An athlete sits up halfway on a medical examination table during physical therapy as a doctor, who is seated, checks her left knee — Alex Neal, DPT, OCS, (right) evaluating Izzy’s knee.

Izzy expects to return to the soccer field in March 2024. This winter, she hopes to take a major step forward by returning to her high school’s track and field team, through which she had previously competed at the national level. Until then, Dr. Matzkin continues to check in on her progress. During each visit, she not only asks about Izzy’s knee, but her mental health.

“She knows how badly I want to return,” says Izzy. “But she also wants to make sure I’m taking care of more than just my knee, especially when deciding on my plans after high school.”

According to Dr. Matzkin, high school athletes often experience what she describes as a heightened fear of re-injury prior to their return to contact sports. Dr. Matzkin refers these athletes to the Sports Psychology Program at Massachusetts General Hospital. The program offers specialized care to athletes struggling to cope with anxiety and depression related to major injuries.

Teaching female athletes how to protect their knees can help alleviate anxiety and prevent re-injury, too. Dr. Matzkin cautions athletes to strengthen and condition several key muscle groups above the knee prior to their return. These muscles include the hip flexors, quadriceps, hamstrings, and abductors.

Each week, Izzy feels her knee returning closer to full strength. The thought of playing in a national championship for her club team this spring motivates her to push past the occasional ache and pain.

“I won’t let my final memory on a soccer field be of my coach helping me off it,” she says. “Thanks to Dr. Matzkin, I know I will be back competing soon.”

Learn how female athletes can avoid ACL injuries

Contributor

Elizabeth Matzkin, MD

Sports Medicine Surgeon

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