DEAR DRS. DONOHUE AND ROACH: I have five children: two boys and three girls. All are athletic. The boys played football and basketball. They never had a single injury in four years of high school. Two girls were gymnasts. Both had knee problems. One had to be operated on because of a torn ligament in her knee. The youngest girl is following in their footsteps. How can she protect her knees? Is there something about the female knee? — G.K.

ANSWER: There is something about the female knee. The female pelvis is wider than the male pelvis, most likely to accommodate infant delivery. The consequence of this structural difference results in the female hips being apart at a greater distance than are the male hips. That, in turn, puts stress on the female knee and the ligaments that hold the knee in place.

A torn anterior cruciate ligament is a common female injury. The anterior cruciate ligament keeps the lower leg bone, the tibia, in line with the thigh bone, the femur. Without this ligament, which some liken to a car’s seat belt, the tibia would slide forward. It stabilizes the knee. Female gymnasts and soccer players are the ones most prone to tear the ligament. The injury doesn’t come about from colliding with other players or the ground; it comes about when the athlete makes twisting movements or cuts to the side while running.

A torn anterior cruciate ligament has a poor blood supply, so it doesn’t heal well. Repairing the ligament involves taking a piece of tissue from a tendon — the kneecap tendon is often chosen — and fashioning a ligament from it. After surgery, four to six months of physical therapy are prescribed to keep the new ligament strong and tear-resistant.

Some people choose not to have surgery. If a person doesn’t engage in strenuous physical activities, that’s an option. These people require extended physical therapy. They manage pretty well without surgical correction. The choice of surgery or physical therapy only is a matter that should be discussed with the orthopedic surgeon. He or she can guide the injured person’s decision.

Your youngest daughter needs a program of leg-muscle strengthening to prevent this sort of injury.

DEAR DRS. DONOHUE AND ROACH: I am 88 and in good condition, except for one problem — my balance. I haven’t fallen, but I worry about falling. Do you have any exercises to improve balance? — R.M.

ANSWER: Balance depends on a complex coordination of input coming from the ear’s balance organ, the eyes’ interpretation of the terrain and sensors in the legs and feet. Balance is not as good in older ages as it once was.

A simple balance exercise is heel-to-toe walking. When taking a step, put the heel of one foot in front of the toes of the other foot. Keep walking in this manner for at least a couple of minutes. If it makes you wobble, get a partner who can steady you.

DEAR DRS. DONOHUE AND ROACH: What’s a MET? I am interested in the science behind exercise, and this term keeps popping up. — S.O.

ANSWER: A “MET” is a “metabolic equivalent.” It quantifies the energy cost of exercises. It gives a more precise estimate of energy expenditure than do calories.

One MET is the amount of energy expended when sitting quietly in a chair. It’s based on the amount of oxygen consumed during the activity. A MET equals 3.5 ml of oxygen consumed per kilogram of body weight per minute.

One to three METs is light exercise; three to six METs are moderate exercise; METs greater than six indicate vigorous exercise.

If you’re more comfortable using calories, do so.

READERS: You can obtain a copy of the hepatitis booklet by writing: Dr. Donohue — No. 503, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475 or email ToYourGoodHealth@med.cornell.edu with medical questions. Readers also may order health newsletters from www.rbmamall.com.

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