An ounce of prevention is worth a pound of cure when it comes to tears of the anterior cruciate ligament, say two certified athletic trainers affiliated with Allegheny General Hospital, who've adapted a rehabilitation program they developed into a prevention program.

The Post-Gazette described in a story May 28 how young athletes -- girls in particular -- have been suffering from tears of the anterior cruciate ligament, a rubber band-like fiber that attaches to the femur in the upper leg and the tibia in the lower and stabilizes the knee.

ACL tears are painful. Surgery is required to repair them, and it typically takes eight to nine months after surgery before an athlete can return to the sport he or she was playing.

ACL injuries can be particularly devastating to children, because the typical repair operation involves drilling through the growth plate, which can keep the leg bone from developing normally.

The long-term effects of an ACL tear in an adolescent are largely unknown. "What do we know about the effect of an ACL tear 50 years from now?" asked Dr. Patrick DeMeo, director of the division of sports medicine at AGH and medical director of the Pittsburgh Pirates. "We've only been fixing them for about 20."

Craig Castor, 36, will begin next Monday at the Greentree SportsPlex a six-week class in how to reduce the likelihood that you or your child will suffer an ACL injury. The program is designed chiefly for middle school students and high school students, but athletes (even of the weekend variety) of all ages are welcome.

The program Mr. Castor is teaching was developed chiefly by his friend, Eric Cardwell, 36, who has a master's degree from California University of Pennsylvania and has been with AGH for 12 years. Based in part on research conducted at the University of Cincinnati, he developed the program to speed the rehabilitation of injured athletes at North Hills High School, where Mr. Cardwell assists with the football team.

Ed Reith, 18, of Ross tore his ACL on a kickoff during the second game of his junior year. He'll be playing running back at Grove City College next fall, in large part because of the program Mr. Cardwell devised.

"It's probably the best thing I could have done," Ed said of the three months he spent working with Mr. Cardwell.

The Cardwell/Castor program emphasizes proprioception, the body's awareness of its position in space. It also emphasizes strengthening the muscles around the ACL.

"The hamstring is really important in rehabilitation," Mr. Cardwell said. "It acts as a decelerator for the knee."

When he works out in the weight room now, Ed said he is conscious of strengthening the muscles that will reduce the likelihood of another ACL injury.

"Most of the guys my age in the weight room emphasize the mirror muscles," Ed said. "I spend a lot more [time] on my legs."

Girls who've been through Mr. Cardwell's program -- it's also been offered to volleyball players at Hampton High School and Bethel Park High School -- have shown substantial increases in their vertical jump, he said.

Dan Glatz, 39, who is both a physical therapist and a certified athletic trainer, conducts a similar rehab program at Performance Unlimited, his firm in Evans City.

Ben Balzer, 16, a nose guard at North Allegheny High School, tore his ACL last year. He came to Mr. Glatz after seven months of physical therapy at Tri-State Physical Therapy.

"When I first came here, he had me running," Ben said of Mr. Glatz. He told me, 'I know exactly how you got here.' "

There isn't much that can be done to prevent ACL tears that occur as a result of a collision, Mr. Glatz said. But ACL tears that don't occur as a result of contact almost always are the result of improper body position.

"I was a lot more lopsided than I thought I was," said offensive lineman Pat Lynch, 17, of Franklin Park, another patient of Mr. Glatz. "I've relearned how to run."

Grace Emmerling, 16, another patient of Mr. Glatz, tore her ACL playing soccer. Her injury was the result of a collision, but she had to relearn how to run, too.

"When you get an injury like this, you get a lot of compensation movements," she said.

"You want to focus on hip control, hamstring strength, knee position and abdominal strength," Mr. Glatz said.

About 70 percent of all ACL tears are noncontact injuries, said Dr. Timothy Sell, coordinator of the Neuromuscular Research Laboratory at the University of Pittsburgh Medical Center's Sports Medicine facility.

UPMC developed an ACL tear prevention program in 2006, but is not currently offering classes.

"If a high school coach or trainer is interested, I'd be happy to send them -- for free -- a copy of the program and the videotapes we made," Dr. Sell said.

The rehabilitation programs designed by Mr. Cardwell and Mr. Glatz are designed to fill the void between the customary three to four months of physical therapy after surgery, and the eight to nine months after injury before the athlete can safely return to his or her sport.

"We work on regaining motion and getting the swelling down," said Josh Lenthall, a physical therapist at Panther Physical Therapy in McCandless. "We use ice, electric stimulation, compression, elevation, a little bit of manual stimulation."

And gentle exercise, as much as it is safe for the patient to attempt.

But, Mr. Lenthall cautioned, "there is only so much we can do here. We've only got about 50 feet in which people can jog."

Mr. Lenthall said he often recommends Mr. Glatz to athletes who are completing the physical rehabilitation program at Panther.

"You've got to be careful about who you pick," Mr. Lenthall said. "For some of these trainers, there is little or no certification. But everyone I've known who's gone to see [Mr. Glatz] is real pleased with what he has done."

The rehab program Mr. Cardwell devised customarily takes 12 weeks. But the prevention program based on it can be taught in six, Mr. Castor said, "because since these kids aren't hurt, you can start on a higher level."

The ACL injury prevention program will meet Mondays and Thursdays from 6 to 7 p.m. beginning June 30. The cost per person for the 12-week program is $150. For more information, contact the Greentree Sports-Plex at 412-922-1818, or Craig Castor at 412-225-4510.