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Four reasons for rising ACL tears and other knee injuries

Two girls help their soccer teammate off of a field after a knee injury. Robert Trasolini, MD, explains why ACL tears are rising among youth and collegiate athletes.

Skeletal immaturity, sports science and increasing recurrence have all contributed to ACL tears spiking among teenage athletes

It seems as if every other day we hear about a notable professional athlete who will be shelved for significant time after tearing their anterior cruciate ligament (ACL).

These are professional athletes, who by trade are in prime condition to endure the wear and tear of their sport. But what happens to youngsters, teenagers and collegiate athletes who are also pushing their limits? They are just as susceptible — if not even more so — to endure a significant knee injury.

When you tear an ACL, your knee feels unstable and may give out when attempting to make a cut or pivot to another position. More than 100,000 ACL reconstructions are performed in the US each year. The injury has skyrocketed among 14-18 year olds, increasing by 147.8 percent over the last 10 years, and increasing 2.3 percent annually, according to the American Academy of Pediatrics.

The varying reasons are below. Some are preventable and some are not.

1. Skeletal immaturity and decreased knee strength

How and when children play youth sports has changed. Long gone are the days of playing multiple sports to keep you busy. Instead, there is more pressure on these young student athletes to develop specific skills in one given sport, forcing them to play all year round. The fear is that if you don't constantly develop these skills, you will not be able to obtain a scholarship or play at a higher level. It’s created a problem because those participating in just one activity sustain more trauma on the same muscles and joints. Their bodies are just not fully developed and are not strong enough to withstand the impact.

As children age and mature, the demand increases to become bigger, faster and stronger. This is good as long as they are exercising properly, otherwise it leads to more injuries and a quicker burnout rate.

2. Need for more sports science

Injury prevention training is critical given the intensity of sport, especially for those between ages 8-23 playing the same game all year. Athletes need to properly prepare for high-intensity activity well before taking the field.

Sports performance facilities that focus on injury prevention have popped up at various locations throughout the country. These are promising, considering they can assist in teaching appropriate stretching and exercises.

Without valuable training, there will be a breaking point and an onslaught of injuries. Exercise-based learning and strength training will ultimately decrease knee and ACL injuries.

3. Escalating recurrence

ACL reconstruction techniques have evolved during the past 50 years, especially with arthroscopy and single-incision procedures gaining popularity. While ACL tears are one of the most common knee injuries, recurrence still happens for 25-33 percent of young, active individuals, according to recent data presented at the American Orthopaedic Society for Sports Medicine’s Annual Meeting.

There’s also growing evidence of higher rates of new ACL injuries and other new knee injuries among female soccer players who had ACL surgery, spotlighting the importance of individualized rehabilitation, and adequate healing time, which is usually nine months.

Recurrence may be due to returning to the field too quickly. It’s important to follow the post-op workout regimen, see your surgeon/physician, rehab and eat right (nutrition plays a huge role in all recovery). These will help avoid re-injury.

4. Lack of knee injury prevention

Good technique. Training and conditioning year-round. These are the secrets to preventing all injuries, not just knee and ACL tears. Learning how to properly stretch and exercise will go a long way for those recovering from surgery and preventing the injury in the first place.

Sports-specific mobility exercises are a new wave of preparation for athletes. Also used by the US Armed Forces to teach explosiveness, these workouts can certainly translate to the field, even after surgery.

Rest is another significant factor. After strength-building exercises, you need enough time to regain equilibrium and develop lactic acid in the muscle. Without adequate rest, proper nutrition and hydration, athletes will regress and cause injury.

Robert Trasolini, MD, is an orthopedic surgeon at Northwell Health Physician Partners Orthopaedic Institute at Smithtown. He has served as assistant team physician for the Harvard University Athletics, the Boston Celtics, Merrimack women’s hockey and the Boston Cannons Major League Lacrosse team.