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Rate of young athletes needing ACL surgery has risen 400% in 10 years

Doctors are recording huge increases in pre-teens needing surgery for ACL injuries.

After one clinic in Philadelphia said rates are up 400 percent in the last 10 years, surgeons all over the country have been chiming in, saying the same, and a study shows a 148-percent increase in Australian teens with ACL injuries over the same time period.

Injuries to the ACL (anterior cruciate ligament), which connects the knee bones and provides stability, are common among professional athletes and marathon runners, who spend nearly all their time practicing the same sport, putting the same, repetitive strain on their bodies.

While pubescent girls have always had a high risk of ACL injuries, at a time of growth and change, surgeons say the rate is climbing well above average. 

Doctors say it seems rates are rising among children because of pressures to excel in their sport of choice earlier in life, demanding more intense, year-round practice.

Among high schoolers, girls account for a significant proportion of ACL injuries, particularly girls who play soccer, since most ACL injuries come from repetitive strain or twisting, rather than being hit or tackled by another player (file image)


An ACL injury is a tear or sprain in the anterior cruciate ligament (ACL).

The injury usually occurs during sport that involves sudden stops, change in direction, and jumping and landing, such as football or basketball.

ACL tears are common among young athletes, with 200,000 injuries occurring every year in the US, according to the journal The Physician and Sports medicine. 

The injury’s prevalence in the UK is unknown. 

Many people hear a ‘pop’ coming from their knee when the injury occurs.  

Other symptoms may include:

  • Severe pain and an inability to move the joint
  • Rapid swelling
  • Feeling of instability or ‘giving way’ with weight bearing 

ACL injuries are more common in women due to differences in anatomy, muscle strength and hormonal fluctuations.

Poor-fitting shoes; poorly maintained equipment, such as skis; and playing on artificial turf also increases the risk. 

ACL injuries raise a person’s risk of developing osteoarthritis of the knee, even if they have surgery to reconstruct the ligament. 

Depending on the severity of the injury, treatment may involve rest and rehabilitation exercises.

This includes:

  • Rest
  • Ice – every two hours for 20 minutes while the patient is awake
  • Compression – a wrap or band around the knee
  • Elevation – lay down with the knee propped up on pillows

In severe cases, surgery to replace the torn ligament with a segment of tendon may be required. 

Source: Mayo Clinic 

‘There is a lot of pressure in the select world to play one sport, year round, and you get a lot of repetitive trauma and use the same muscles over and over and your more prone to injuries in general,’ Dr David Gray, director of orthopedics at Cook Children’s Hospital in Fort Worth, Texas, told NBC. 

The ACL is one of four ligaments in the knee. 

It stabilizes the knee when it rotates, connecting the thigh bone to the shin.

If it tears, it often means surgery.  

Puberty increases the risk of ACL injuries, too, from the age of 12 for girls and 14 for boys. 

Boys, however, tend to be slightly protected from injury because they naturally develop more muscle power than teen girls, creating more stability for their joints. 

Among high schoolers, girls account for a significant proportion of ACL injuries, particularly girls who play soccer, since most ACL injuries come from repetitive strain or twisting, rather than being hit or tackled by another player.

It means they are more likely to require surgery. 

However, doctors often recommended postponing surgery as long as possible to allow the bone to grow to its fullest extent, to prevent growth plate injury.

According to the Bone and Joint Initiative USA, ‘there is an increasing incidence of ACL injuries in kids and teenagers. This is because more kids and teenagers are playing competitive sports at a high level at a younger age.’  

Dr Gray told NBC one solution is to maintain variety in a child’s sports schedule.

‘One of the things we’d like to see is children play more than one sport,’ Dr Gray said. 

‘There should be some breaks and you have different activities, so you’re using different muscles.’ 

The Bone and Joint Initiative says more needs to be done to understand how teen girls use their muscles differently to teen boys, since girls are more often affected.

We should be analyzing ‘how girls (and all females) use the muscles in their legs during sports and how they land from jumps,’ a team of orthopedic surgeons said in a press release for Bone and Joint Action Week. 

‘Females naturally land from jumps with their legs straight, at both the hip and knee,’ which, they say, puts ‘more stress on the ACL.’


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