ACL injuries are on the rise, but can they be prevented?

Anterior cruciate ligament (ACL) tears are serious knee injuries, accounting for over 14% of all injuries in teen athletes and nearly 4% professional athletes. The ACL is a critical ligament that stabilizes the knee, particularly during cutting and pivoting activities. For athletes participating in high-intensity sports involving sudden stops and changes in direction, the ACL is at a higher risk for injury. These injuries –– which can affect athletes at all levels –– are most common in sports involving agility and abrupt turns, such as football, soccer, basketball, and skiing.  

The number of ACL tears has increased among athletes in recent decades, says Garwin Chin, MD, an orthopedic sports medicine specialist at Loma Linda University Health. He says the reasons behind the increase vary but may represent increased activity among patients and a greater desire to lead an active lifestyle.

As ACL injuries become increasingly common among young athletes, Chin shares valuable advice on reducing the risk of these injuries.

How ACL injuries happen

When someone injures their ACL, often athletes feel a pop in the knee followed by immediate pain and swelling. The majority of ACL tears are non-contact injuries that occur when landing or planting the foot during rapid direction changes. The torque across the knee can overcome the strength of the ACL, which causes it to tear. 

When an ACL tears — often seen in dramatic injuries during live professional sports — it typically prevents the athlete from continuing to play, often requiring assistance to leave the field.

Soon after the injury, the knee can become stiff due to swelling and pain, making movement uncomfortable. Most ACL tears require surgery, followed by a 9-12 month recovery period. However, Chin says that pre-surgery rehabilitation is sometimes necessary for restoring range of motion and preparing the patient to achieve the best possible outcome from ACL surgery.

It is important to evaluate each athlete individually by understanding their mechanism of injury, chosen sport, and athletic goals. A thorough physical exam is vital to understanding the injury followed by corroboration with an MRI scan. 

“Even if an MRI suggests a partial tear, it is frequently treated as a full tear,” Chin says. “More often than not, when imaging suggests a partial tear, the ACL is completely torn and nowhere to be found during surgery.” 

Can ACL tears be prevented?

ACL tears cannot be entirely prevented, but the risk can be significantly reduced with a combination of training in neuromuscular control, strengthening, plyometrics, and education. Chin explains the following methods to help protect the ACL.

Neuromuscular control: Jumping and landing properly can reduce the risk of ACL tears. Landing ‘softly’ –– knees and hips flexed, knees facing forward and aligned with the shoulders and over the toes –– will reduce stress on the ACL. The technique should be practiced and incorporated into an athlete's workout for the best results. 

Strength training: Strength training, especially hamstring strengthening and recruitment, can reduce stress on the ACL and serve as a counterbalance for athletes who are more quadricep dominant. Additionally, strengthening the gluteal and core muscles allows for better control and stability. 

Plyometrics: High-intensity drills working on footwork and explosive maneuvers should be practiced with a focus on maintaining proper form and mechanics. 

Education: Learning about the ACL and proper techniques for injury prevention provides athletes with the awareness to protect themselves. 

Treatment and recovery

Surgery is often recommended for younger, active individuals to prevent serious future complications. “In teenagers and young adults, it is vital to reconstruct the ACL to prevent accelerated degeneration of the knee,” Chin says. “When ACL tears go untreated, it can lead to arthritis, chronic pain, and the potential need for an early knee replacement.”

Surgical options must take into account the type of tissue used for ACL reconstruction. 

Patients may choose their own tissue or donor tissue. Younger patients typically benefit from using their own tissue to mitigate the risk of re-injury.

Following surgery, Chin warns that rehabilitation is a lengthy but crucial process that requires a lot of commitment to regain strength and mobility. An ACL tear is a serious injury that often requires an athlete to miss an entire year of activity, but surgery and rehab make it possible to get back to the same level of sport.

“There are many professional athletes who have had ACL tears and surgeries who are still competing at the professional level,” Chin says. “After an ACL injury, surgery and rehab are meant to get athletes back to playing their sport.”

For more information on ACL tears and other sport-related injuries, call 909-558-2808 or visit our website here.