Anterior cruciate ligament (ACL) injuries are among the most common knee issues for adult and teen athletes.
“ACL tears happen primarily in athletes involved in cutting and pivoting sports like soccer, football and even basketball,” said Kiera Kingston, MD, Endeavor Health Swedish Hospital orthopaedic surgeon. “They’re typically non-contact injuries where the player plants their foot, turns and the knee gives out.”
Surgeons like Dr. Kingston see their share of ACL injuries in young skiers in the winter months, and while a fall or collision may be involved, the injury follows a similar mechanism with the knee buckling and the skier going down.
There are high rates of ACL injuries in both female and male athletes, though adolescent girls have different risk factors.
Females may be at higher risk than their male counterparts due to a smaller notch inside their knee and the fact that females tend to be more quadricep dominant, as opposed to strength balanced more evenly between quadricep muscles in the front of the thigh, and hamstring muscles in the back.
“There’s also some thinking that hormonal changes during the menstrual cycle may play a role in the higher injury rates,” Dr. Kingston said.
She shares some things to know about ACL injuries in teen athletes:
Prevention programs. While there is no one silver bullet to prevent all ACL injuries, there is a significant amount of research highlighting the importance of ACL prevention programs focusing on strengthening exercises and teaching good landing mechanisms as a way to help protect young athletes as much as possible.
“They won’t prevent all injuries, but it is important to incorporate these programs and we are hopeful that as more research is published and awareness is increased, more high schools and youth sports organizations will start implementing them,” said Dr. Kingston.
- Warning signs. ACL injuries tend to be dramatic and the athlete can feel or hear a pop that is often loud enough that others around them hear it too. Typically, they can’t and shouldn’t return to the game or practice as they often have difficulty bearing weight/walking on the injured leg. Very significant swelling can develop that day or the next day and any of these signs of injury should not be ignored, said Dr. Kingston.
- Consulting a doctor. “Don’t take knee swelling lightly as it is often a sign of an intra-articular injury like an ACL, meniscus or cartilage injury,” said Dr. Kingston who urges athletes and their parents to consult a sports medicine or orthopaedic specialist as soon as possible after a serious knee injury. A physical exam and an MRI will quickly reveal the diagnosis, which starts the ball rolling for the most efficient treatment and recovery. “Unfortunately, I’ve seen a fair number of patients where the swelling has gone away or gone unnoticed and they return to their sport, which sets them up for another buckling event that results in more injuries, which are often not as easy to treat,” said Dr Kingston.
- Surgery. ACL tears in teens and younger athletes almost always mean surgical reconstruction to help them regain stability in their knee. Surgery is especially critical for those who want to return to their sports that involve cutting or pivoting.
- Returning to sport. Unfortunately, the post-operative rehabilitation is a lengthy process and athletes need to wait 9-12 months before returning to their sport. “It’s really hard for young athletes to hear that,” said Dr. Kingston. “A lot of factors come into play, but the risk of retearing an ACL is up to 5-10% and repairing an ACL the second time is more complicated.”
