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1st Nov


Increased Occurrence of ACL Injuries: What We Need to Do

Anterior cruciate ligament tears, or ACL tears, are dreaded injuries, and unfortunately commonly occurring in many sports.  Recent data furthermore indicate that these injuries are dramatically increasing, especially in girls and women.  Kevin Wilks, D.P.T., F.A.P.T.A., a well known sports physical therapist in our field, just published an editorial, quoting released data showing an increase in ACL reconstructions from 86,687 in 1994, to 148,714 in 2013, a 58% increase.  The fastest-rising demographic to undergo such surgery during this period, is females younger than 20 years of age, especially high school-aged female athletes.

Several years back, I wrote about how, and potentially why females suffer these injuries so more often than men.  It has been reported that female athletes have a 4-7 fold increased risk of ACL injury, compared with male athletes.  Of interest is, that up until puberty, there is no significant difference between girls and boys when it comes to these injuries.  However, at the age of 12, there is a large rise in ACL injuries in females, with the peak of injuries occurring near the age of 16 in girls.

One proposed reason for this increase in ACL injuries in girls is muscular weakness, as the body grows, and the sports get more demanding.  Whereas boys during puberty demonstrate progressive increase in power, strength and coordination with chronological age, girls typically show little change throughout puberty.  Females also tend to often develop neuromuscular imbalances during this time, which has been shown to often persist well into the college years, making them more injury prone.

In sports that involve running, cutting and jumping, female athletes have also been shown to either land following jumps with the knee too straight, or show a “knock-knee” angle, or increased valgus angle of the knee, both typical results of poor coordination and/or strength. This can put the athlete at greater risk of tearing the ACL.

Another issue is that athletes who have had an ACL injury to one knee, are at greater risk of sustaining a second ACL injury, to the opposite knee, again the most common in females.  There could be many reasons for this, but Wilk theorized that it may be due to incomplete or inappropriate rehabilitation, premature return to sports or strenuous work activities or engaging in physical activities too advanced for the level of the person’s achieved recovery.  So, some of the responsibility here falls on the entire team: the athlete, coaches, parents, and rehabilitation team (physical therapists, physician, athletic trainer).

Yet another long-term complication following ACL injuries, is the increased risk of developing osteoarthritis in the injured knee later in life, whether you have surgery or not.  The data show that 61% to 74% of all patients undergoing ACL reconstruction will have x-ray evidence of osteoarthritis within 7-20 years.

Therefore, not only is sufficient and advanced rehabilitation important, but screening and prevention is of equal or greater importance, to reduce the risk of ACL injury.  I have written about studies showing great results in decreasing ACL injuries after preventive programs focusing on correcting movement patterns with running and jumping, combining plyometric and other power or strength training, balance training, multi-directional speed/agility training, and core strengthening, while focusing on performance enhancement.  This is especially effective if started already in pubertal athletes.

Please let us know if anyone you know could benefit from these described measures, and feel free to forward this letter.  Our free consultation offer can be used and don’t forget to view our past newsletters.

With best wishes for a healthy and injury free fall and winter,


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