ACL Injuries in Teen Athletes

ACL injuries are common in girls soccer.
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ACL (anterior cruciate ligament) injuries of the knee are no longer seen only in adults. More and more teenage athletes are showing up in the emergency rooms with torn ACLs, and a large percentage of those injured are young female athletes.

How Is the ACL Injured?

The ACL, along with the PCL (posterior cruciate ligament) is one of the major ligaments that help stabilize the knee joint. The ACL is most often stretched or torn by a sudden twisting motion while the feet remain planted. The majority of ACL injuries occur when an athlete misses a landing from a jump, pivots quickly while changing direction, or decelerates abruptly. These movements may cause the ACL to stretch to the point of tearing.

Teens at Risk

There's a growing number of ACL injuries in young athletes who play sports such as soccer, basketball, and volleyball. Physicians speculate that part of the reason for the increase in ACL injuries may be related to the year-round sports training that many teens are doing. Playing sports constantly with no time off, playing multiple sports or playing field and court sports that emphasize quick starts, stops, and pivots make teen athletes more susceptible to ACL tears. The risk is particularly high among athletes who play soccer, football, volleyball, or basketball.

ACL Injury Prevention Programs for Teens

However, teens who participate in ACL prevention programs may greatly reduce their risk of an injury. These prevention programs are becoming more popular in youth sports and generally include exercises to help strengthen muscles and improve faulty movement patterns in teens. Multiple studies have demonstrated the effectiveness of ACL injury prevention programs.

This 15-Minute Prevention Program 

These prevention programs are made up of training drills that emphasize balance, power, and agility. Plyometric exercises and balance drills help improve neuromuscular conditioning and reaction time and may decrease the risk of ACL injury. Many coaches use an ACL conditioning program, especially for their female players, as a basic part of sports practice. These programs should include the following phases:

More Tips for Preventing ACL Injuries 

  • Coaches and trainers should help the teen athletes learn proper body mechanics and move with good alignment to protect the knees. This includes drills to teach proper jumping and landing, accelerating and decelerating with the knees directly over their feet and not angling inward.
  • Teen athletes who have poor alignment should be tested for muscle weakness or imbalance. Strengthening programs should be designed to correct any weaknesses.
  • Teen athletes should be required to complete a thorough warm-up before all practices and games.
  • Teen athletes should perform the six phases of the ACL prevention program 2-3 times per week during the preseason until proper movement patterns and body alignment is consistently demonstrated.
  • Teen athletes should be encouraged to take a break from sports during the year or perform some cross-training that emphasizes different movement patterns. For example, a teen who plays on the soccer team may benefit from cycling or swimming in the off-season. This will help prevent overuse injuries, which can also lead to ACL tears.
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Article Sources

  1. Renstrom P, Ljungqvist A, Arendt E, et al. Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med. 2008;42(6):394-412. doi:10.1136/bjsm.2008.048934

  2. Evans J, Nielson Jl. Anterior Cruciate Ligament (ACL) Knee Injuries. [Updated 2019 Mar 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. 

  3. Trivedi V, Mishra P, Verma D. Pediatric ACL Injuries: A Review of Current Concepts. Open Orthop J. 2017;11:378-388. doi:10.2174/1874325001711010378

  4. Gokeler A, Seil R, Kerkhoffs G, Verhagen E. A novel approach to enhance ACL injury prevention programs. J Exp Orthop. 2018;5(1):22. doi:10.1186/s40634-018-0137-5

Additional Reading

  • American Academy of Orthopaedic Surgeons. Three Studies Examine Causes, Prevention of ACL Injuries in Women. News Item, February 26, 2005.

  • American Journal of Sports Medicine. A Randomized Controlled Trial to Prevent Noncontact Anterior Cruciate Ligament Injury in Female Collegiate Soccer Players. Gilchrist J, Mandelbaum BR, Melancon H, Ryan GW, Silvers HJ, Griffin LY, Watanabe DS, Dick RW, Dvorak J. 2008 Aug; 36(8):1476-83.

  • Santa Monica Orthopaedic and Sports Medicine Research Foundation, ACL Injury Prevention Project.