By Dr. Andrew D. Pearle
I can always tell when school sports are back in full swing by the steady stream of athletes who limp into my office with torn ACLs. Every year, I have to tell heartbroken players that they’ll have to spend the rest of their season on the bench. Sadly, these conversations are becoming more frequent: The number of high school athletes who suffered ACL tears increased 26% between 2007 and 2022.
The incidence of torn ACLs has increased with the growth of youth sports. Kids are playing at younger ages and year-round. They’re training harder.
Yet we haven’t matched this growth with an investment in injury prevention.
Most ACL ruptures occur when an athlete moves in a way that involves a change of direction, like dodging another player or landing after a jump. Agility-based sports — like soccer, football, and basketball — have higher rates. Girls experience ACL tears up to eight times more frequently than boys. High school girls playing year-round soccer have the highest risk of all — an alarming 16% to 18% chance of rupturing an ACL.
Knee injuries are not an inevitable part of playing sports. Decades of research have shown that targeted exercises to improve agility-based body control can reduce the risk of ACL tears and other knee injuries by 50% to 80%.
As an orthopedic surgeon at the Hospital for Special Surgery, I work with hundreds of professional athletes to prevent ACL tears using neuromuscular training programs, or NMT. Younger athletes can also benefit from these techniques.
NMT trains athletes to stay in control of their bodies when rapidly changing directions. It teaches them to plant and move explosively and safely, keep their balance when landing jumps, and decelerate, stop, and start with proper body mechanics. They require no special equipment; a typical regimen can be completed in just 30 minutes a week in the space of a yoga mat.
In one study, regular practice reduced all injuries by one-third. The NFL and NBA have incorporated neuromuscular training into their workout programs.
Yet few high school athletes are trained in the method. The result has been an epidemic of knee injuries.
Each year, surgeons perform about 350,000 ACL reconstructions. But surgery is only a first step. Many athletes will never return to the field. Rehab typically takes a year, and half of those who tear their ACLs will develop early-onset arthritis within five to 15 years. These athletes are at greater risk of re-tearing their ACLs — and are seven times more likely to need knee replacements.
Sports leagues have long mandated protective equipment like helmets, pads, and shin guards. Now it’s time for them to adopt the same attitude toward the prevention of torn knee ligaments.
I hate having to tell young athletes that their season is over — and that their dreams of playing competitive sports may be, too. We have an effective way to keep them out of the operating room and on the playing field. Let’s use it.
Dr. Andrew D. Pearle is the Chief of Sports Medicine at the Hospital for Special Surgery in New York. This piece originally ran in The Detroit News.
