By CHRISTOPHER JONES, MD
Anterior Cruciate Ligament (ACL) injuries can cause devastating problems for young athletes. Approximately 150,000 ACL injuries occur annually in young athletes, and the number is increasing yearly.
An ACL injury requires several months of rehabilitation and can even cause lowered academic performance and long-term disability from arthritis of the knee. With the fall sports season approaching, it is important for providers, parents and kids to understand that many of these injuries might be preventable.
Why do ACL injuries occur in kids?
Most ACL tears do not occur from player-to-player contact. In fact, most ACL tears occur from a non-contact injury to the knee. The most common causes are change of direction or cutting maneuvers combined with sudden stopping, landing awkwardly from a jump, or pivoting with the knee nearly fully straight when the foot is planted on the ground.
Female athletes have a higher risk than male athletes, and this is felt to be due to several factors, including a more knock-kneed position, decreased hamstring strength, and improper landing technique.
How can an ACL injury be prevented?
Simple measures can reduce the risk of an ACL tear.
- Balance and body awareness are key – Improving balance and strengthening of the muscles of the feet, ankles, legs, knees, and hips can prevent unnatural twists of the knee that can cause an ACL tear. It is critical to develop body awareness, strength, and balance to support the knees and ankles. Always jump, land, stop, and move with the knees directly over the feet. Do NOT let the knees collapse inward. By performing a variety of drills until the movement patterns are second nature, athletes can avoid injury. The following is typically advised in any athlete:
- Chest high and over the knees
- Bend from the hips and knees
- Knees over the toes
- Toes straight forward
- Land like a feather
- Strength training – Weight training in kids has often been thought to cause stunted growth. This is a myth! Studies actually show that strength training in children is a good way to improve muscle control, balance, and will help advance them as an athlete. Weakened muscles around the knee can make athletes more susceptible to ACL tears and other injuries. Strength training that targets the ACL and the other musculoskeletal components of the knee such as squats, walking lunges, and exercises focusing on core strength can prevent ACL injuries. High-intensity jumping and plyometric exercises that strengthen the quadriceps and hamstrings of the thigh can also be helpful.
- Warm up and stretch – Warming up prior to intense activity will loosen muscles, which will prevent injury because the body is less stiff. Muscles and ligaments that are cold and stiff are far more prone to injury.
- Proper footwear and proper technique – Improperly fitting footwear will impair balance and increase the likelihood of awkward motions that send shock through the knee joint and can result in an ACL tear. Practicing proper athletic technique is critical to avoid high-impact, damaging motions. Emphasis on QUALITY of movements, rather than quantity, should be employed with all young athletes. Consult with your coach or physical trainer to ensure that your technique is safe and correct.
- Meet with a sports medicine specialist – speaking with an expert in sports medicine and undergoing a physical examination can help target any musculoskeletal weakness or vulnerabilities. An orthopaedic sports medicine specialist can identify areas of muscle weakness or joint instability that can make athletes of any age susceptible to sprains or tears. They can also advise athletes in specific activities and exercises that can improve these anatomic regions.
Christopher M. Jones, MD is a board-certified, fellowship-trained orthopedic surgeon with Hughston Clinic Orthopaedics – Tennessee. He specializes in the care of athletes and disorders of the shoulder, knee, hip, and elbow. As a fellow at the esteemed American Sports Medicine Institute (ASMI) in Birmingham, Jones received the 2015-2016 award for excellence in clinical research for the American Sports Medicine Fellowship Society. He has worked with high school, collegiate and professional athletes throughout his career.