Teenagers Experience Dramatic Increase in the Incidence of ACL Tears

June 30, 2015 in STSMPT

A growing body of scientific evidence reveals a strong trend of more ACL tears among teenagers. Recently, Dr. Emily Dodwell and her team of researchers out of the Hospital for Special Surgery in New York revealed that the incidence of ACL reconstruction surgeries is up 189% among young people under age 21. ACL tears were most likely at age 17. Some popular theories for the increase in teenage ACL tears include year-round participation in sports, improved diagnostic procedures, more sports specialization, sports at younger ages, and/or increasing hours of organized athletic exposure.


The ACL is a very important ligament that keeps the knee within normal range of motion while the foot swings forward. Tears and ruptures mean discomfort, time away from sports and activity, physical therapy, and often surgery.


We encourage any physical and sports activity that teens find enjoyable and would never recommend reducing sports participation to reduce a general risk of injury. However, the apparently growing risk of injury, especially ACL injury, does give notice to parents, coaches, and PE teachers to take seriously foot, ankle, knee, and leg symptoms. For instance, one known risk factor for ACL injuries among teens is a tight iliotibial band. That’s the fascia that runs basically from the hip to the knee on the outside of the leg. Look up iliotibial band stretches and make sure a good one is part of your teen’s usual stretching routine.


Another known risk factor for teenage ACL tears is a previous ankle sprain. Teenagers heal so quickly that people often believe it’s safe to rest it until it feels comfortable to return to full activity. Unfortunately, even long after a return to full activity, research shows that ankle sprains leave asymmetrical strength, asymmetrical flexibility, and neurological damage associated with delayed reaction times. Physical therapy assessment and individually designed rehab programs of all foot and leg injuries are the best bet for safe return to activity, optimal sports performance, and prevention of reinjury. Teens often need surprisingly few visits with a physical therapist to make sure they are on the right track and ready to return to sport.


A final known risk factor worth mentioning today is low arches in the feet or flat feet. Some would argue that every flat foot needs a good arch support, because proper biomechanics simply require an arch in the foot. If a teen is having foot or leg pain or injury, the arches of the foot should definitely be assessed. The arch of the foot is created by fascia – not muscle – so there is no way to exercise an arch into the foot. If the arch is fallen, the only correction is some sort of arch support – usually a foot orthotic that is inserted into the shoe.


In summary, ACL tears are seeing a dramatic rise among teens. There is no need to reduce enjoyable activity, but this is our call to action to take smaller symptoms and injuries seriously.


Source: Dodwell E, LaMont L, Green D, et al. 20 years of pediatric anterior cruciate ligament reconstruction in New York state. The American Journal of Sports Medicine, 2014; 42 (3): 675-680.

ACL Tears Teenagers

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