Dramatic Increase in ACL Injuries and Surgery in Adolescent Girls

MedicalResearch.com Interview with:

Mackenzie M. Herzog, MPH PhD Candidate, Injury Epidemiology The University of North Carolina at Chapel Hill 

Mackenzie Herzog

Mackenzie M. Herzog, MPH
PhD Candidate, Injury Epidemiology
The University of North Carolina at Chapel Hill 

MedicalResearch.com: What is the background for this study?

Response: In 1999, a study by Arendt et al. reported that women were more likely to tear their ACL than men while playing the same sport. Since then, numerous studies have investigated this sex difference in ACL injury, and many prevention programs targeting youth athletes have been developed and tested. Although randomized trials have demonstrated the value of injury prevention programs in reducing the risk of ACL injury, the overall impact of these programs has not been examined in the general population. Our study investigated the net impact of research and prevention efforts over nearly 20 years in reducing ACL injuries by assessing time trends of ACL reconstruction, a consequence of ACL injury, among commercially-insured individuals in the United States.

MedicalResearch.com: What are the main findings?

Response: During our investigation into time trends of ACL reconstruction we hoped to see decreases or stability of ACL reconstruction rates given the research dedicated to preventing ACL injuries during this period. To the contrary, we noted a dramatic increase in rates of ACL reconstruction among 13-17 year old females in recent years. From 2006 onwards, females aged 13-17 years had the highest rates of ACL reconstruction of any age or gender group examined in our study. Also concerning was the increase, though less dramatic, in males aged 13-17 year old.

Our results suggest that over the same time period, the proportion of 13-17 year old patients who had surgery within one year of ACL injury diagnosis did not increase, leading us to believe that the increase in rates of reconstruction is not due to patients having surgery more often but rather to a true increase in ACL injuries.

MedicalResearch.com: What should readers take away from your report?

Response: The alarming increase in adolescent ACL injuries over time necessitates collaboration within athletic communities to adopt and implement evidence-based ACL injury prevention programs that include balance, jumping, and landing exercises, such as FIFA 11+, across all levels of athletics. Parents and athletes, especially those who participate in basketball and soccer, should encourage their coaches to include this type of program into their warm ups, practices, or conditioning sessions. Research has shown that these programs are effective in reducing the risk of having an ACL injury, but we need broader promotion among youth sports to see population-wide impacts. Prioritization of sports injury prevention research and program implementation is also crucial for maintaining the health benefits of physical activity participation throughout the lifespan while reducing the potential for negative consequences of injury, such as osteoarthritis.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: More research is needed to understand the multiple factors that likely contribute to the rising injury rates observed. In recent years, we have seen mounting intensity in sports participation, increased trends toward youth and adolescents participating in year-round athletics and focus on specialization in a single sport at a young age. It is important for future research to investigate these trends and their effect on injuries, such as ACL tears. In addition, it is important to continue to research effective injury prevention strategies and understand how they can best be implemented among youth and adolescents, particularly among young females. In the mean time, existing programs that have been shown to be effective in reducing injuries, such as FIFA 11+, should be promoted at all levels of athletic participation to start to address the alarming rates of ACL injury in this population.

MedicalResearch.com: Is there anything else you would like to add?

Response: There are no disclosures directly associated with this research; however, Dr. Marshall and the UNC Injury Prevention Research Center are partly supported by award R49/CE002479 from the Centers for Disease Control and Prevention, National Center for Injury Control and Prevention. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


Herzog MM, Marshall SW, Lund JL, Pate V, Mack CD, Spang JT. Incidence of Anterior Cruciate Ligament Reconstruction Among Adolescent Females in the United States, 2002 Through 2014. JAMA Pediatr. Published online June 12, 2017. doi:10.1001/jamapediatrics.2017.0740

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Last Updated on June 13, 2017 by Marie Benz MD FAAD