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The ACL is typically injured during sports participation. Sports that involve frequent cutting and twisting motions, such as football, soccer, basketball, lacrosse and gymnastics, have relatively high rates of ACL injury.
The ACL can be torn when a player stops quickly, changes direction rapidly, lands after a jump or collides with other players. The athlete may hear a pop
when the ACL tears.
Teens are the most athletically active age group and have the highest risk of ACL injuries.
Teens who are especially at risk include those who play contact sports (such as football and hockey) and sports that involve cutting and pivoting (such as soccer, basketball, gymnastics and lacrosse).
Girls are five to eight times more likely than boys to tear their ACLs for several possible reasons:
• Girls tend to put more stress on their ligaments, compared
to their muscles, relative to boys, when playing sports.
• At puberty, boys grow in height and develop their lower leg muscles at the same time. When girls grow, they don’t
tend to develop lower leg strength unless they train for it.
• Girls tend to land with a straighter knee than boys. This reduces the effectiveness of their muscles as shock
• Girls tend to let their knees drop inward during cutting/pivoting/landing maneuvers, which can put larger stresses
on the ACL.
• Girls often have more strength in their quadriceps muscles than their hamstring muscles. This puts more stress
on the ACL.
Despite relative success of surgeries to repair the torn ACL, it is clear that it is equally important to devise strategies to prevent this serious injury.
In 2013, the Sports Medicine Division opened The Micheli Center for Sports Injury Prevention based at the Boston Children’s Hospital satellite in Waltham. Each child receives a comprehensive assessment to determine child and sport-specific risk factors for injury, including ACL injury. The child and family are given a series of recommendations to help prevent injury in sports training and competition.
In general, athletes and active young people can reduce their risk by:
• maintaining general health and fitness: sport-specific conditioning, diet, exercise, sleep
• learning/using proper sport-specific movements and techniques
• wearing/using proper sport-specific gear
• learning which moves cause risks (risk awareness)
• strengthening hamstring/leg (especially for girls)
To learn more about ACL injury prevention, please visit The Micheli Center for Sports Injury Prevention and download Boston Children’s ACL Injury Prevention Guide. To learn more about female athletes and ACL injuries, please download Boston Children’s Female Athlete ACL Guide.
There are several factors behind the apparent increase in ACL injuries, including:
• Children are playing sports at a more competitive level at younger ages and are more likely to focus on a single
sport. Both factors may increase risk for ACL tears.
• Children are maturing earlier. They are bigger, stronger and faster, which means greater risk for adult-like injuries like
• Doctors are more aware of the injury and have become more adept at recognizing it.
• Newer technologies like MRI and arthroscopy help doctors better visualize the injury.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”