Female basketball team in a gym stretching

ACL Injury Prevention

Author: CHKD Sports Medicine, Sara Stites, DPT, ATC
Published Date: Thursday, April 12, 2018

By Sara Stites, DPT, ATC

ACL injuries in young athletes are on the rise. The ACL, or anterior cruciate ligament, is one of the ligaments that attaches the femur bone in the upper leg to the tibia bone in the lower leg, and helps provide stability to the knee. The rate of young athletes suffering an ACL injury has increased significantly over the past 20 years, with an average increase of 2.3% per year. ACL injuries account for 6.3% of sports injuries in children 5 to 12, and rise to 10.6% in the 13- to 18-year-old age group. The risk of a second ACL injury has also risen to between 25 and 35%. Surgical techniques continue to improve, but there are other things we can do to help prevent these injuries and provide better outcomes when an injury does occur.

Injury Prevention

Injury prevention programs can reduce the risk of all lower extremity injuries. FIFA 11+ is a program designed as a warm-up for youth soccer players to address strength, core stability, balance, muscle coordination, proper form, and landing technique by using agility activities and plyometrics. This program has been shown to decrease injury rates in soccer players by as much as 39%.

Because girls are four to six times more likely to suffer an ACL injury than boys, CHKD’s Sports Performance Academy offers an injury-prevention program called Strong Girls, specifically designed to address the issues that put females at higher risk. CHKD also offers a variety of other injury prevention training for individuals and groups. For more information on these programs, visit our injury prevention page.


Even with good prevention programs, injuries still happen. Surgery is often required to repair a torn ACL. Once the surgery is done, then what? Well, that’s when the real fun begins. Post-surgery rehabilitation is very important to not only improve range of motion and strength but also to get the athlete mentally and physically ready for a return to sports. Instead of a standard period of rehabilitation time after surgery, the focus is now more individualized; making sure each patient is meeting function milestones before returning to play. Some athletes meet these milestones within six months, but many will need 9-12 months for a complete recovery. A recent study at Duke University showed that a longer period of time devoted to recovery resulted in a decreased risk of a second ACL injury.

For most athletes, their first question is “When can I play again?” So, it is vital that everyone involved – athlete, parent, physical therapist, coach, athletic trainer, physician, and anyone else – understands the importance of meeting criteria-based rehabilitation goals. Athletes returning to play without meeting these goals have up to a 4 times greater risk of re-injury.

Return to Sports

Return-to-play progression is another important component of rehabilitation and injury prevention. It is important that an athlete works back up to being “game ready” by starting with non-contact practice activity, followed by full practice participation before a full return to game play. When available, an athletic trainer is the perfect person to help guide this progression for safe return to play. Injury-prevention programs can also be beneficial in reducing the risk of re-injury in young athletes.


While ACL injuries are on the rise, the sports medicine team at CHKD is striving to decrease these statistics by educating athletes, parents, and coaches on the importance of reducing risk factors, participating in injury prevention, proper rehabilitation after injury, and ensuring a safe return to play. The ultimate goal is prevention, but when these injuries do occur we owe it to these young athletes to work together to get them back to the sport they love as safely as possible, setting them up for a successful return to play.

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About CHKD Sports Medicine

CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.