When Megan Rapinoe tore the anterior cruciate ligament (ACL) in her knee in December, the midfielder's teammates on the U.S. women's national soccer team blamed the turf field on which they were scrimmaging.

While the field may have factored into her injury, it's likely that her gender may have too. The fact is, young women and girls are more likely than males their age to sustain an ACL tear. In addition, these injuries are striking young athletes at a higher rate than ever, as they spend more time playing organized sports and do not always train properly.

ACL tears sideline kids for nearly a year from playing sports and all its spoils - competition, socializing and opportunities to earn a spot on a team in the future.

You can address this burgeoning problem with your children, however, by helping them prevent and treat these injuries. Seven in 10 ACL tears are not caused by contact with another athlete, and many of these injuries can be prevented with proper training. Hard work aids treatment too. If your young athlete suffers the injury, she can recover fully by being dedicated to her rehab after surgery.

ACL Injury Prevalence

The ACL is one of four major ligaments in the knee, working with the posterior cruciate, medial collateral and lateral collateral ligaments to stabilize the knee.

When too much pressure is applied, the ACL can tear. This injury has long plagued athletes, but it has become especially prevalent over the last two decades. More than 100,000 people in the U.S. now sustain ACL injuries every year, with healthcare costs exceeding $1 billion annually. ACL tears are surging among kids in particular, increasing by 2.3 percent each year among patients 18 and under - as more young athletes play sports year-round, play on multiple teams at the same time and start participating in sports at earlier ages.

While football players suffer the most ACL tears in sum, researchers estimate that between 16-34 female high school athletes sustain the injury for every 10 males playing the same sport. Girls playing high school basketball and soccer are more than three times as likely to sustain this injury as boys playing those sports, and more likely than boys playing football. Girls are especially more vulnerable than boys during puberty.

Why are girls more likely to tear ACLs? This is due to both their muscles not activating properly during certain activities and their anatomy.

Many non-contact ACL injuries occur when athletes pivot or land after jumping. During these actions, girls tend to activate their quadriceps more than their hamstrings, straightening the knee and stressing the ACL more than what happens in a bent-knee position.

Regarding anatomy, girls' lower legs veer out (as opposed to curving in for many males) and do not sustain impact as well.

ALC Tear Prevention

Three in 10 ACL tears are caused by contact and cannot be prevented, but many non-contact tears are preventable. Research has shown that regular training can build strength and endurance that all adolescent athletes, especially girls, need to do better to prevent tears.

Young athletes should engage in plyometrics (specialized jumping exercises) and other workouts that strengthen the core (abdominals and lower back), as well as those that build balance and agility. They should also hone proper landing techniques and other sport-specific skills. These exercises, performed for 30 minutes several times each week, can improve knee stability and endurance to significantly reduce risk for ACL tears. Athletes should engage in the exercises for two months prior to a sports season and during the season, beginning this cycle when puberty starts.

Surgical Interventions for ACL Tears

If an ACL does tear, most young sufferers will need surgery.

So how do you know if your child has suffered the injury? If she feels pain, hears a pop or crack in her knee and it begins to swell, take her to a doctor. We will administer a physical exam, x-rays and maybe an MRI. If we diagnose the tear, we will ask her to rest and wait for the swelling to subside before reconstructing the ligament.

Most young athletes should undergo surgical reconstruction because successful surgery restores knee stability, and prevents long-term complications (such as arthritis) and compromised knee function. Without surgery, the knee can shift out of place and often become unstable.

After surgery, patients need physical therapy, with full rehabilitation taking at least 8-to-10 months. Rehab is integral to your child's chances of regaining the prior level of function she had in the knee when she returns to action. Not every patient recovers fully, but if your child wants to pull an Adrian Peterson (the NFL running back who tore his ACL a few years ago) and be back playing at a high level in a year, embracing the rehab will give her the best chance.

ACL Treatment Programs

Keep in mind that not every patient gets the results she wants from surgery - one reason why preventing ACL tears is crucial. Parents, coaches, trainers and young athletes themselves must unite in following the endurance and strength programs, no matter how arduous they seem. Studies show they produce positive results. Two good programs to consider are the Prevent Injury and Enhance Performance (smsmf.org/smsf-programs/pep-program) and FIFA 11+ (f-marc.com/11plus/home/).

Don't just try these programs to prevent ACL injuries; they also help your child's conditioning and prevent other debilitating knee injuries. ACL tears account for only 20-to-25 percent of all knee injuries sustained by high school athletes.

But that still adds up to a lot of physical and emotional pain, given the thousands of young athletes in this area alone. I see significantly more ACL tears than only a decade ago, and a higher proportion are in their teens and early 20's.

It's time to tear this trend down.


A board-certified orthopedic surgeon with fellowship training in sports medicine, Leonard Tassy is a member of the Mid-Atlantic Permanente Medical Group in the Washington area. He has offices in Gaithersburg and Kensington.