ACL Injuries Part 1: We Have Been Trending in the Wrong Direction

We want to share what we think puts an athlete in the best position to come back safely, with as little risk as possible for re-injury. Based on the stats you will want to do whatever it takes to put the odds in your favor, trust me.

Oct. 23, 2023

Dr. Donald Mull, DC

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We want to share what we think puts an athlete in the best position to come back safely, with as little risk as possible for re-injury. Based on the stats you will want to do whatever it takes to put the odds in your favor, trust me.

We have noticed more and more younger athletes experiencing ACL injuries, especially being in the area we are located in San Diego. The conditions are ripe for a high exposure to competition given the beautiful weather year round and the ability for most families to afford to participate in private organized competitions and private skills sessions. 

It is a perfect storm for a whole lot of sports for kids. Though this sounds great, it greatly increases the risk for injuries. Afterall, the more you play the higher the risk. This article is for those that have experienced or know someone that has experienced an ACL injury while playing their respective sport. 

This is something we feel extremely passionate about because despite all of the technological progress that has been made in medicine, this injury has become MORE common and by a lot. It is not just our observation in our area either, from 1994 to 2006 overall rates of ACL tears have increased 37%, ACL tears in females have increased 307% and ACL injuries in ages 15 or younger have increased 924% (1). Not only have the numbers jumped, but the population that is struggling with this injury the most are young active children. (2)

Another study from looking at athletes from 2002 to 2014 illustrates how much younger female athletes are being affected by ACL tears and subsequent surgical reconstruction (3) (figure below). 

Such a steep rise in youth female athletes could be explained by the increased rates of sports participation of that demographic. (4) However when studying college age athletes, females are 3.5 times more likely to tear their ACLs when playing basketball and 2.7 times more likely when playing soccer when compared to college male athletes. (4)

We are not alone here in the States as Australia has found similar outcomes when studying a population of over 200,000 ACL cases from 1998 to 2018.They found a significant rise in annual ACL tears with subsequent reconstructions with the highest rates being in females aged 5-14 years old. (5) This article was published in 2022 and seems to be the most up to date article (that I can find) in regards to trends in ACL tear incidents.

Not only are ACL injuries and subsequent repairs on a steep rise in youth sports (especially in female sports like soccer), the likelihood of re-injury when coming back to play is astounding. One in five athletes experience a reinjury upon returning to high-risk sports after an ACL reconstruction (6). This number is way too high and makes me uncomfortable. 

As you can see we are trending in the wrong direction. There are far too many ACL injuries occurring and the rate of re-injury is far too high. 

How can we do better?

From my perspective, I believe we can first do a better job decreasing the risk of reinjury, starting even before the ACL reconstruction surgery happens. The next part of this blog will discuss what we think is the first priority when an ACL injury does occur and the sooner you do it the better.


  1. Buller LT, Best MJ, Baraga MG, Kaplan LD. Trends in Anterior Cruciate Ligament Reconstruction in the United States. Orthop J Sports Med. 2014 Dec 26;3(1):2325967114563664. doi: 10.1177/2325967114563664. PMID: 26535368; PMCID: PMC4555588.
  2. Werner BC, Yang S, Looney AM, Gwath is mey FW Jr. Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injury and Reconstruction. J Pediatr Orthop. 2016 Jul-Aug;36(5):447-52. doi: 10.1097/BPO.0000000000000482. PMID: 25985368.
  3. 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. 2017 Aug 1;171(8):808-810. doi: 10.1001/jamapediatrics.2017.0740. PMID: 28604937; PMCID: PMC6583877.
  4. The female ACL: Why is it more prone to injury? J Orthop. 2016 Mar 24;13(2):A1-4. doi: 10.1016/S0972-978X(16)00023-4. PMID: 27053841; PMCID: PMC4805849.
  5. Maniar N, Verhagen E, Bryant AL, Opar DA. Trends in Australian knee injury rates: An epidemiological analysis of 228,344 knee injuries over 20 years. Lancet Reg Health West Pac. 2022 Mar 22;21:100409. doi: 10.1016/j.lanwpc.2022.100409. PMID: 35345847; PMCID: PMC8956823.
  6. Barber-Westin S, Noyes FR. One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years. Sports Health. 2020 Nov/Dec;12(6):587-597. doi: 10.1177/1941738120912846. Epub 2020 May 6. PMID: 32374646; PMCID: PMC7785893.