A Doctor’s Guide to Preventing ACL Injuries

As doctors, a high percentage of the patients we care for with anterior cruciate ligament (ACL) issues sustain their injuries from movements that occur when the body abruptly decelerates or changes direction. 

Deceleration, a sudden decrease in speed that increases forces across the knee, can put tremendous stress across the knee leading to injury. Also, other sport-specific maneuvers such as pivoting, jumping, twisting, or cutting (quickly changing directions) can lead to devastating knee injuries. Any athlete involved in sports that require these types of movements runs the risk of an ACL injury and faces the reality of having to take time off from playing in order to rehab and recover from knee surgery.

So what’s the best way to stay in the game and keep what’s often referred to as “the dreaded ACL injury” at bay? The solution isn’t extravagant, and is actually very simple, as long as you stick to it. The secret to minimizing your risk of an ACL injury is implementing the correct prevention exercise program to be done regularly and throughout the season…so the injury never happens to begin with.

Know Your Risk

While exercise is certainly good for your heart it can, under particular conditions, pose a risk to your physical body. ACL injuries happen most commonly in sports like soccer, basketball, football, skiing, and lacrosse, not from direct contact but rather when the body twists in an unexpected way causing significant stress the knee. 

Studies have shown a ratio of nearly 9:1 for female vs. male ACL injuries, meaning women are at a higher risk. Females tend to land with the knee in an angulated position, the so-called high valgus alignment or “knock-kneed” position. In this position, the kneecaps face inward toward each other. They also tend to land with their knees in a more extended or straight position, which does not allow as much muscle absorption of the landing impact stress.

Teenagers are also more susceptible to ACL issues in part due to their poorly coordinated joint mechanics. In addition, they are still developing muscle mass at their age, and as they get into more competitive, higher-level sports, the risk of injury increases. As the velocity at which they run and move grows, so do the forces across their joints. They are becoming faster and stronger, but with the poorly coordinated mechanics prevalent in a still-growing body.

Train Smart First

The best way to prevent ACL injuries from happening is through a proper preconditioning program before you begin your season, working on neuromuscular rehabilitation and prevention. When people have stayed devoted to these preconditioning programs it has shown to have a dramatic decrease in the rate of ACL injuries over the subsequent season. They key with this type of training is to make sure it continues on a regular basis, not just before, but throughout the season. 

During the season, in particular, athletes should implement the preconditioning training as warm-ups prior to games or practice. Programs focus on individual athletes’ specific weaknesses and landing mechanics so that they can better understand their own individual body’s needs and work consistently on injury prevention.

Physical therapists including those at the OrthoCarolina Wellness Center can guide you through pre-sport prevention and ACL Prevention programs, and you do not need a referral to make an appointment.

Scott O’Neal, MD is a fellowship-trained surgeon in sports medicine and shoulder and elbow surgery. He practices at OrthoCarolina Ballantyne. He is the head team physician for the Wingate University Bulldogs, the Ballantyne Smokies and Ardrey Kell High School.