ACL tear statistics are important to know for athletes and non-athletes alike. ACL tears can happen to anyone, anytime, anywhere. Knowing the ACL tear statistics will help you be better prepared if you do suffer a torn ACL.
In this blog post, we will explore ACL tear statistics in detail. We will answer some of the most common questions about ACL tears, such as: how often do they occur? How is an ACL tear treated? And more!
The Knee Joint
Before learning about the particular statistics associated with ACL injuries it is important to understand the knee joint overall. This hinge joint is the largest in the body and is made up of three bones: the femur (thigh bone), tibia (shin bone), and patella (knee cap).
The ACL is one of four major ligaments that connect these bones and provide stability to the knee joint. The other ligaments besides the anterior cruciate ligament are the posterior cruciate ligament, the medial collateral ligament, and the lateral collateral ligament.
ACL Tear Statistics
Now that we have reviewed the basics of the knee joint and ACL, let’s get into some ACL tear statistics.
Incidence and Injury Rates
Gender and Age Statistics
In independent research completed by keagenhadley.com, there were some interesting findings regarding gender and age statistics among those who have an ACL rupture. Find the below graphic on the findings in gender.
These results were consistent with academic studies that found that females were 2.8 to 3.5 times more likely to tear their ACL compared to their male counterparts.
In recent studies, it was found that female athletes have two peaks throughout their lifespan in which they are at an elevated risk of ACL injuries. Both in their teens and in their forties, while male athletes’ average age of injury was in their early twenties.
Mechanism of Action for ACL Ruptures
ACL tears are caused by either contact or non-contact injuries. ACL tears occur when the knee is twisted or decelerated suddenly. ACL injuries can also be caused by fatigue, a discrepancy in limb length, muscular imbalance, and poor ankle mobility.
ACL Surgery Statistics and Trends
ACL reconstruction surgery is the most commonly performed ACL procedure, totaling roughly 100,000 per year in the United States. Patients who tore their anterior cruciate ligament utilized surgical intervention 76.6% of the time. This surgery can be completed using several graft choices such as autografts (the patient’s tissue) as well as allografts (tissue from a donor).
The ACL reconstruction statistics show that the most commonly used graft for ACL surgery is the autograft, although some literature shows allografts and autografts are more similar than previously thought, and other studies show that autografts or patellar tendon grafts are the most reliable.
Due to these conflicting research conclusions, additional research is required for conclusive ACL reconstruction outcomes statistics.
The common choices for autografts are:
-Hamstring Tendon Autograft
-Patellar Tendon Autograft
-Quadriceps Tendon Autograft
The independent research done by keagenhadley.com provided the following statistics regarding graft choice among patients requiring surgery.
The Function of Patients-Post Surgery
“Will I ever be the same?” This question echoes through almost all individuals who have gone through an ACL injury.
ACL reconstruction surgery is not a guaranteed intervention, with the research showing that 81% of those involved treated with ACL reconstruction returned to some form of athletic activity, 65% returned to the preinjury level of competition, and 55% of high-level athletes returned to normal play and competition.
More research shows less than ideal outcomes for the current return to sport rehabilitation programs with the rate of second ACL injury in athletes under the age of 20 having been reported to be as high as 40% after return to sport.
Another proportional meta-analysis showed that only 23% of patients after ACL reconstruction passed the necessary return to sports goals. These findings highlight that many patients may have returned to sports without acceptable knee function. This study further found that although an athlete who passed the RTS criteria reduced the risk of subsequent graft rupture by 60%, unfortunately, it increased the risk of contralateral ACL rupture rate by 235%.
Where do These Injuries Occur?
ACL rupture injury rates vary greatly on what type of athletic event is taking place. One study found the injury rate was higher in competition compared to practice.
Various sports have their own ACL tear statistics, with girls’ soccer having the highest injury rate, followed by boys’ football, with boys’ basketball players and boys’ baseball athletes having the lowest rates.
Independent research at keagenhadley.com found the below statistics regarding which activity an athlete was participating in when the injury occurred.
Diagnosing ACL Ruptures
An ACL rupture diagnosis can be confirmed using magnetic resonance imaging (MRI), and a physical examination, including a Lachman test, anterior drawer sign, and pivot shift test. ACL rupture can also be diagnosed using X-rays, although they are primarily used to rule out other pathologies.
ACL tear injuries are graded on a scale of I-III by severity. Grade I ACL sprains consist of fibers being stretched but not torn, Grade II ACL sprains consist of moderate ACL stretch and partial tears, and Grade III ACL injuries consist of ACL tears with complete rupture, which often require ACL reconstruction surgery.
An older, yet reliable study found that the Lachman test has a diagnostic accuracy of acute ACL ruptures (within 2 weeks of examination) of 77.7% sensitivity. Compared to the pivot shift test which was the most sensitive (88.8%). The anterior drawer sign was the least sensitive at 22.2%. All tests had a specificity of more than 95%.
This injury affects more than just young athletes or high school sports. ACL ruptures also affect professional athletes.
In the NFL, between the years of 2013 and 2020, 379 ACL tears were identified, including 67.6% during gameplay and 31.1% during practice. Preseason injuries were more common than those sustained during the rest of the season.
The number of games and snaps at the time of injury did not differ by year. The incidence rate of preseason injuries was significantly greater relative to in-season injuries (95% Confidence Interval).
There was an elevated incidence rate of in-season injuries in 2020 relative to 2014-2019 combined.
The most frequent month of injury from 2013-2019 was August, the first month of preseason, with 119 out of 334 tears (35.6 %). In 2020, however, the most common month was September, with 13 out of 41 tears (31.7%). The number of tears in September 2020 was no greater or lesser than the average amount of tears from August 2013 to 2019.
An ACL injury often co-occurs with other knee ligaments, tendons, and cartilage injuries.
Psychological Impact of ACL Injuries
ACL reconstruction surgery can have a significant impact on an athlete’s life. It often involves long-term physical therapy and rehabilitation, as well as a decreased quality of life due to the inability to engage in sports activities.
In addition to the physical impacts, ACL injuries also have psychological implications. A systematic review on the subject has found that patients who sustain an ACL injury can suffer from symptoms of depression, especially during the first 6 weeks after ACL reconstruction. Depressive symptoms are more common among professional versus nonprofessional athletes.
A vast majority of patients experienced avoidance symptoms (87.5%), while others acknowledged symptoms of intrusion (83.3%) and hyperarousal (75%). Out of all the age groups, PTSD symptoms were most severe in high school athletes and young adults, more specifically those aged 15-21 years old (P=.033).
Females who went through the trauma experienced greater emotional consequences than males (P=.017). Finally, those with high athletic identities felt more emotionally shaken by the event but it was not statistically different from those without as much investment into their athleticism (P=.14)
These findings suggest greater care needs to be made to help these patients on the psychological side of injury to meet their rehabilitation objectives.
Treatment of ACL Tears
Whether you have had an ACL tear due to competing in contact sports, like football or soccer, or due to an accidental fall, ACL tears must be treated with proper medical care.
The ACL is typically repaired surgically, but in some cases can be managed non-surgically. Non-surgical treatment options are only recommended if the ACL tear is mild and/or the knee is stable.
Physical therapy can help improve knee stability and reduce pain. A physical therapist is an expert in the musculoskeletal system and can help design an individualized plan of care that encompasses strengthening exercises, flexibility activities, and balance training.
In cases where the ACL tear is severe or the patient desires to return to competitive sports, surgery is generally recommended. ACL reconstruction surgery performed by an orthopedic surgeon generally involves replacing the ACL with a tissue graft, typically taken from the patient or from a donor allograft.
The decision on which type of surgery is performed is made as a collaborative decision between the patient and their orthopaedic surgeon. ACL repairs or revisions may be necessary if a patient experiences a subsequent graft rupture, additional ACL tear, or other overuse injuries to optimize knee function.
ACL Injury Prevention
ACL injuries are often preventable with proper training. A recent 2019 systematic review of randomized controlled trials with a meta-analysis of injury prevention programs reported that the use of such programs led to a 53% overall reduction in ACL injury rates.
Prevention programs can provide significant differences in the overall outcomes of athletes throughout their life span, and can commonly be implemented by an athletic trainer or other certified providers.
ACL injury prevention programs primarily focus on neuromuscular training, plyometrics, and balance techniques to improve overall coordination of the lower extremities.
These exercises help athletes become more aware of their body’s movement patterns and teach them how to move with proper form. ACL injury prevention programs can be implemented in youth, high school, and collegiate athletes, as well as the general population.
Coaches, parents, and medical providers need to work together to provide a safe training environment with ACL injury prevention at the forefront of each program. This can ultimately help reduce ACL tears and improve the overall health of athletes.
Risk Factors to ACL Injury
ACL injuries can affect anyone, but certain risk factors increase one’s likelihood of ACL tears. Risk factors of ACL injury commonly include:
• Sex: Females are more likely to have ACL tears than males, especially in sports that require cutting and pivoting motions.
• Previous ACL injury: Those who have had a previous ACL tear are at a higher risk of experiencing ACL tears.
• Poor strength and flexibility: Weakness in the hip, thigh, or core muscles can elevate the risk of ACL tears.
• Poor neuromuscular control: As mentioned earlier, ACL injury prevention programs focus on teaching athletes how to move correctly.
• Muscle imbalances: Imbalances in strength between the quadriceps and hamstring muscles can increase ACL tear rates.
• Poor balance: Good balance is essential for optimal performance and ACL injury prevention.
• Body fat: Higher body fat has been linked to ACL tears, especially in adolescent female athletes.
• Poor nutrition: Eating a healthy diet is essential for ACL injury prevention and overall performance.
• Muscle fatigue: Muscles become weaker when they are tired and can result in ACL injury.
Knowing ACL tear statistics and risk factors is important for athletes, coaches, medical professionals, and parents to help prevent ACL injuries from occurring.
ACL prevention programs should be implemented with proper technique training to reduce the likelihood of ACL tears. ACL injury prevention is a critical component to ensure that athletes can stay healthy and continue to participate in the sports they love.
About the Author
Hi there! I’m Dr. Keagen Hadley, OTD, OTR/L. Straight out of the University of Mary, I’m all about blending my know-how in knee health, well-being, and medical technology. As a licensed occupational therapy doc, I’m here to translate complex concepts into clear, actionable insights – whether it’s knee care or groundbreaking healthcare tech.