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Injuries in Youth Sports Part 1: ACL Rupture

Participation in organized sports for both male and female young athletes is on the rise in the US and across the globe and, not surprisingly, so are sport-related injuries. While youth sport injuries range from mild to severe, one serious and rapidly increasing injury is a tear (or rupture) of the anterior cruciate ligament (ACL). A torn ACL can take a young player off the field for an entire season, and often marks the end of a young athlete’s participation in sports altogether.

By the Numbers

It has been suspected for some time that the incidence of sports-related injuries in children and youth was on the rise, but until recently there was no longitudinal data to back it up. Finally, a longitudinal study emerged at the American Academy of Pediatrics 2015 conference that confirmed the rapid rise of ACL tears among young athletes. The data revealed:

  • The incidence of ACL tears among children and teens aged four to 18 is increasing at the rate of 2.3% per year
  • Female athletes saw a shaper rise in ACL tears than males, at the rate of 2.5% vs 2.2%
  • Peak age for injury was 16 for girls and 17 for boys
  • Surgical treatment for youth ACL injury also rose by an average of 3% per year over a 20 year period, from 55% to 75%
  • The rise in ACL tears in young athletes was attributed to increased sports participation by females and younger children, and improved diagnoses

Causes of ACL Tears

While many parents fear contact sports are most likely to cause their child to become injured, ACL tears do not usually involve contact or collision. The ACL is a strong ligament that keeps the shin from sliding forward when force from the strong quadriceps muscles are applied to the patella. When the forces of muscular contraction are subjected to opposing forces, the ACL takes the brunt, and a rupture occurs. ACL injury often occurs during quick change of direction, deceleration, twisting and landing from a jump, all motions that occur in soccer and other field sports, basketball and volleyball, in non-organized sports like skateboarding, and on the playground.

Female athletes are more prone to ACL injuries than males, due largely to:

  • Smaller ACL
  • Higher quad to hamstring strength ratio
  • More hip abduction and less knee flexion when landing
  • Other anatomical differences

Preventing ACL Tears in Youth Sports

The incidence of ACL tears in children and youth can be reduced by some simple strategies, like those proposed by the Orthopedic Institute for Children (OIC):

  • Help your child get in shape before enrolling in sports. A child who has been sedentary all summer is at greater risk for injury when returning to sports in the fall.
  • Regularly practice agility drills that involve balance, jumping, agility and power, the same types of movements they will encounter on the playing field, to improve neuromuscular conditioning.
  • Perform other exercises like squats, leg extensions, side lunges and hip extensions that build up the muscles that support the knee.
  • Do not allow your child to skip warmups, and make sure they are well hydrated during practice and play.
  • Insist on your child using equipment properly, and wearing appropriate safety gear.


Fitness professionals who want to help children need to understand the basics about youth nutrition and physical activity, and the liability of working with children. W.I.T.S. has everything you need to get started. Begin with a certification like Personal Fitness Trainer, Youth Fitness Specialist and Lifestyle Fitness Coach. Continue your education with Nutritional Concepts, Youth Fitness Foundations, Fundamentals of Sport and Exercise Nutrition, Exercise Program Design for Special Populations, and much, much more!


American Academy of Pediatrics: “Rate of pediatric ACL tears increasing 2.3% annually.” Retrieved from:

Orthopaedic Institute for Children: “Anterior Cruciate Ligament Sprain.” Retrieved from:

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