ACL Injuries by the Numbers
Dr. Mitch Robinson Discusses 10 statistics about ACL injuries and upcoming trends in care
ACL (anterior cruciate ligament) injuries are among the most common and challenging injuries in sports medicine. Dr. Mitch Robinson, an orthopedic sports medicine physician, provides insight on some key statistics about ACL injuries to help patients understand the associated risks, factors, and evolving treatment options.
Prevalence and Risk Factors for ACL Tears
1. ACL Injury Frequency: 1 in 3,500 People Annually (2)
ACL injuries are prevalent, particularly among athletes in sports like skiing, soccer, and football. Dr. Robinson explains, “These injuries tend to happen in high-risk sports where speed, torque, and unexpected changes in direction are involved.” Each year in the U.S., about 400,000 ACL reconstruction surgeries are performed to address these injuries.
2. 70% of ACL Tears Occur Without Contact (4)
The majority of ACL injuries happen without direct contact, typically from sudden pivoting, twisting, or cutting motions. Dr. Robinson describes these as “non-contact pivoting injuries,” often resulting from movements where athletes plant their feet and quickly change direction. Football and soccer, due to frequent cutting maneuvers, are prime examples of sports with a high incidence of non-contact ACL injuries.
3. ACL injuries make up 14.9% of skiing injuries vs only 3.1% in snowboarding (8)
In a study that measured skiing- and snowboarding-related injuries, they found that skiers hurt their ACL about 15% of the time when they get injured, while snowboarders only hurt it about 3% of the time.
Dr. Robinson explains why this is often the case, “In skiing, the knee is vulnerable to rotational forces, especially when a skier catches an edge or loses control.” This twisting and rotation is less intense in snowboarding, where falls tend to result in upper body injuries instead of ACL tears.
4. 7x Higher Risk of ACL Injuries During Competition Compared to Practice (3)
Intensity and competition pressure can lead to higher injury rates. “In a game setting, players are more likely to take risks or encounter unpredictable situations,” Dr. Robinson explains. This data highlights the importance of in-game conditioning and mental preparedness to avoid high-risk movements under pressure.
Long-Term Consequences and Post-Injury Risks
5. 10x Increased Risk of Developing Arthritis Post-ACL Tear (4)
“Many patients are surprised to learn that an ACL injury greatly increases the risk of arthritis in the affected knee over time,” says Dr. Robinson. This arthritis risk is likely due to factors such as initial cartilage damage, blood within the joint that can harm cartilage, and subsequent surgeries or meniscus damage. It’s an important long-term consideration, especially for athletes and younger patients looking to stay active.
6. Contralateral (Opposite Knee) Tear Risk: 11.2% Within 6 Years (5)
The opposite knee is also at heightened risk of ACL injury after the first tear. Dr. Robinson emphasizes that understanding this risk can help athletes prepare and take action to prevent another ACL tear. Studies have shown that younger, high-impact athletes, face an even higher risk of ACL tears on both knees, with young female soccer players experiencing rates over 30% in some cases.
Surgical and Rehabilitation Outcomes
7. Less than 10% of ACL Tears are Partial (4)
“When an ACL tears, it’s almost always a complete tear,” Dr. Robinson explains. “This means the ligament is fully torn, typically requiring surgical reconstruction rather than repair, especially for those looking to return to sports.” A complete tear significantly impacts knee stability and can hinder an athlete’s ability to safely perform high-intensity activities.
8. 85% of Patients Return to Their Previous Activity Level Post-Surgery (1)
ACL surgery has a high success rate, but effective rehabilitation is critical. “The goal isn’t just to regain strength, but to achieve the dynamic stability required for sports. This requires extensive rehab work,” Dr. Robinson explains. Rehabilitation programs are structured to help patients gradually progress to their pre-injury level of activity while minimizing re-injury risk.
9. ACL Reinjury Rates Vary 10-14% (7)
The likelihood of re-injury is influenced by factors like the patient’s age, activity level, and the type of graft used. “Young athletes, especially in high-stress sports, have higher re-tear risks, often due to the intense demands they place on their knees after surgery,” Dr. Robinson shares. Try out the ACL Retear Risk Calculator below to see how this applies to you.
10. Preventative Training Can Reduce ACL Injury Risk Up to 70% (6)
A study in 2018 found that athletes who do a variety of preventive exercises are much less likely to injure their ACL compared to those who don’t. These exercise programs can reduce injuries by anywhere from 39% to 73%. The range is wide because the studies looked at different types of injuries – some from direct contact and others from movements like landing or pivoting.
Dr. Robinson highlights, “Patients who follow structured, supervised programs focusing on both strength and dynamic stability see significantly better outcomes.” He often emphasizes this during consultations, underscoring that proper rehab is just as crucial as the surgery itself for long-term success.
Trending in ACL Care: New Techniques and Procedures
While ACL reconstruction remains the primary treatment, newer approaches are emerging, offering targeted solutions for specific patient needs.
1. Lateral Extra-Articular Tenodesis (LET)
LET is an adjunctive procedure to ACL reconstruction that stabilizes the knee further by reinforcing the outer (lateral) side. Dr. Robinson explains, “We’re finding that LET is beneficial for patients at higher risk of re-tearing, such as those who have already had an ACL repair.” LET reduces the rotational forces on the knee, potentially lowering the chance of future injury.
2. Posterior Slope-Correcting Osteotomy
This advanced surgical option targets patients with a naturally high posterior tibial slope, a factor that can place extra stress on the ACL. “Correcting this slope may prevent recurrent ACL injuries, especially in patients with a steep slope who are prone to ACL tears,” Dr. Robinson notes. He shares that this is an area of emerging research, inspired by studies in veterinary medicine where a similar approach has seen success.
3. ACL Repair vs. Reconstruction
Traditionally, a torn ACL has been reconstructed using a graft from either the patient or a donor. However, repair techniques—sewing the torn ligament back together—are being revisited in specific cases. “We’re seeing renewed interest in ACL repair, particularly for patients who experience tears close to the ligament’s attachment point on the bone,” Dr. Robinson explains. A major study comparing ACL repair outcomes with reconstruction is underway and is expected to shed more light on the efficacy of each approach.
Each of these procedures represents a nuanced approach to ACL injuries, recognizing that different patient profiles may benefit from unique treatment strategies. These evolving methods offer hope for reducing re-injury rates and improving long-term outcomes for athletes and active individuals alike.
Sources:
- ACL Tear Treatment and Reconstruction. www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/acl-tear-treatment-and-reconstruction
- Evans J, Mabrouk A, Nielson Jl. Anterior Cruciate Ligament Knee Injury. [Updated 2023 Nov 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499848/
- Joseph AM, Collins CL, Henke NM, Yard EE, Fields SK, Comstock RD. A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. J Athl Train. 2013;48(6):810-817. doi:10.4085/1062-6050-48.6.03
- MOON Knee Group. [Updated 2024]. https://acltear.info/.
- MOON Knee Group, Spindler KP, Huston LJ, et al. Anterior Cruciate Ligament Reconstruction in High School and College-Aged Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament Revision Rates?. Am J Sports Med. 2020;48(2):298-309. doi:10.1177/0363546519892991
- Padua DA, DiStefano LJ, Hewett TE, et al. National Athletic Trainers’ Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. J Athl Train. 2018;53(1):5-19. doi:10.4085/1062-6050-99-16
- Petit CB, Slone HS, Diekfuss JA, et al. Sex-Specific Outcomes After Anterior Cruciate Ligament Reconstruction Using an All-Soft Tissue Quadriceps Tendon Autograft in a Young Active Population. Am J Sports Med. 2024;52(10):2450-2455. doi:10.1177/03635465241262018
- Subaşı İÖ, Gür V. Recreational Skiing- and Snowboarding-Related Extremity Injuries: A Five-Year Tertiary Trauma Center Cohort. Cureus. 2023;15(7):e42688. Published 2023 Jul 30. doi:10.7759/cureus.42688