ACL Injuries in High School Sports

ACL injuries in High School Sports

High school sports continue to be at the forefront of injury-related discussions. The increase in competition over the years is pushing the boundaries of what we expect of young athletes, and more and more we see injuries as a result of stress, over-use, and excess strain on the body.

At the high school level, athletes are expected to train to be faster and stronger than their rivals, and the pressure to perform is a very real issue. In terms of injuries, one of the most popular locations for injury is the knee. According to studies on high school injuries, the knee is the second most commonly injured area of the body behind the ankle; however, it is the leading injury for sports-related surgeries.

In this article we will be discussing what goes on in ACL injuries, how they’re treated, what causes them, and who is at risk.

What Is the ACL?

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ACLThe anterior cruciate ligament (ACL) is one of four ligaments that help the knee to perform properly. The ACL is located inside the knee joint and it criss-crosses in the shape of an “X” with another ligament known as the posterior cruciate ligament.

The anterior cruciate ligament is located in the front of the knee, and the posterior cruciate ligament is located in the back. Together, they allow the knee to move back and forth fluidly. The ACL is also responsible for making sure that the tibia does not slide out in front of the femur.

What Are the Types of Injuries that Occur?

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When the anterior cruciate ligament becomes injured, it is often referred to as a sprain. A sprain occurs when the threads of the ligament are either stretched or torn and there are three stages to classify the seriousness of the injury:

Knee pain imageGrade 1 sprain is the mildest injury that includes some stretching of the ligament; however, the stability of the knee is not compromised. Athletes may notice some tenderness and swelling, but they can still perform.


Woman holding ankle in painA Grade 2 sprain occurs when the fibers of the ligament are partially torn. The swelling increases, as well as the discomfort, and individuals may notice that their knee gives out during activities or that they feel unstable when performing.


Runner with knee injuryA Grade 3 sprain occurs when there is a full tear of the ligament fibers, which cause the ligament to separate. The level of swelling differs in every individual, as does the pain or discomfort. The knee at this point has lost quite a lot of stability and the athlete may feel as though they have no control over the joint.


One of the injuries that is less common is called an ACL avulsion, and this is when the ligament is torn from either the femur or the tibia (upper leg bone or lower leg bone). However, this tends to be more prevalent in children than in teens and adults.

What Can Cause ACL Injuries?

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Portrait of beautiful young woman playing paddle tennis indoor.There are a number of movements that can increase the chances of an athlete acquiring an ACL injury. One of the most common is with sports that require quick directional changes, which can put excess pressure on the ligaments and cause them to tear. Sports such as hockey, football, basketball, skiing, and tennis all require quick, directional changes that can be harmful.

Awkward movements are also a culprit of sprains in the ACL. These are not always from the actual sport, but do occur if the athlete has not received proper training in their sport or if they’re not used to specific gear. Movements like falling, stumbling, or missing a step are just as capable of causing injury.

Unbalanced leg muscle strength can also be a problem for the ACL; if an athlete has stronger muscles in their quadriceps than in their hamstrings, they may be more prone to injury.

Why Are the Injuries Increasing?

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More and more, young athletes are expected to perform at much higher levels and for longer periods of time in order to succeed. Some athletes may even play through current injuries in order to achieve their goals and the goals of their mentors or coaches. This is one of the most common reasons for ACL injuries on the rise; intensive sports training starts earlier, and it’s much more competitive than it used to be.

Woman holding kneeA rise in injuries can also be attributed to larger numbers of youth taking part in sporting events each year, as well as the fact that we are more aware of the injury and how it can be prevented. In previous decades, surgery on the ACL meant very invasive procedures that meant months of rehabilitation and poor outlooks for future performance.

Now, however, surgery to repair the ACL is much less invasive, and some athletes can return to their high-contact and high-intensity sports soon after their recovery.

What Sports Cause the Most Injuries?

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man playing sports in orange outfitIn an ACL study in 2015, it was found that basketball, soccer, and lacrosse were the leading sports for ACL injuries in females. For males the leading sports for ACL injuries included football, lacrosse, and soccer.

The study also found that ACL injuries were particularly high in high-risk sports such as football, basketball, soccer, and lacrosse across both genders.


Who Is More Prone? Males or Females?

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Soccer team with ballIt has been explained in various studies that there is somewhat of a stalemate between the genders when it comes to which one is more prone to ACL injuries. While males have a higher number of injuries overall, the rate of injury per exposure was much higher in females.

Essentially, the risk is higher for females to experience an ACL injury, based on the lower number of females in sports and their ratio of injuries. Males had more numbers overall; however, sports like football require much larger team numbers and are part of the reason that their overall number is higher for them.


Researchers believe that these numbers might be due to several factors including: neuromuscular control, lower limb biomechanics, and ligament strength. It has also been suggested that women may have less flexion in their knees and hips than their male counterparts, which can force the knee ligaments to do more of the work and cause injury.


What Is the Treatment?

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When treating ACL injuries, there are a few goals in mind. The first and most important is to bring stability back to its original state. Restoring the stability helps to improve the function of the knee again and allows the athlete to begin using their limb again. It is also important to remove any pain that is occurring and to prevent further injuries from taking place post-treatments.

large black knee braceTreatment depends on the severity of the injury, but it can also depend on the patient. While invasive surgery is an option for athletes with tears and breaks in their ACL, some patients may undergo non-invasive treatment that requires physical therapy and rehabilitation.

Non-surgical treatment has the ability to bring some knees back to their original state before the tear; however, patients will have to be very observant of the changes and work on their rehabilitation frequently to ensure the treatment is successful. Those with no stability loss and only small tears may be eligible for non-invasive surgery, however those who have larger tears may be forced to give up high-intensity sports.

Many athletes in high school have long seasons and may opt for invasive surgery that has a shorter recovery time and a positive success rate. The surgery is done by removing the torn ligament and using a skin graft (ligaments or tendons) from another part of the leg to replace it. The graft is attached through holes that the surgeon drills in the thigh bone and shin bone, and it is secured with screws or other devices.

How to Prevent Injury?

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There are quite a few ways that ACL injuries can be prevented, although none are outright able to prevent injuries from occurring. One of the most important ways to increase prevention of ACL injuries in all athletes in high school sports is to offer educational information to both parents and athletes about the specific sport they’re playing, and its potential dangers.

Close up photo of knee braceThe more the athletes and their support systems understand the risks in specific sports, the more they can prepare and prevent injuries from happening. This can include making sure the athlete properly warms up and cools down, taking preventative measures when small problems arise, and taking them to a sports doctor throughout the year to make sure they stay healthy.

Another preventative measure is for high school athletes to invest in high-quality knee braces, which can help to increase stabilization in the knee and help to prevent injuries in the area. There are a wide variety of knee braces available, many which can be worn under uniforms and comfortably throughout performance. For some high schools where there are regulations about metal-free knee braces, there are knee braces to meet these rules as well.

Another tactic to preventing ACL injuries in high school athletes is to work on the strength and flexibility of their hips and thighs, as well as working on drills that strengthen their overall balance, power, and agility. Increasing plyometric exercises like jumping and balancing may help to mimic the types of movements that will be performed during game play, which may help the body to respond better to these movements at higher speeds.


What Is the Outlook for ACL Injuries?

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Softball player sitting in grassThe outlook has certainly become brighter for those with ACL injuries over the past decade. It is now possible for today’s ACL surgeries to bring some athletes back to full health to continue performing on their high school teams by the next season.

As mentioned, those high school students who opt for non-invasive treatment may have to give up high-intensity sports if their sprains are severe enough; however, they do have the option to opt for playing lower-intensity sports.

Sports continue to be a very popular pastime for children and teens alike, especially as technology and social media have made our favorite teams and players so much more accessible. As the desire to play sports continues to increase, it will be very important for parents to recognize the types of sports their children are interested in and what kind of injuries are common in that sport.

While ACL injuries are certainly on the rise in high school sports, we are now aware more than ever of ways that we can prevent these kinds of injuries and how to treat them when they do occur. While females tend to show a higher ratio of players to injuries, both male and female athletes at the high school level should take care and be diligent about proper warming up strategies, beneficial drills, and warning signs of injury to help avoid ACL issues.

It is suggested that athletes, parents, and coaches keep the line of communication open; while competition continues to increase across all sports, it’s a good idea to understand the goals of your high school athlete and to offer support rather than pressure through their athletic career. More than anything, it is important for high school athletes to enjoy their time on the rink, field, or court, as opposed to spending it on the sidelines with an injury.

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