ACL injury prevention is better than the cure

There has been a stunning and concerning increase in the number of Anterior Cruciate Ligament (ACL) ruptures in Australia among children aged between 6 and 17 years old. 

Following the 2018 International Olympic Committee recommendations for greater research, an Australian longitudinal multidisciplinary prospective paediatric ACL Registry was established at the Queensland Children’s Hospital. 

The registry looks at which ages are most prevalent for ACL injuries among boys and girls as well as the sports or activities involved, and the ethnicity of the patients. 

Not surprisingly, the two rugby codes are seeing the most number of injuries followed by football and netball. 

 While organised sport is seen as beneficial for the health and wellbeing of children, there are risks involved. The question for parents, coaches, practitioners and the children themselves, is how to minimise any risk.  

Sheanna Maine from the Queensland Limb Reconstruction Clinic says preventative strategies are key to bringing the numbers down. 

 “We are currently in an epidemic of ACL ruptures in Australia,” she said. 

 “There may be a number of factors to this, including increased youth participation in contact and collision sports, increased pressure on youth to perform at an elite level, increased sedentary time with children on screens causing a lack of developmental gross motor co-ordination and increased female participation in sports such as soccer and footy.” 

 “Unfortunately, Australia now has the highest ACL injury rate per capita in the world. 

 “This is extremely concerning because young patients experience a significant physical and emotional impact as a result of the injury and surgery required to manage it. 

 “In certain sports, collision is unavoidable, however, many of the ACL injuries we see are as a result of impact when landing, which is the primary cause of non-contact ACL ruptures.” 

 Sheanna says this is where preventative strategies can help to reduce the number of children being injured. 

 “A good knee injury prevention program is important for any child participating in “at risk” sports,” she said. 

 “Good biomechanics, strength and coordination are the best way of stopping involuntary pivoting or twisting in the knee when landing. 

 “There are a number of good prevention programs available, such as FIFA 11+, that can assist in better preparing our kids.” 

 At this stage, surgery is the most effective way to treat an ACL rupture. 

 “Without surgery, physio can help to stabilise the knee, but a return to sport is risky, particularly in patients with previous meniscal trauma.” 

 “Further instability can damage meniscus and lead to arthritis down the track. 

 “Surgery requires at least 9 months to recover prior to returning to sport specific training and 12 months to return to competition, providing return to sport strength and agility milestones have been met. 

 “Even then, the re-rupture rate in young patients for the same and opposite knee has been shown to be as high as 30 per cent.” 

 Which is why Sheanna says a prevention strategy is so important. 

 “It is vital that our coaches and parents are better educated to help the kids before injury occurs,” she said. 

 “So, preventative techniques must be given a higher priority than they are now. 

 “Of course, we need to continue high quality research and develop better specialised child specific rehabilitation. 

 “Until then, an adjusted focus in training and instilling different landing techniques at a young age, may mean the difference between a long sporting life or a long life of injury management.” 

For more information on the FIFA 11+ program visit

You can read more about the statistics in this article from the Lancet Regional Health

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kids playing a game of competitive football. Two boys are running at the soccer ball.