Member Research and Reports

Member Research and Reports

UNC Study: ACL Reconstructions on the Rise in U.S., Particularly among Teen Girls

A new study has found a dramatic increase in the rate of anterior cruciate ligament (ACL) reconstructions among females 13-17 years old in the United States.

Research conducted in 1999 showed that women are more likely to tear an ACL than are men while playing the same sport. This new evidence reveals that, after almost two decades of subsequent research and prevention efforts aimed at reducing ACL injuries in young athletes (and females, particularly), there nonetheless has been an increase in ACL injuries among this population.

[Photo: UNC’s Ms. Mackenzie Herzog, left, studied anterior cruciate ligament (ACL) reconstructions among young women athletes in the United States.]

Ms. Mackenzie Herzog, doctoral candidate in epidemiology at the UNC Gillings School of Global Public Health, is lead author of the study. The full article, “Incidence of Anterior Cruciate Ligament Reconstruction Among Adolescent Females in the United States, 2002 Through 2014,” was published online June 12 by JAMA Pediatrics.

Ms. Herzog wrote the study with Gillings School co-authors Dr. Stephen Marshall, professor, Dr. Jennifer Lund, assistant professor, Ms. Virginia Pate, applications analyst, and Dr. Christina Mack, adjunct assistant professor, all in the Gillings School’s Department of Epidemiology. Dr. Marshall and Ms. Herzog also are members of the UNC Injury Prevention Research Center, where Dr. Marshall is director.

Assessing U.S. trends of ACL reconstruction rates among commercially-insured individuals revealed that, since 2006, females ages 13 to 17 years have had the highest reconstruction rates of any age or gender group in the country. Also concerning was a similar, though less dramatic, increase in males ages 13 to 17 years.

“Addressing this alarming rise in adolescent ACL injuries will necessitate collaboration within athletic communities,” Ms. Herzog said. “There is a need to adopt and implement evidence-based ACL injury prevention programs – which include balance, jumping and landing exercises – across all levels of athletics. Parents and athletes, especially those who participate in basketball and soccer, should encourage coaches to add this type of program into warm-ups and practices.”

These injury prevention programs, including FIFA 11+, have been proven effective in reducing the risk of ACL injuries. To date, however, these programs have not had the desired effect because of limited promotion and uptake among youth sports organizations.

As the U.S. has seen a mounting intensity in youth sports participation in recent years – including increased trends toward youth and adolescents participating in year-round athletics and a focus on specialization in a single sport at a young age – prioritizing sports injury prevention research and program implementation has become especially crucial for public health.

“If we want to maintain the health benefits of physical activity throughout the lifespan while reducing the potential for the negative consequences of injury, such as osteoarthritis, we need to better understand the factors that contribute to rising injury rates,” Ms. Herzog said. “The take-home message from this study, especially for sports groups with a strong female playing base, is the importance of implementing an evidence-based ACL injury prevention program.”

Read more: