As practices, tryouts and games return to school calendars, it is a good time to talk about one of the most serious knee injuries in youth sports: the ACL tear.
ACL injuries can sideline students for months, disrupt school and sports routines, and raise the risk of future knee problems. According to Ramez Hoveydai, DO, a non-operative sports medicine physician with ThedaCare Orthopedic Care, many ACL injuries are preventable.
“These injuries often happen during movements athletes can learn to control better —especially landing, cutting, pivoting and slowing down,” he says.
With the school sports season now underway, Dr. Hoveydai shares key facts on ACL prevention, risk factors and treatment. He also discusses why girls and young women are more prone to these injuries.
What is an ACL Injury?
The ACL, or anterior cruciate ligament, is one of the main ligaments inside the knee. It helps keep the shinbone from sliding too far forward and aids in controlling twisting motions. An ACL injury usually means the ligament has been stretched or torn, often during a quick stop, sharp change of direction, awkward landing, pivot or collision.
“Some people feel or hear a ‘pop,’ followed by pain, swelling, trouble bearing weight or a knee that feels unstable,” Dr. Hoveydai says. “Anyone with these symptoms should stop playing immediately and be evaluated before returning to their activity.”
Prevention Before the First Whistle
ACL injuries are not completely preventable, but a smart preseason routine can decrease risk. The best programs begin neuromuscular training. These programs teach athletes how to land, cut, decelerate and balance with better control.
Follow these general guidelines:
- Practice soft landing: Athletes should bend at the hips and knees, keep their knees aligned over their toes and avoid landing with stiff legs.
- Build hip, core and hamstring strength: Strong muscles around the hips, trunk and back of the thighs help reduce stress on the knee.
- Warm up with purpose: A 10- to 20-minute warmup that includes dynamic movement, balance, jumping mechanics and sport-specific drills can be more useful than jogging alone. Cool down with static stretches.
- Avoid doing too much too soon: Sudden increases in training volume, year-round specialization and skipping recovery days can up injury risk.
- Check shoes and play surfaces: Cleats, court shoes and field conditions should match the sport and surface to reduce slipping or sticking.
Know the Risk Factors
ACL injuries can happen in any sport, but risk is higher in activities that involve jumping, cutting, pivoting and quick changes of speed. These include soccer, basketball, volleyball, football, lacrosse and gymnastics.
Risk factors can include:
- Poor landing mechanics, such as knees collapsing inward or legs staying too straight
- Weakness in the hips, core or hamstrings
- Limited balance, body control or coordination during growth spurts
- Previous knee injury or return to participation before restoration of strength and movement quality
- Rapid increases in practices, games or tournaments at the start of the season
- Fatigue late in practices or games, when technique can break down
- Sport specialization without enough rest or variety in movement
- Environmental factors, such as uneven fields, wet courts or footwear that grips too much or too little
ACL Injuries More Common in Girls
Girls and young women have higher rates of noncontact ACL injury than boys in similar sports, especially during and after puberty. The reason is not attributable to one single factor. It is usually a combination of anatomy, hormones, strength patterns and movement mechanics.
“This does not mean girls should avoid sports. It means schools, coaches and families should be intentional about prevention,” Dr. Hoveydai says. “This is especially true for middle school and high school athletes entering a new season.”
Importance of Licensed Athletic Trainers
Many school districts in northeast and central Wisconsin have licensed athletic trainers (LATs) on staff for practices and games, contracted through ThedaCare Orthopedic Care. This connection can help students get evaluated quickly and safely in the event of a suspected ACL injury.
LATs play an integral role in caring for athletes. They are highly trained, multi-skilled healthcare professionals with a minimum master’s degree training, Dr. Hoveydai says.
“They provide on-site emergency services, examination and clinical diagnosis at athletic events,” he says. “They’re experts in therapeutic intervention and rehabilitation of musculoskeletal injuries and certain medical conditions. They are integral in improving functional outcomes as well as helping prevent injury and re-injury.”
Diagnosing and Treating ACL Injuries
A student athlete with a suspected ACL injury can expect:
- Immediate evaluation: The LAT assesses pain, swelling, range of motion, stability, walking ability and how the injury happened.
- Removal from play: In the event of a suspected ACL tear or other serious knee injury, the athlete should not return to practice or competition that day.
- Parent or guardian communication: The LAT explains the concern, discusses next steps and may recommend urgent or timely medical evaluation. ThedaCare Orthopedic Walk-in Care is available seven days a week in Appleton and weekdays in Oshkosh.
- Referral within ThedaCare: A ThedaCare LAT will help connect the family to sports medicine, orthopedics or primary care for further assessment.
- Clinical exam and imaging: A clinician may perform knee stability tests and order imaging — often an MRI — to confirm an ACL tear and look for related injuries, such as meniscus damage.
- Treatment plan: Treatment may include bracing, physical therapy, surgery or a combination. This depends on the athlete’s age, growth plates, sport goals, injury pattern and overall health.
- Rehabilitation and return-to-play testing: Recovery usually takes many months. Return should be based on strength, balance, movement quality, confidence and medical clearance — not just the calendar.
Takeaway for Student Athletes and Families
“ACL prevention works best when it becomes part of team culture,” Dr. Hoveydai says. “Coaches can build short prevention warmups into practice. Parents can encourage rest, recovery and reporting pain early. Athletes can learn safer landing and cutting habits before the season speeds up.”
And when schools have ThedaCare LATs on staff, students have an important safety net for early evaluation, referral and guided recovery.
Connect to orthopedic care on your time.
To schedule, visit us online or call 920-831-5050. You can also visit ThedaCare Orthopedic Walk-in Care in Appleton or Oshkosh for no-appointment-needed expert care.
