Generation Gap: Surge in ACL Injuries in Teens Raises Alarm Among Doctors

The ACL, or anterior cruciate ligament, is a vital component for athletes who engage in sports that require pivoting, sprinting, and landing. Its function is crucial in various sports such as football, netball, rugby, basketball, and more.

The Anterior Cruciate Ligament (ACL) is a powerful ligament located in the knee that attaches to the thigh bone and shin bone, resembling the length of a little finger. If it tears or ruptures, the injury can be devastating, and this is not an overstatement. Recently, orthopaedic surgeons like Nev Davies and Will Jackson, along with other medical colleagues, have expressed concern over the significant increase in teenage ACL injuries, prompting them to conduct research on the issue. Their findings reveal an alarming statistic.

According to Davies, a consultant orthopaedic surgeon at the NHS Royal Berkshire Hospital in Reading, the incidence of significant knee injuries, particularly ACL ruptures, among young people has been increasing every year. The numbers are alarming, with 29 times more ACL reconstruction surgeries being performed today than just over 20 years ago.

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The increase in devastating injuries caused by sports is a concern shared by many medical professionals, including Professor Stefan Kluzek from Nottingham University who specializes in sports medicine. He splits his time between Oxford and Nottingham and has seen a 29-fold increase in the number of operations due to these injuries. This can cause a complete change in the life trajectory of the patient and lead to early onset arthritis. To address this issue, medical professionals have come together at conferences and seminars to raise awareness.

At Ryland Netball Club in Bromsgrove, ACL injuries in teenage players are unfortunately not uncommon. Despite the club's focus on member care and successful junior and senior programs, many players have still experienced this type of injury. Youth coach and player Caitlin Hillier herself suffered an ACL rupture from an awkward landing, which brought attention to the importance of understanding and prioritizing proper body care before participating in sports. While the club is working towards greater awareness and prevention, a significant number of girls have already been impacted by ACL injuries.

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At Bedfont Sports Club in West London, young footballers are taught the importance of warm-ups and injury prevention by coaches like Lee Taylor. As an ex-pro player, Lee understands the value of proper preparation for both training and matches, while also being mindful of the risk of injury for his young players. Unfortunately, ACL injuries are not limited to just girls and women, as recent injuries suffered by Beth Mead and Leah Williamson have shown. Lee's professional background and expertise are a valuable asset to the grassroots game, especially in light of the increasing incidence of ACL injuries among young athletes.

According to Kluzek, it is concerning to see that people are not taking proper care of their bodies despite the increasing popularity of football. He expressed surprise that individuals are not preparing themselves better, considering the accessibility and prevalence of the sport. Kluzek attributes this lack of preparation to individuals committing to only one or two sports within their local communities, resulting in less time spent developing additional skills that would naturally come with participating in multiple sports. Additionally, he notes that people are spending more time in front of screens and less time moving around, which is a departure from previous generations.

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Parents and guardians can take control of their child's sports experience by opening up privacy options. As Davies mentions, children can easily be pushed towards specializing in one sport, but by adjusting privacy settings, parents can ensure their child has a more diverse experience in various sports.

In the UK, however, there seems to be a lack of understanding about the importance of injury prevention programs and warming up kids. This misconception in grassroots sports that children are less prone to injuries and therefore do not require warming up is far from the truth.

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Leah Williamson, the captain of England's team, is one of the many top athletes who have undergone ACL surgery. Our previous report highlighted that female football players at the elite level are six times more susceptible to ACL injuries compared to their male counterparts. Although statistics for the grassroots level are not yet available, medical experts believe that young girls and women face a higher risk of injury.

Dr Kate Jackson is an expert in sports and exercise medicine who has worked with various sports teams including football, England Netball, and Olympic sports. She explains that for two decades, it has been established that women and girls have a higher likelihood of experiencing ACL injuries compared to men and boys. The anatomical structure of the ligament makes it more susceptible to rupturing, and the actual rupture is similar regardless of gender; it's due to overloading.

However, there are other factors that contribute to the likelihood of an ACL injury. One of the most prominent ones is the menstrual cycle. The fluctuation of hormones during the menstrual cycle may have an impact, but it's not the sole cause of the injury. There's still much to learn about ACL injuries in women, and research is ongoing.

"There is a complex issue surrounding gender that requires further examination. Are attitudes towards physically active girls around that age a factor? Is accessibility an issue? We still do not fully comprehend the opportunity for teenage girls to remain physically active. While it is true that there has been some gender bias, efforts are being made to address and counteract this issue."

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Dr Kate Jackson explained why girls and women are more likely to have ACL injuries but says more resarch is needed to explain why

Dr Jackson provided valuable insights during our conversation. She explained that the term 'attitudes' encompasses various factors such as the quality of the playing surface, changing facilities, and equipment. However, the most significant takeaway was the lack of certainty surrounding the reasons why female athletes, whether at the grassroots or elite level, are more prone to ACL injuries. Dr Jackson emphasized the need for more focused research to gain a comprehensive understanding of the issue.

But why is an ACL injury so devastating? The answer is two-fold: it requires a significant amount of time away from the sport, and there is a high likelihood of recurrence if rehabilitation is not taken seriously. The injury itself can happen in a split second to anyone, regardless of age or gender, and is typically accompanied by a distinct popping sound and difficulty walking or running. To repair or reconstruct the damaged ligament, the majority of patients will need to undergo surgery under general anaesthesia.

Davies and his team at the Royal Berkshire Hospital have revolutionized surgical techniques, reconstructing an ACL in as little as an hour. Witnessing the team skillfully rebuild an ACL for 15-year-old footballer Marley Wright was a true privilege.

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15-year-old Marley Wright is one of many thousands of teenagers having rehabilitation after knee surgery

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During the surgery, News captured footage of the procedure as medical professionals worked on Marley Wright, a teenager undergoing ACL surgery. Marley's right leg had experienced a violent rupture, resulting in the absence of his ACL. Surgeon Davies performed a complex grafting procedure, utilizing Marley's right hamstring to create a new, robust ACL. Using various surgical tools, drills, and cameras, he skillfully secured the new ligament in place and strengthened the surrounding area to provide Marley with added protection upon his return to athletics.

Returning to sport after an ACL injury is a lengthy process that involves a significant amount of rehabilitation. According to Davies, patients must undergo rehabilitation for a considerable amount of time before they are allowed to return to activities such as football, rugby, and netball. While Davies enjoys operating, he finds the conversations with patients and their families to be distressing. Burden, the senior lead physiotherapist who works alongside Davies, is passionate about helping patients return to sport but is disheartened by the number of teenagers she sees with ACL injuries. She emphasizes that the road to recovery is a long one and urges people to understand this.

Patients often mistakenly believe that their knee is fully healed after an ACL operation, but in reality, the road to recovery is lengthy and cannot be rushed. According to experts, it takes a year to fully recover and attempting to speed up the process can result in reinjury or damage to the other ACL. While there is no foolproof way to prevent ACL injuries, medical professionals recommend a warm-up routine as a simple and effective way to reduce the risk of injury.

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Some doctors claim that a focused warm-up routine can effectively decrease the occurrence of ACL injuries by more than 50%. Among the UK's most reputable knee specialists is consultant orthopaedic surgeon Will Jackson, who shares the same frustration with the rising number of teenage ACL injuries. However, he firmly believes that a basic, all-encompassing warm-up or injury prevention program prior to training or game time can significantly improve the situation. Unfortunately, he is not as optimistic about how well this approach is being adopted in the UK.

Countries like Australia, some Scandinavian countries, the Netherlands, and Canada have already implemented national programs aimed at providing warm-up programs. Unfortunately, the UK has yet to follow suit and it is a source of shame for some. However, there is hope as there are individuals like Will and other medical professionals who are determined to make a difference. Their suggestion is to spend 15 minutes, three times a week, on stretching. This can be divided into 10 minutes before a workout, training or a match and five minutes afterwards. It is a simple process that does not require a degree in physiotherapy and can easily be integrated into normal practice.

According to Davies, incorporating a warm-up routine can result in a significant reduction of 50-70% in injury risk. This underscores the importance of taking injury prevention seriously and implementing basic warm-up practices. It's impressive to note that even volunteer grassroots coaches understand the value of warming up.

Proper stretching and warm-up routines are crucial for the safety and performance of young basketball players, according to Shaun Romeo, who is involved in the youth program at Reading Rockets. With injuries often occurring due to inadequate preparation, Shaun stresses the need for ensuring that all kids are well-oiled and stretched before hitting the court. As someone who has experienced injuries from not warming up properly, he understands the importance of taking this aspect seriously. Taylor, who coaches the U11s team, also emphasizes the need to make it fun and engaging for kids while instilling the importance of preparation and routine for their benefit.