byMayo Clinic

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No one wants to hear the distinctive pop of an ACL tearing or rupturing, which typically means the player's season is at an end. The ACL, or anterior cruciate ligament, is located inside the knee and provides stability during movements such as cutting, turning, twisting, and jumping. Deanna Brinks, M.D., a physical medicine and rehabilitation and sports medicine physician at the Mayo Clinic Health System in Mankato, explains prevention and treatment.

Female athletes areup to roughly eight timesmore likely to experience ACL injuries, Dr. Brinks explains. While the causes are still being studied, several factors may contribute to the increased risk:

"Awareness of the factors behind increases in injuries can lead to improved training for women that addresses proper technique, muscle strength, balance, and biomechanics," Dr. Brinks says.

One resource for helping prevent ACL injuries is theFIFA 11+ Warm-up Program. It was developed by an international group of experts and is available online for free.

Divided into three segments, each segment has its own set of exercises with progression levels to add difficulty and variation. The exercises pay special attention to knee strength and position. Although this 20-minute warmup was developed for soccer players, it can be translated to any sport, from basketball to pickleball.

"Whether you follow this program or something similar, players should commit to strength, balance, and knee-position work for at least 10 minutes, three or more times a week," Dr. Brinks says. "There's a push to incorporate this kind of training into youth, high school, and college programs."

No one is completely protected from ACL injuries, which range from sprains to partial tears to ruptures, she adds. With a partial tear, segments of the ligament remain connected. A rupture rips the ligament in two.

If you experience an injury, you may seek treatment first from a sports medicine or orthopedics clinician. They'll ask questions about how the injury happened and if contact was involved. About 70% of injuries are noncontact and may have been caused while pivoting or landing from a jump. Typically, patients undergo an MRI to clarify the extent of the injury.

If it's a sprain, treatment may involve wearing a knee brace while the ligament heals, which can take weeks to months. Intensive physical therapy to strengthen the knee and alleviate biomechanical imbalances is a mainstay of treatment. Once the ACL heals, the athlete may return to their sport.

If the ACL is torn, the severity of the tear will determine ifsurgeryis needed. A rupture requires surgery toreconstruct the ACLusing a graft from the patient's patellar, quadriceps, or hamstring tendon. No matter the type of graft, athletes can expect at least nine months of recovery and rehabilitation before returning to play.

"For any ACL injury, part of recovery is regaining confidence in the injured knee," Dr. Brinks says. "Physical therapy can help restore and reinforce confidence."

While the recovery period may be up to a year or more, return-to-play rates are excellent—around 80%. However, once athletes return to play, there's a risk of reinjury, especially for those in their teens and early 20s. About 1 in 4 athletes will experience a second ACL injury.

Studies showthat reinjury to the reconstructed knee is similar for men and women. However, some studies report women have agreater riskof ACL injury in the opposite knee. So prevention through strength and biomechanics training is key.

"Before an injury happens, youth and student athletes should consider a biomechanical assessment by their team's athletic trainer, a sports medicine specialist, or a physical therapist," Dr. Brinks says.

While this approach will lessen injuries, it won't completely prevent them, she adds.

Key medical concepts Anterior Cruciate Ligament Anterior Cruciate Ligament Injuries Anterior Cruciate Ligament Reconstruction Physical Therapy