What are the Odds of Tearing Your ACL in the Sports You Play?

A study published online in Pediatrics confirmed that ACL injuries in children and adolescents are on the rise. The study authors found a 2.3 percent annual increase from 1994 to 2013 in the number of ACL tears in patients 6 to 18 years old. Females had significantly higher rates of injury in the younger ages, while males demonstrated higher incidence in the 17- to 18-year-old age group.

Understanding your risk of suffering an ACL tear is the first step to prevention. At Children’s Hospital of Philadelphia (CHOP), Dr. Theodore Ganley and our sports medicine team wanted to counsel our patients and families about each individual athlete’s risk of an ACL injury based on their sex and the sports they play.

To start, we combined the data reported in every article published worldwide on the incidence of ACL tear (called a meta-analysis). Using this information, we were able to calculate the risk of ACL tear in each season of sport by sex.

Calculate your risk of tearing your ACL

1. Circle the sports you play in the table below. For each sport, find your risk for tearing your ACL in a single season based on your sex.
2. Multiply this risk by the number of seasons of the sport you play each year to find your risk per year for each sport.
3. Repeat for each sport you play, and add up your yearly risk for each sport to get your total overall yearly risk of ACL tear.

For example:

(Sport A risk per season from table) x (Sport A seasons played per year) = Sport A risk per year

(Sport B risk per season from table) x (Sport B seasons played per year) = Sport B risk per year

(Sport A risk per year) + (Sport B risk per year) = Combined risk per year of Sport A and Sport B together

This table is simplified from the published version. See the original published table here. Our numbers are most applicable to the average high school athlete since most of the data came from published incidence rates on this population. Your risk may vary from the rates shared here based on your level of competition, exposures per season, and age.

Using our table, “ACL Tear Risk per Season by Sport and Sex,” we’re able to calculate that males who play one season each of football, basketball and baseball have a roughly 1 percent risk of tearing their ACL over the course of a single school year. A female who plays soccer all four seasons has a 4.4 percent chance of tearing her ACL each year.

How can I lower my risk for an ACL tear?

ACL injuries happen when an athlete:

• Stops suddenly, slows down or changes direction while running
• Jumps or lands incorrectly
• Is tackled, as in football
• The primary prevention strategies to avoid ACL injuries are to:

Avoid overuse and risks associated with participation in multiple sports on multiple teams in the same season. The American Academy of Pediatrics recommends encouraging children to try a variety of sports, limiting participation in sports to five days a week, and taking a combined two to three months off per year from each specific sport (see the AAP for more recommendations) 

Prepare your knee to better withstand injury-causing behaviors. A prevention program will include specific stretches, warm ups, and strength and agility training that prepares the muscles and tendons in the knee for practice and games. These prevention strategies can be implemented as a pre-practice warm up or daily on your own using the Ready, Set, Prevent program.