An ACL Comeback - is it possible?

It’s 80 minutes into a soccer match in the heat of summer. Everyone is dog tired when suddenly you watch your teammate go down, clutching her knee after she jumps and lands incorrectly. Your stomach sinks and you think “please, anything but the ACL.” Growing up as a competitive female soccer player, ACL injuries were one of my (as well as my teammates’) most feared injuries, primarily because it meant a long road to recovery and the potential to not come back as strong as you were before. Although injuring your ACL is a very serious injury, with the right rehabilitation plan and healthcare team, it is very possible to not only get back to your sport, but to come back even stronger (I mean, look at Megan Rapinoe!)

Before we talk about prevention, let’s first get to know the ACL a bit more…

What is the ACL? The ACL, or anterior cruciate ligament, is a structure with runs diagonally in the middle of the knee and attaches the tibia to the femur.

The role of the ACL is to provide rotational stability for the knee as well as prevent the tibia from sliding out in front of the femur. 

*Image from Mayo Clinic

*Image from Mayo Clinic

Most Common Mechanisms and Risk Factors for Injury

Over 80% of ACL injuries are non-contact. Typical mechanisms of injury include:

  • Rapid change in direction including cutting or pivoting maneuvers

  • Stopping suddenly

  • Deceleration while running

  • Landing after a jump, especially onto one leg

  • Direct contact with another player leading to hyperextension or internal rotation of the leg

Risk factors identified in research to predispose athletes to ACL injuries include: 

  • Being female: in general, females are 3-8 times more likely to injur their ACLs compared to males

  • Anatomy

  • Jump and landing mechanics

  • Poor core and hip strength

  • High BMI

  • Previous ACL injury

  • Family history of ACL injuries

Although some of these factors are non-modifiable, the bolded three are all things that can be changed through injury prevention training or physical therapy and lifestyle changes.

How to help prevent ACL injuries?

Always perform a dynamic warm-up prior to practices and games to prime your body for the demands of your sport.

Include strength training as part of your overall training regimen with a focus on quadriceps, hamstrings, glutes, and core.

Practice movements in your sport such as jumping, landing, pivoting, and cutting with proper body mechanics.

These are just a few tips to keep you injury-free this Summer. Our article on stretching for athletes dives deeper into how to prevent injury in the knee. Prevention is always ideal, but working with a sports physical therapist can help you identify areas in need of strengthening as well as how to perform movements properly to reduce the risk of injury.


Dr. Dave Gerbarg

Dr. Dave Gerbarg is the President and Physical Therapist at One Nine Sports Medicine and Physical Therapy in Solana Beach. He specializes in sports medicine for teenage and adolescent athletes.