By Dev Mishra, M.D.
President, Sideline Sports Doc
Clinical Assistant Professor of Orthopedic Surgery, Stanford University
- A recent study revealed a 924% increase in ACL surgery performed in the under-15 age group between 1990 and 2007
- This study along with other data point to the need to do ACL tear prevention training in the youngest age groups
A recently published study in the open source Orthopaedic Journal of Sports Medicine revealed some amazing – and somewhat disturbing – trends in ACL surgery. The authors examined data on ACL surgeries performed in the United States from 1990 to 2007. From the youth sports perspective one of the key findings was an astounding 924% increase in surgeries performed on individuals younger than 15 years old.
This study focused on people who had surgery to reconstruct the ACL, thus it does not give us data on how many people actually sustained ACL tears in any given year but it gives us insight into the trends favoring surgery in the young athlete. The data used is already old, with 8 years elapsed between the end of the data set and now so I suspect the numbers of young athletes opting for ACL surgery has only increased.
There are two possibilities for the huge rise in ACL surgeries amongst young athletes. First, there could be many more ACL tears in young athletes. And second, the number of young athletes with ACL tears electing to have early surgery rather than delaying it into their later teenage or early adult years is also increasing.
Both reasons are plausible and there is evidence to support both mechanisms. We know that overall numbers of adolescents participating in organized sports rose during the study period, and several studies point to an increased number of those athletes sustaining ACL tears. This is particularly true amongst girls. So it is likely that the number of adolescents with ACL tears increased considerably from 1990 to 2007.
Additionally, there is evidence that U.S. based surgeons favor ACL surgery over nonsurgical options for almost all age groups compared to their European colleagues. This type of treatment bias likely contributes to the rise in ACL surgery for young athletes too.
Regardless of the reasons behind the trends I believe it is clear that more adolescents sustain ACL tears nowadays compared to 20 or more years ago. I wrote recently about the need to start ACL protection training as early as possible, and these surgical trends support the same theme: ACL tears are happening more often in young athletes so we need to do whatever we can with training and rules enforcement to give these athletes the best chance to compete with healthy knees for as long as possible.