Right steps to curbing the ACL injury epidemic

It’s a nightmare for an athlete. She jumps — maybe to spike a volleyball or grab a rebound — and on the landing she hears a “pop.” Her knee gives out, and she collapses to the ground. She knows it in her gut: her season is over.

The anterior cruciate ligament (ACL) is a critical ligament for the knee. It is also a tragically vulnerable ligament. In recent decades the number of ACL injuries in young people has surged. There are over 300,000 ACL reconstructions done in the United States every year. Girls are especially susceptible, tearing their ACL four or five times more often than boys. 

It’s bordering on an epidemic at this point.

ACL injuries are also a nightmare for coaches and fans. In women’s soccer, six of the world’s top 16 players tore an ACL between June 2022 and April 2023. Five of them missed the World Cup because of it.

A torn ACL is almost always a season-ending injury. We typically can’t repair an ACL; it needs to be replaced. It takes six to nine months, sometimes a year, to fully recover.

With the stakes so high, athletes and coaches are looking for ways to prevent ACL injuries. My colleagues at the Hospital for Special Surgery have been featured in national news recently for a neuromuscular training tool they developed. The app is called RIIP reps, an acronym for “Reduce Injury, Improve Performance,” and it helps athletes build strength, agility, and control. 

The basic idea is that when we move efficiently and correctly, we get injured less and perform better. Athletic movement training, also known as neuromuscular training, develops muscle memory that optimizes body control during athletic movements like cutting, stopping on a dime, and jumping and landing. These are the very movements that make someone a great athlete when they are performed with precision and control; however, when they are executed with poor form or faulty technique, they can result in ACL injury. Indeed, scientific evidence shows that neuromuscular training programs such as what RIIP offers can reduce the risk of ACL injury by 62 percent.

We have 20 years of data showing that we can save a lot of knees with these training programs. The challenge is implementing this at scale and making it a part of the culture of team sports. With the RIIP rep app now available, widespread implementation is possible, and we look forward to making a real impact.