Teenage girls are most likely to tear their ACLs. Parents say more must be done to protect them

HARRISBURG, Pa. — Sofia Tepichin was about 30 minutes into her soccer team’s practice in October when she spotted a defender quickly approaching. She kicked the ball and jumped over the defender’s outstretched foot, went down awkwardly and heard a “pop.”

She immediately fell to the ground, pain shooting through her left knee and knew it wasn’t good. It was, she said, “heartbreaking.”

“And I knew personally that I tore my ACL,” Tepichin said.

Tepichin joined the growing ranks of female high school athletes who have torn their anterior cruciate ligament, a devastating knee injury that researchers are urging the sports world to take more seriously.

Decades of research on prevention methods are available, but parents, researchers and coaches say teams, coaches and leagues aren’t doing enough to protect girls and educate parents.

Sports fans often hear about high-performance athletes like U.S. Olympic skier Lindsey Vonn tearing their ACLs, and many ACL injuries are attributed to bad luck or a portion of sports that will continue to be played at all levels of competition.

Yet female high school athletes suffer these injuries at much higher rates than their male counterparts — up to eight times more likely, according to one study — and than adults, most often in non-contact situations in sports that require rapid changes of direction, researchers say.

Biomechanics researchers, coaches and physiotherapists say that there are pre-workout warm-ups and strengthening routines, such as FIFA 11+ or PEP, that can at least reduce the risk of injury that carries such heavy physical and mental consequences for young athletes.

But, they say, most coaches lack training or expert help, and high school girls compete in settings with far fewer resources than the professional and college levels. As a result, risk reduction routines are rarely included in daily coaching programs and practices.

“The real crime is that the data has been around for 25 years,” said Holly Silvers-Granelli, a physical therapist and biomechanics researcher who advises athletes, professional teams and major sports leagues on injury prevention. “People are demanding answers, and the answers are largely there. »

The trend in ACL injuries isn’t entirely clear, but the National ACL Injury Coalition — formed by the Aspen Institute and the Hospital for Special Surgery in New York — said its analysis of data from high school athletic trainers showed that the average annual rate of ACL injuries among high school athletes increased nearly 26% from 2007 to 2022.

The rate for girls increased by more than 32%, compared to 14.5% for boys, according to the release.

When they get injured, high school athletes and their parents are often left to deal with it alone. ACL injuries can require surgery and a year of rehabilitation, physical therapy and strength training, which insurance may not fully cover.

Recovery changes their routine and their identity: They lose team camaraderie and stay apart, which can be as hard as the physical trauma, parents say.

Many high school athletes who tear their ACL never perform at the same level again, even if they return to sports, says the National ACL Injury Coalition. And once injured, they are at increased risk of re-injury of the ACL and long-term complications like degenerative joint disease, researchers say.

The coalition urged the sports world to treat ACL injuries like brain injuries now that professional and youth sports have attempted to improve training, rules and equipment standards to prevent and detect concussions.

Sophia Gerardi, a sophomore at Apollo Ridge High School in Pennsylvania who tore her ACL during a basketball game in December, has been informed by her doctors that she will still need to wear a knee brace while playing sports. She had surgery in January, will miss the volleyball season and hopes to be back for next winter’s basketball season.

Like many girls who have torn their ACL, she doesn’t remember taking any ACL injury prevention training.

Surveys of coaches show that many are unaware of risk reduction programs, aren’t trained to implement them or aren’t encouraged to learn more, said Vince Minjares, who directs the Aspen Institute’s ACL Injury Prevention Project. Some coaches tell Minjares it’s taking too long.

He hopes that changes.

This spring, the American Youth Soccer Organization – one of the leading national youth soccer organizations in the United States – will launch new age- and stage-based neuromuscular training programs aimed at preventing ACL injuries through warm-ups.

Coaches will receive a series of exercises in bite-sized chunks, with video instructions. The goal is to develop good habits before preteens become more physical and demanding competitors.

“My biggest shock was that this didn’t already exist,” said Scott Snyder, AYSO’s senior director of programs and education. “Everyone I talk to says, ‘Yeah, that makes perfect sense,’ but no one has done it yet.”

Last year, biomechanics researchers at Scottish Rite Hospital for Children in metro Dallas began providing high school teams with resources typically available or affordable only at the professional and collegiate levels.

They created pre-season injury prevention workouts, tailored for female athletes, to improve strength and movement quality. At the start of the eight-week program, each athlete receives a free 3D motion capture assessment to identify weaknesses in strength, movement or balance. Another evaluation at the end determines whether the program has reduced risks.

Future training could include nutrition and sleep, said Sophia Ulman, who directs the hospital’s movement sciences lab.

“My team and I were tired of looking at ‘why, why, why’ when there are so many different possibilities to answer that question. And we wanted to move on to the ‘what’s the solution’ question,” Ulman said. Other biomechanics labs in the United States are trying similar efforts, she said.

One of the participating teams was Plano East High School in Texas, where players — including Tepichin — had suffered a rash of torn ACLs over the past two years.

Plano East coach Cristy Cooley said getting a hands-on demonstration from trained professionals on proper exercises and movement patterns makes a big difference.

“It’s one thing to talk about it,” Cooley said. “But it’s a totally different thing to show us.”

Like other parents, Tiffany Jacob said she learned a lot about ACL injury prevention that she wishes she had known before her daughter – East Plano sophomore Aliya Jacob – tore her ACL last February. For example, the surgeon told them that three days a week of strength training was an absolute must for football players.

“Something has to change,” Tiffany Jacob said. “The coaches, the clubs, something. They have to do something to prevent this because it’s such a horrible injury.”

Aliya — who knows at least seven other soccer players who tore an ACL, her mother said — is back to play for East Plano. She endured twice-weekly physical therapy, the isolation of rehab and, according to her mother, “figuring out who you are when you’re not playing football.”

Tepichin, a high school student, remembers her surgeon telling her to take a few days to release all her sadness and anger, then focus on her recovery.

She will miss her senior year of high school and club soccer. Her next time on a court could be for Saint Vincent College in Pennsylvania, where she has committed to the NCAA Division III team.

Tepichin saw a sports psychologist, was comforted by others who had the surgery — her sister, her father and her friend — and found a new routine after being constantly busy with two soccer teams and a job.

“There isn’t a day that goes by that I don’t work out or do something,” she said, “or that my health and recovery improves. »

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