What active adults should know about ACL injury prevention

Whether you're a competitive athlete or you play recreational sports, a common knee injury can sideline you instantly—an anterior cruciate ligament (ACL) tear. And while not every ACL injury can be prevented, understanding your risk can help reduce your chances of getting hurt.

According to James Ryan, MD, an Atlantic Health orthopedic surgeon who specializes in treating knees, hips and shoulders, an ACL tear is usually caused by sudden pivoting, cutting or directional changes.

“The ACL connects your thighbone to your shinbone and its main job is to provide rotational stability in the knee,” says Dr. Ryan. “If the joint is placed under extreme stress beyond what the ligament can handle, that’s when it can be at risk of tearing.”

Who is most at risk?

Although a handful of movements can cause the ACL to tear, Dr. Ryan explains that some people are naturally at greater risk than others.

“We see ACL injuries more frequently in younger athletes whose bodies are still growing and developing, and also in female athletes whose anatomy and landing mechanics are different than males’.”

The more frequently you play sports that require cutting, pivoting and jumping—soccer, basketball, football, volleyball, tennis and skiing—the greater your risk is, too.

Other factors that can increase the chances of an ACL tear include:

• Naturally loose joints (joint laxity)
• Imbalances in muscles or anatomy
• Genetics that affect movement and stability

How can ACL tears be prevented?

Dr. Ryan says the research shows that knee braces do not prevent the ACL from tearing. Instead, prevention should focus on improving strength, balance and body mechanics.

A few potentially helpful exercises include:

• Squats and lunges to strengthen quads and hamstrings
• Balance and stability drills
• Plyometric exercises (jump training)
• Agility drills for speed, flexibility and quick decision-making

"Cross-training is also beneficial," says Dr. Ryan. "Playing multiple sports trains different muscle groups and movement patterns. If you only play one sport year-round, you may develop imbalances that can make you more susceptible to injury."

Know the warning signs

If you hear a pop and feel immediate severe pain and swelling in your knee, don’t wait to see a doctor. The initial pain and swelling often improves within a few days, but this doesn’t mean your injury wasn't serious. An early diagnosis can help prevent more damage and improve long-term recovery.

Here are a few common signs of a torn ACL:

• A popping sensation in the knee
• Immediate pain
• Significant swelling
• A feeling that the knee is unstable or "giving out"

The surgical solution for a torn ACL

Although it’s possible to live with a torn ACL, Dr. Ryan exlains that ACL reconstruction offers significant benefits—particularly for young active patients who want to regain function and mobility.  

“ACL reconstruction surgery replaces the torn ligament with a graft that become a new ACL,” says Dr. Ryan. “This restores knee stability and gets patients back to their activities. It also helps prevent further damage to the knee's cartilage and meniscus for better long-term joint health.”