Anterior cruciate ligament (ACL) injuries were once considered to affect adult athletes primarily. Today, however, healthcare professionals are seeing a concerning rise in ACL tears among children and adolescents.
For young athletes, an ACL injury can be more than just a season-ending setback. It can affect long-term knee health, limit participation in sports, and increase the risk of future injuries and early-onset arthritis. Understanding why these injuries are becoming more common and how to prevent them is essential for parents, coaches, and athletes alike.
THE GROWING CONCERN AROUND PAEDIATRIC ACL INJURIES
Research shows that ACL injuries in children and adolescents have increased significantly over the past two decades. Studies from Finland found that ACL injury rates more than doubled among adolescents between 1997 and 2014. The largest increase was seen in girls aged 13 to 15 years.
The trend is similar in Canada. In Quebec alone, 388 paediatric ACL tears were reported in the last year, with girls experiencing ACL injuries at rates up to seven times higher than boys in some sports. Several factors may be contributing to this rise:
- Increased participation in organized and competitive sports
- Earlier sports specialization
- More year-round training and competition
- Higher participation rates among female athletes
- Movement patterns that place greater stress on the knee during cutting, jumping, and landing activities
Sports such as soccer, basketball, volleyball, football, and skiing are particularly associated with a higher risk of ACL injury.
WHY ACL INJURIES ARE DIFFERENT IN GROWING ATHLETES
Children are not simply "small adults."
Young athletes have open growth plates around the knee that contribute significantly to lower-limb growth. Because of these growth plates, treatment decisions can be more complex than in adults.
In many cases, surgery is not the first-line treatment for children whose growth plates remain open. While ACL reconstruction can be successful, operating on a growing knee carries potential risks, including disturbances to normal bone growth. This is why prevention is especially important in the paediatric population.
ARE ACL INJURIES PREVENTABLE?
The encouraging news is that many ACL injuries are considered preventable.
Research has consistently shown that neuromuscular training programs can significantly reduce ACL injury risk. When properly implemented, some prevention programs may reduce ACL injuries by as much as 70%. These programs focus on improving:
- Landing mechanics
- Jumping technique
- Balance and coordination
- Agility and body control
- Lower limb alignment
- Strength throughout the quadriceps, hamstrings, glutes and core
Poor movement patterns, such as allowing the knees to collapse inward during landing or cutting (dynamic valgus), are known risk factors for ACL injury. Fortunately, these movement patterns can be identified and improved through targeted training.
THE IMPORTANCE OF PHYSIOTHERAPY
Physiotherapists play a key role in helping young athletes move safely and efficiently.
Children and adolescents require a different approach to injury prevention and rehabilitation than adults. Research shows that young athletes benefit most from structured, supervised programs that are tailored to their age, stage of growth, and sport-specific demands.
Whether the goal is ACL injury prevention or recovery after an injury, proper supervision helps ensure exercises are performed with correct technique, appropriate progression, and consistent participation. This is particularly important during periods of rapid growth, when changes in strength, coordination, and movement patterns can increase the risk of injury.
Physiotherapists provide ongoing assessment and guidance to ensure exercises remain safe, effective, and appropriate as the athlete develops. They also work closely with parents, coaches, and other healthcare providers to create a comprehensive plan that supports long-term knee health and athletic performance.
Without proper supervision, young athletes may develop compensatory movement patterns, progress too quickly, or fail to address underlying risk factors for ACL injuries. A structured physiotherapy program helps build confidence, improve movement quality, and reduce the risk of future injury.
At Great North Physiotherapy, we assess factors that may increase ACL injury risk and develop individualized prevention programs tailored to the athlete's age, sport, growth stage, and movement patterns. Some of the most effective prevention strategies include:
1. Improving Landing Mechanics
Many ACL injuries occur when athletes land awkwardly from a jump.
Physiotherapists teach athletes how to land with proper alignment, absorb forces effectively, and maintain control through the hips, knees, and ankles.
2. Building Hamstring and Glute Strength
Strong hamstrings and gluteal muscles help stabilize the knee and reduce excessive stress on the ACL.
Targeted strengthening programs can improve lower-body control and support safer movement during sports.
3. Enhancing Balance and Neuromuscular Control
Balance training helps athletes react more effectively to unexpected movements and changes in direction during competition.
Better body awareness often translates into improved movement quality and reduced injury risk.
4. Identifying Risk Factors Early
Growth spurts can temporarily affect coordination, strength, and movement control.
Regular physiotherapy assessments can identify developing risk factors before they contribute to injury.
5. Supporting Safe Return to Sport
For athletes who have already experienced an ACL injury, physiotherapy is a critical component of rehabilitation.
Treatment focuses on restoring strength, stability, confidence, and sport-specific function while ensuring the athlete meets appropriate criteria before returning to play.
WHAT PARENTS AND COACHES SHOULD KNOW
Parents and coaches are often the first line of defence against ACL injuries. Consider having young athletes assessed if they:
- Participate in jumping and cutting sports
- Have experienced rapid growth recently
- Demonstrate poor landing technique
- Have a history of knee injuries
- Report recurring knee pain or instability
- Early intervention can help address movement deficits before they become a problem.
THE BOTTOM LINE
ACL injuries in children and adolescents are becoming increasingly common, particularly among female athletes. While not every injury can be prevented, research shows that many ACL tears can be avoided through proper training, movement education, and strength development.
Because children are not simply small adults, supervised physiotherapy and age-appropriate training play an important role in ensuring injury prevention programs are both safe and effective. Physiotherapy provides young athletes with the tools they need to move better, perform confidently, and reduce their risk of injury.
Investing in injury prevention today can help keep children active, healthy, and participating in the sports they love for years to come.
Want to learn more? Book an appointment with Alida Bonomo at Great North Physiotherapy in St. Catherines. Schedule online at www.greatnorthphysio.ca or call 289-606-0966 to speak with our team.
Always consult a healthcare professional before starting a new exercise routine and prioritize consistency and good form for optimal benefits.
SOURCES
Dietvorst, M. (2023). Anterior cruciate ligament injuries in children and adolescents (Doctoral dissertation, Maastricht University). Maastricht University. https://doi.org/10.26481/dis.20230210md
Magosch, A., Nührenbörger, C., Hoffmann, F., Mouton, C. and Seil, R. (2026), Paediatric and Adolescent ACL Injuries. Sportverletz Sportschaden, 40: 71–81. https://doi.org/10.1055/a-2537-6205
Webster, K.E. and Hewett, T.E. (2018), Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. J. Orthop. Res., 36: 2696-2708. https://doi.org/10.1002/jor.24043
CTV News Montreal. (2026). Hundreds of Quebec children are tearing their ACLs every year, doctors say. CTV News Montreal article
Alida Bonomo - MScPT, BKin (Hons)
Registered Physiotherapist (General Rehabilitation, Orthopaedic, Concussion & Paediatrics)
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