ACL reconstructions on the rise in US, particularly among teen girls

June 16, 2017

A new study has found that, in the United States, there has been a dramatic increase in the rate of anterior cruciate ligament (ACL) reconstructions among females 13-17 years old.

Research conducted in 1999 showed that women are more likely than are men to tear an ACL while playing the same sport. This new evidence reveals that, after almost two decades of subsequent research and prevention efforts aimed at reducing ACL injuries in young athletes (and females particularly), there has nonetheless been an increase in ACL injuries among this population.

Mackenzie Herzog

Mackenzie Herzog

Mackenzie Herzog, MPH, doctoral candidate in the Department of Epidemiology at the UNC Gillings School of Global Public Health, is lead author of the study. The full article, titled “Incidence of Anterior Cruciate Ligament Reconstruction Among Adolescent Females in the United States, 2002 Through 2014,” was published online June 12 by JAMA Pediatrics.

Herzog wrote the study with Gillings School co-authors Stephen Marshall, PhD, professor, Jennifer Lund, PhD, assistant professor, Virginia Pate, MS, applications analyst, and Christina Mack, PhD, adjunct assistant professor, all in the Gillings School’s Department of Epidemiology. Marshall and Herzog also are members of the Injury Prevention Research Center, where Marshall is director.

Assessing U.S. trends of ACL reconstruction rates among commercially-insured individuals revealed that, since 2006, females aged 13-17 years have had the highest reconstruction rates of any age or gender group in the country. Also concerning was a similar, though less dramatic, increase in males 13-17 years old.

“Addressing this alarming rise in adolescent ACL injuries will necessitate collaboration within athletic communities,” Herzog said. “There is a need to adopt and implement evidence-based ACL injury prevention programs – that include balance, jumping and landing exercises – across all levels of athletics. Parents and athletes, especially those who participate in basketball and soccer, should encourage coaches to add this type of program into warm-ups and practices.”

These injury prevention programs, including FIFA 11+, have been proven effective in reducing the risk of ACL injuries. To date, however, these programs have not had the desired effect because of limited promotion and uptake among youth sports organizations.

As the U.S. has seen a mounting intensity in youth sports participation in recent years – including increased trends toward youth and adolescents participating in year-round athletics and a focus on specialization in a single sport at a young age – prioritizing sports injury prevention research and program implementation has become especially crucial for public health.

“If we want to maintain the health benefits of physical activity throughout the lifespan while reducing the potential for the negative consequences of injury, like osteoarthritis, we need to better understand the factors that contribute to rising injury rates,” Herzog said. “The take-home message from this study, especially for sports groups with a strong female playing base, is how important it is to implement an evidence-based ACL injury prevention program.”

Hear Herzog talk about her research in a WRAL-TV interview.


Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or

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