Back to School Sports What Athletes and Parents Should Know
Sept 25
Authored by R. Garrett Steinmetz, M.D.
Orthopedic Surgeon, Sports Medicine
As students return to school and fall, sports begin, athletes are once again running, jumping, cutting, tackling, and changing direction at full speed. Unfortunately, these movements can also place significant stress on the knee, particularly the anterior cruciate ligament, commonly known as the ACL.
ACL injuries are among the most common serious knee injuries in sports. They frequently occur in football, soccer, basketball, volleyball, and other activities involving sudden stops, quick changes in direction, jumping, or contact with another athlete. Understanding how these injuries happen, recognizing the warning signs, and seeking an evaluation early can help athletes and their families make informed decisions about treatment and recovery.
What Is the ACL?
The ACL is one of the primary ligaments that helps stabilize the knee. It runs through the center of the joint and helps prevent the shinbone from moving too far forward in relation to the thighbone. It also provides rotational stability during movements such as pivoting, cutting, and landing.
An ACL injury may involve a partial tear or a complete tear of the ligament. Athletes may also injure the meniscus, cartilage, or other knee ligaments at the same time.
How Do ACL Injuries Happen?
Many people assume ACL tears happen only after a major collision, but most occur without direct contact to the knee. An athlete may plant a foot and change direction, stop suddenly, land awkwardly after a jump, or slow down rapidly while running.
Common causes include:
Changing direction quickly while the foot is planted
Landing from a jump with poor balance or knee position
Stopping or slowing down suddenly
Twisting the knee during a fall
Receiving a direct hit to the knee during contact sports
Because these movements are common during competition, an ACL injury can happen in an instant, even when an athlete has trained and prepared properly.
What Does an ACL Injury Feel Like?
Some athletes hear or feel a popping sensation at the time of the injury. The knee may give out or feel unstable, and swelling often develops within the first several hours. Other symptoms can include pain, difficulty walking, limited range of motion, tenderness around the joint, and a feeling that the knee cannot be trusted during turning or changing direction.
An athlete should not attempt to play through these symptoms. Returning to activity before the knee is properly evaluated may increase instability and place the meniscus, cartilage, and other structures at risk.
How Is an ACL Injury Diagnosed?
An orthopedic evaluation typically begins with a conversation about how the injury occurred, followed by a physical examination of the injured and uninjured knees.
X-rays may be used to check for fractures or other bone injuries. An MRI can provide a detailed view of the ACL, meniscus, cartilage, and surrounding ligaments. Although an MRI is not always required to identify an ACL tear, it is often valuable for determining the severity of the injury and identifying additional damage within the knee.
Does Every ACL Tear Require Surgery?
Not every ACL injury requires the same treatment. The right approach depends on the athlete's age, activity level, symptoms, knee stability, associated injuries, and goals for returning to sports. Some patients may be treated without surgery through physical therapy, activity modification, and exercises designed to restore motion and strengthen the muscles surrounding the knee. This may be appropriate for certain partial tears or for patients whose knees remain stable during everyday activities.
However, surgery may be recommended for athletes who experience continued instability, want to return to sports involving cutting or pivoting, or have additional injuries involving the meniscus, cartilage, or other ligaments. Young and active patients with complete ACL tears frequently require reconstruction to restore knee stability and support their desired activity level.
ACL treatment continues to evolve, and today's athletes can benefit from significant advances in surgical technology, imaging, rehabilitation, and return to sport planning. In my practice, I use some of the most advanced technology and current surgical techniques available to personalize treatment based on each athlete's anatomy, injury, sport, and long-term goals.
As one of the highest volume orthopedic surgeons treating ACL injuries in Oklahoma, caring for these injuries on a regular basis gives me extensive experience working with athletes across different ages, sports, injury patterns, and levels of competition. That experience is especially valuable when developing an individualized plan for both reconstruction and a safe return to activity.
What Happens During ACL Reconstruction?
A torn ACL usually cannot be stitched back together in the same way as a cut in the skin. During ACL reconstruction, the damaged ligament is replaced with a graft made from tendon tissue. The graft may come from the patient's patellar tendon, hamstring tendon, or quadriceps tendon. In some situations, donor tissue may be considered. Each option has potential benefits and considerations, so graft selection should be based on the patient's age, sport, activity level, anatomy, and recovery goals.
If the meniscus or other structures are damaged, those injuries may also be addressed during surgery.
Recovery Is More Than Waiting for the Knee to Heal
Whether treatment involves surgery or rehabilitation alone, physical therapy is a critical part of recovery. Therapy focuses on reducing swelling, restoring motion, rebuilding strength, improving balance, and gradually preparing the athlete for sport-specific movements.
Returning to sports should be based on progress, strength, stability, movement quality, and confidence rather than the calendar alone. Every athlete heals differently, and returning too soon may increase the risk of another injury.
Can ACL Injuries Be Prevented?
No prevention program can eliminate every ACL injury, but athletes can reduce their risk through proper training.
Programs that emphasize leg and core strength, balance, controlled landing mechanics, agility, and safe cutting techniques can help athletes move more efficiently. A proper warmup, gradual conditioning, appropriate footwear, adequate recovery, and communication about pain or instability are also important. Athletes should be encouraged to speak up when something does not feel right. Reporting knee pain or instability early is far better than turning a manageable problem into a season- ending injury.
When Should an Athlete See a Specialist?
An athlete should be evaluated when a knee injury causes significant swelling, difficulty walking, limited motion, locking, instability, or an inability to return comfortably to activity. Early evaluation does not automatically mean surgery. It provides the athlete and family with a clear diagnosis, a personalized treatment plan, and realistic expectations for recovery.
At OSSO, our goal is to help athletes understand their injury, explore the appropriate treatment options, and safely return to the activities they enjoy. To schedule an evaluation with Dr. Garrett Steinmetz, call 405-486-6985.