The Center for Podiatric Care and Sports Medicine

A Snowball Effect: Study Shows That a Second ACL Tear is Six Times More Likely Than A First

Posted by on Friday, August 16th, 2013


Chances are, you or someone you know has injured their Anterior Cruciate Ligament (ACL) at some point. There are approximately 95,000 ACL ruptures each year. The ACL is one of the four most important strong ligaments connecting the bones of the knee joint together. It is comprised of strong, dense structures of connective tissue that stabilize and minimize stress on the joint, thereby preventing it from dislocating. Tears occur when this ligament becomes overstretched or strained.

What Causes ACL Injury?

Most people injure their ACL doing a physical activity or playing sports. It may be caused by a sudden stop and twisting / pivoting motion, a blow to the front of the knee, hyperextension of the knee, changing direction quickly, landing on the ground with the knee straight, or sudden deceleration while moving quickly. Skiing, volleyball, basketball, football, tennis, wrestling, gymnastics and running all increase the odds of suffering this type of sports injury. Car accidents or repeat trauma and small tearing over time can also cause ACL injuries.

Is ACL Surgery A Good Idea?

About half of the patients who suffer ACL injuries also have meniscal tears. ACL deficiency increases the likelihood of suffering from degenerative changes significantly. For this reason, 60,000 to 75,000 ACL surgeries are performed annually in the United States. The long-term success rate for ACL surgery is very good, at 75 – 95%, with stability and activity fully restored. The failure rate of 8% is related to complications such as recurrent instability, graft failure or arthrofibrosis. People who are only engaged in very light manual work and low-impact sports like cycling or who are sedentary may consider nonsurgical treatment. However, most people want to be able to jump, pivot, ski and participate in heavy manual work again in their lifetimes.


Second ACL Injury More Likely After Reconstruction

The likelihood of having to go through a second ACL surgery within 24 months is six times’ greater than the chances of having a tear in the first place, according to researchers presenting at the American Orthopaedic Society for Sports Medicine’s Annual Meeting in Chicago. In the Cincinnati Children’s Hospital study, 78 subjects between the ages of 10 and 25 years old were assessed. Of them, 29.5% of the athletes suffered a second ACL injury within 24 months of resuming regular activities, including 20.5% sustaining an injury on the opposite leg and 9% tearing the same leg. Females were more than twice as likely to suffer an opposite leg injury than males. While ACL prevention programs are generally considered effective, the research suggests a need to reevaluate some of the rehabilitation programs out there, lead author Mark V. Paterno suggested.



If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.