Jan 29, 2015
High School ACL Injury Rates

dawncomstock-head.jpgBy Dawn Comstock, PhD

On average, athletes are eight times more likely to suffer anterior cruciate ligament (ACL) injuries in competition than practice and girls are eight times more likely to suffer ACL injuries than boys when playing similar sports. These findings are among those reported by researchers from The Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital in Columbus, Ohio. Here, they share their analysis of knee injury rates for high school athletes as they relate to sport and gender.

Knee injuries are a common concern amongst athletes because they can lead to a discontinuation of their season, particularly if a ligament such as an ACL is torn. This is a valid concern given that previous research has found that knee injuries account for 60 percent of all sports-related surgeries.¹ Specifically, ACL injuries can account for more than 50 percent of knee injuries.²,³ While they will never be completely eliminated, sports injury surveillance can help athletic trainers and coaches develop sport-specific strategies to decrease their athletes’ risk for ACL injuries.

The National High School Sports-Related Injury Surveillance Study, currently in its fourth year of data collection, has found that approximately one ACL tear occurred in every 15,000 times an athlete practiced or competed. On average, athletes are eight times more likely to suffer ACL injuries in competition than practice. Data was collected from a national sample of nine boys and girls high school sports (including football, soccer, basketball, wrestling, baseball, volleyball, and softball). In all sports examined, three out of four athletes who suffered ACL injuries were either medically disqualified for the season, or required a recovery period of three weeks or longer.

When comparing sports that are played by both boys and girls, girls were eight times more likely to suffer an ACL injury. Following is a brief description of the most common sports in which ACL injuries appear to occur:

Three most common sports for ACL injury during practice or competition:

  • Girls’ Soccer: One in 6,500 times an athlete practiced or competed
  • Football: One in 9,800 times an athlete practiced or competed
  • Girls’ Basketball: One in 11,000 times an athlete practiced or competed

Football had a lower number of ACL injuries per exposure; however, due to the larger number of players per team, it accounted for 41 percent of all ACL injuries in this study.

Percentage of ACL injuries per sport observed:

  • Football: 41 percent
  • Girls’ soccer: 19 percent
  • Girls’ basketball: 13 percent
  • Boys’ soccer: Nine percent

One important reason to focus on ACL injury prevention is because most ACL injuries typically require surgery. Most sports have a rate of at least two-thirds of their injured athletes requiring surgical repair.

Percentage of ACL injuries requiring surgery by sport:

  • Volleyball: 100 percent
  • Boys’ basketball: 85 percent
  • Softball: 80 percent
  • Girls’ basketball: 70 percent
  • Football: 68 percent
  • Girls’ soccer: 68 percent
  • Wrestling: 62 percent
  • Boys’ soccer: 58 percent
  • Baseball: 50 percent

The mechanism leading to ACL injury varies by sport. Knowing these mechanisms can help coaches and athletic trainers develop targeted preventive interventions.

Top mechanisms leading to ACL injury by sport:

  • Football: player-to-player contact
  • Boys’ soccer: player-to-player contact/player-to-surface contact
  • Girls’ soccer: player-to-player contact/non contact (i.e., rotation around a planted foot)
  • Volleyball: player-to-surface contact/non contact
  • Boys’ basketball: non contact
  • Girls’ basketball: non contact
  • Wrestling: player-to-player contact/player-to-surface contact
  • Baseball: no contact
  • Softball: player-to-player contact

Coaches and athletic trainers working with high school athletes should practice targeted preventive measures to reduce the risk of ACL injuries. These measures could include some of the following: proper strengthening and training programs, use of supportive devices such as braces, and identification of high-risk individuals with consideration given to weak ACLs, a family history of ACL injuries and any previous ACL injuries. Also, an emphasis on safety in officiating, coaching and playing must be practiced in high school athletics to prevent this devastating injury from overtaking an athlete’s season.


1. Powell JW, Barber-Foss KD. Injury patterns in Selected High School Sports: A Review of the 1995-1997 Seasons. Journal of Athletic Training. 1999;34(3):277-284.

2. Brown University. Prevalence and Incidence of ACL Injuries in Various Sports. Accessed Sept. 21, 2008.

3. Majewski M, Habelt S, Steinbrück K. Epidemiology of Athletic Knee Injuries: A 10-year Study. Knee. 2006(13):184-188.

Dawn Comstock, PhD, is a principle investigator at the Center for Injury Research and Policy at The Research Institute at Nationwide Children’s Hospital. She is also an assistant professor at The Ohio State University in the College of Medicine and the College of Public Health. Her research interests include the epidemiology of sports, recreation, and leisure activity-related injuries among children and adolescents as well as the life-long health benefits associated with an active childhood. She can be reached at: [email protected].

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