An estimated 55% of all high school students participate in sports, which include basketball, soccer, lacrosse, football, and more. (1) With an increasing number of young adolescents playing sports, risks of injury are increasing. Anterior cruciate ligament (ACL) injuries among young athletes are steadily increasing at higher rates than among adults. (5) Several factors increase the risk of ACL injuries such as gender, type of sport, poor conditioning, and age. Because females have a lower muscle mass, they are at higher risk for ACL injury. From the ages of 15 to 20, female athletes account for the largest number of ACL injuries. (2) Unfortunately, these injuries lead to long-term complications like osteoarthritis (OA), growth plate injury, and secondary tear risk. (3) To avoid these risks, taking preventative measures at a young age before these injuries occur is vital. 

It is reported that children and teens with ACL injuries are 10 times more likely to develop early arthritis in the next 15 years. Injured patients at 10-15 years have the possibility of facing arthritis pain as early as 30 years old. (2) The risk of arthritis is unavoidable despite going through reconstructive surgery. In a meta-analysis study, there was still a relative risk of 3.89 statistical weight in developing even minimal OA in both operative and non-operative patients. (4) In some cases, there was even a high risk of OA when going through reconstructive surgery. Studying the progression of OA after 10 years, operated patients had a higher ratio risk of 4.71 than non-operated patients with a ratio risk of 2.41. (4) Along with the risk of early-onset arthritis are the complications of performing surgery in skeletally immature patients. 

Performing ACL reconstruction in prepubescent patients runs the risk of growth plate injuries. (3) Though not many instances are reported, experienced ACL surgeons from the Herodicus Society and The ACL Study Group identified 15 patients with postoperative deformity due to plate injury. Some of these include genu valgum, tibial recurvatum, and leg-length discrepancy. (6) In one small study, 3 out of 4 skeletally immature patients, ages 13-14, required additional surgery after ACL construction to treat tibial recurvatum and genu valgum. (7)

In addition to ACL injuries, approximately one-third of ACL reconstructed athletes experience a second ACL injury. (8) The risk of a secondary injury can be due to quick return to sports. In a study of 159 athletes, patients were given a survey of how long they returned to sports after their first ACL tear. Results showed that young athletes who returned to playing sports in 9 months or less had a 3 to 5 times higher rate of new ACL injury. (9) Given that young athletes in school may return to sports quicker than older adults (9), taking prevention is the best method to decrease the risks associated with ACL tears.

According to the American Academy of Pediatrics, neuromuscular training (NMT) reduces the ACL injury risk, specifically in female adolescents. (10) In a study to find the effects of NMT on ACL injuries, NMT was most effective in reducing the injury in mid-teens (14-18 years old); however, compliance and adherence to NMT were not reported. (11) While NMT is done off the field, having a device that prevents injury on the field can also decrease injury risks and help the benefits of NMT translate into real-time sports activities. Esurgi’s product, the Joint Spy, is a wearable garment that gives real-time biofeedback for athletes on the field. The device provides vibrations when the patient performs high-risk maneuvers that exceed the prescriber’s threshold for safe knee biomechanical forces. ACL injuries in young athletes were once rare but not are becoming increasingly frequent. To avoid the detrimental long term risks of ACL injuries, young athletes should take effective prevention. 

Do you think a wearable biofeedback garment can significantly help young athletes in reducing ACL injuries? 


  1. Koebler, J. (2011, September 2). High School Sports Participation Increases for 22nd Straight Year. Retrieved October 08, 2020, from
  2. Wolf, S. (2019, March 29). ACL Injuries in Young Athletes. Retrieved October 08, 2020, from
  3. Wojtys, E. M., & Brower, A. M. (2010). Anterior cruciate ligament injuries in the prepubescent and adolescent athlete: clinical and research considerations. Journal of athletic training, 45(5), 509–512.
  4. Ajuied, A., Wong, F., Smith, C., Norris, M., Earnshaw, P., Back, D., & Davies, A. (2014). Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. The American journal of sports medicine, 42(9), 2242–2252.
  5. Werner, B. C., Yang, S., Looney, A. M., & Gwathmey, F. W., Jr (2016). Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injury and Reconstruction. Journal of pediatric orthopedics, 36(5), 447–452.
  6. Koebler, J. (2011, September 2). High School Sports Participation Increases for 22nd Straight Year. Retrieved October 08, 2020, from
  7. Shifflett, G. D., Green, D. W., Widmann, R. F., & Marx, R. G. (2016). Growth Arrest Following ACL Reconstruction With Hamstring Autograft in Skeletally Immature Patients: A Review of 4 Cases. Journal of pediatric orthopedics, 36(4), 355–361.
  8. Zhou, J., Schilaty, N. D., Hewett, T. E., & Bates, N. A. (2020). ANALYSIS OF TIMING OF SECONDARY ACL INJURY IN PROFESSIONAL ATHLETES DOES NOT SUPPORT GAME TIMING OR SEASON TIMING AS A CONTRIBUTOR TO INJURY RISK. International journal of sports physical therapy, 15(2), 254–262.
  9. Beischer, S., Gustavsson, L., Senorski, E. H., Karlsson, J., Thomee, C., Samuelsson, K., & Thomee, R. (2020). Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return. Journal of Orthopaedic & Sports Physical Therapy, 50(2), 83-90. doi:
  10. Labella, C. R., Hennrikus, W., & Hewett, T. E. (2014). Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention. Pediatrics, 133(5). doi:10.1542/peds.2014-0623
  11. Sugimoto, D., Myer, G. D., Barber Foss, K. D., Pepin, M. J., Micheli, L. J., & Hewett, T. E. (2016). Critical components of neuromuscular training to reduce ACL injury risk in female athletes: meta-regression analysis. British journal of sports medicine, 50(20), 1259–1266.