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  • Writer's pictureJay Kasthuriarachchi

Why are ACL injuries becoming more prelevant?

Updated: Oct 16, 2023

It's hard to dispute the fact that ACL injuries are becoming more prelevant.

"The incidence of ACL reconstructions in Australia is the highest in the world, and is increasing." - Zbrojkiewicz et al 2018

There are a few reasons why I think this is

Increased exposure: Quite simply the more you do an activity with an injury risk, the more likely you are to get said injury. Wealthier countries have a population that have more time (and money for leisure). 200 years ago, our ancestors were trying to survive. Work. Eat. Sleep. Repeat. Today, most of our population in Australia has played or is playing sport at some level on any given weekend

Secondly, female participation in sport has exploded. This has steadily increased since the 70's when schools started to include girls in sport, and has increased recently in cricket, rugby and AFL

The demands of sport, particularly in the professional level are increasing. I pulled out only a couple of examples here with AFL and NRL. Travel, games, and the amount of competitions have increased. The rules have changed as well making the game faster, notably in the NRL last season with the six again rule.

AFL has also had the demands of the competition increase, with the sport turning from a Victorian based competition, to an Australian based one

Poor or non- existent athletic development programs: I couldn't find any research as such to show that poor athletic development = increase in ACL injury, aside from the work on biomechanics and resistance training reducing injury. But I think this passage highlights it well.

In the first three years of the AFLW, on average, one ACL injury was sustained per club per season. When exposure is considered ACL injuries were the most frequent injury to occur per 1000 player hours.
ACL injuries also occurred at a highly concerning six (6) times higher rate in the women’s compared to men’s competitions, which already have among the highest rate across sports worldwide.
- Webster et al 2021

ACL injury occurs 6 x more in AFLW than the AFL. The reality is that AFLW is not a professional as yet, and as a result those athletes will get a shorter preseason and less time in the gym compared to their male counterparts. More time in the gym, longer preseasons and more time investment will lead to a decrease in injury over time.

Access to imaging: MRI's are the gold standard for ACL diagnosis, and that didn't come around till the 80's. Only recently has the funding for Medicare increased to allow bulk billing of MRI's for suspected ACL injuries (Another luxury that a 1st world country has)

So if we are scanning more knees, we will pick up more ACL injuries

Hopefully ACL incidences will decrease as our injury reduction techniques improve. Lots of research has already been done in this area, and there is more to come.

Want to learn more about ACL injuries? Check out our new ACL specific website here

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